Exercise Interventions Improve Frailty in Patients Living in Long-Term Care: A Systematic Review and Meta-Analysis

The objectives of this study were to examine the impact of exercise training interventions on frailty levels in people who live in long-term care and explore the implementation science outcomes for these interventions.

Systematic review and meta-analysis of controlled trials (pre-registered: CRD42024542751).

Adults residing in long-term care settings who are enrolled in exercise training interventions.

Sources (Scopus, EMBASE, MEDLINE, CINAHL, Academic Search Premier) were searched in May 2024. Studies were included if they conducted an exercise intervention and assessed frailty via a validated frailty assessment tool. The between-group effect size of change in frailty (intervention vs control) was calculated as the standardized mean difference (SMD) using a random effects model.

Six studies conducted in nursing homes (n = 1), residential care (n = 1), and long-term care (n = 4) included 191 intervention [age: 81.9 (range: 73.3-86.7) years; n = 115 reported women] and 205 control [age: 81.3 (range: 77.8-86.4) years; n = 106 reported women] participants. Studies included the frailty phenotype (n = five-sixths) or the Study of Osteoporotic Fractures Index (n = one-sixth). The types of training were heterogeneous, but interventions were 3.2 ± 1.1 (range: 2-5) times/week for 44 ± 8.9 (40-60) minutes/session for 23.6 ± 17.7 (6-52) weeks. Most interventions improved frailty compared with controls (n = five-sixths), with the one study observing no change in the intervention, but the control group worsened. A large effect size of the intervention relative to controls was observed (SMD: 1.83; 95% confidence intervals: 0.66-2.99). Implementation outcomes were scarcely reported, but were generally positive when reported (high adherence, high retention rate, low adverse events, strong feasibility).

This review and meta-analysis support that exercise training is an effective model of improving frailty levels among older adults in long-term care. Strategies to address the practical aspects of these programs are needed, but this study emphasizes that structured exercise should be a crucial aspect of long-term care.