Exercise to prevent falls in older adults with physical frailty: A systematic review and meta-analysis

Abstract

Introduction Physical frailty is associated with increased risk of falls. Although exercise mitigates age-related declines, evidence regarding its effects on falls in older adults with frailty is limited. This systematic review examined the effects of exercise on fall-related outcomes in older adults with frailty. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, and CINAHL for randomised controlled trials published from 2001 (when the Fried frailty phenotype was introduced) to January 2024. Eligible studies included older adults with frailty and reported at least one of the following outcomes: i) physical function (gait speed, strength, balance), ii) fear of falling, or iii) falls incidence. Meta-analyses were conducted using random-effects models, with results presented as weighted/standardized mean differences with 95% confidence intervals. Results Fourteen studies (n = 2719; mean age range 73–86 years) were included, most of which used the Fried frailty phenotype (n = 12) and were conducted in Europe (n = 6). Most interventions included multicomponent (n = 10) and resistance (n = 4) training. Exercise improved gait speed (MD 0.09 m/s, 0.02/0.15; I2=94%; n = 5), TUG (MD -3.73 s, -5.92/-1.55; I2=95%; n = 6), and 5-times sit-to-stand (MD -2.66 s, -4.19/-1.14; I2=77%; n = 4) over short-term period (≤12 weeks), with low-to-very low certainty evidence. A trend toward improved balance was also noted (SMD 2.80, -0.17/5.76; p = 0.06; I²=99%; n = 5), with very low certainty evidence. Limited data was observed for fear of falling (n = 1) and falls incidence (n = 2). Conclusions Exercise training enhances physical function in older adults with physical frailty. However, its impact on fear of falling and fall incidence remains uncertain. Prospero registry CRD42024502865