Exercise for Reversing Prefrailty to Robustness in Older Adults: A Systematic Review

To examine the efficacy of exercise in reversing prefrailty in exclusively prefrail older adults.

A systematic review.

The older adults (≥60 years old) in the prefrailty period.

In this systematic review of randomized controlled trials (RCTs), 6 international databases were systematically searched. We employed the revised Cochrane risk of bias tool for RCT quality appraisal. Due to substantial heterogeneity of the included studies, we did not conduct meta-analyses. Instead, for each included study, we extracted the data on postintervention frailty status to calculate the odds ratio for improvement in frailty status in the intervention vs the control group. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence bodies.

Eight RCTs were included. It is found that professionally supervised exercise was safe and well accepted for prefrail older adults. However, on the efficacy of exercise in reversing prefrailty, the observed positive effects were primarily supported by low-certainty bodies of evidence, whereas the more methodologically rigorous evidence largely showed nonfavorable results, particularly for sustained benefits.

Given the inconsistent findings and the limited certainty of the available evidence, it remains uncertain whether exercise has immediate and sustained effects on reversing prefrailty in older adults. Professionally supervised exercise is safe for older adults; it should, however, be approached with caution as a standalone strategy to reverse prefrailty. To provide more scientific guidance for practice, we recommend future high-quality RCTs with both intention-to-treat and per-protocol analyses, rigorous handling of missing data, and well-defined, tailored exercise regimens for prefrail older adults.