Review: exercise interventions improve functional and physical performance but not activities of daily living in older adults
Do exercise interventions improve functional status in older adults?
Included studies compared exercise-only interventions that were directly supervised by research staff with no contact or attention-only interventions in adults ⩾65 years of age, included ⩾10 participants/group, randomised individual participants, and reported a measure of functional status. Studies involving exercise interventions for patients with specific diseases or conditions were excluded. Outcomes were direct and indirect measures of functional status, including activities of daily living (ADL), functional performance, and physical performance (chair-rise, walk speed, walk endurance, balance, and coordination).
Medline and CINAHL were searched for English-language randomised controlled trials (RCTs) published between 1990 and 2006. 23 RCTs met the inclusion criteria: 3 were excluded because of insufficient data and 1 as an outlier; 19 were included in the analysis (n = 2201, 30 interventions, median 79% women, median age 75 y, duration of intervention 8–96 wks). 8 RCTs involved healthy adults, and 11 involved inactive, frail, or functionally limited participants. 23 interventions included a strength or resistance exercise component, and 7 used behavioural strategies for motivation.
Meta-analysis showed that exercise-only interventions improved functional and physical performance more than no contact or attention-only interventions in older adults; groups did not differ for ADL (table).
In older adults, exercise-only interventions improve functional and physical performance but not activities of daily living.
Gu MO, Conn VS. Meta-analysis of the effects of exercise interventions on functional status in older adults. Res Nurs Health 2008;31:594–603.
Clinical impact ratings: Elderly care 5/7; Family/general practice 6/7; Health promotion 6/7
Although Cochrane reviews have evaluated the effectiveness of physical activity,1 2 none have specifically examined ADL, functional performance, and physical performance in adults ⩾65 years of age. Strengths of the review by Gu et al include a priori identification of preferred valid and reliable outcome measures, inclusion of only RCTs, exclusion of studies using multiple interventions, and testing for heterogeneity. Limitations of the review include potential publication bias, with searches restricted to articles published in English, and exclusion of an outlier study from analysis. An information gap exists regarding assessment of study quality and methods of data abstraction. Furthermore, women may be disproportionately represented in the meta-analysis (median 79%). In 2007, women comprised 58% of the US population ⩾65 years of age.3
Gu et al showed that strength exercise improved functional status in older adults and suggested that this should be combined with exercises targeted to particular deficits. The small effect sizes raise questions about the clinical usefulness of exercise to improve ADL and functional abilities. However, limitations in existing ADL measures do not allow for an in-depth comparison between improved functional status and ability to perform ADL. From a nursing practice perspective, exercise is important for overall health and may contribute to clinically important functional status improvements when combined with other targeted interventions.