Home Exercise Interventions in Frail Older Adults

Abstract

Purpose of Review Frailty is characterized by decreased physiological reserve and increased risk of falls, disability, hospitalization, and mortality. Frail older adults may benefit from exercise interventions targeting their multiple problems and functional deficits; however, most research focuses on center-based interventions, which may present accessibility challenges for frail older adults. Therefore, the purpose of this review is to summarize the most recently published home-based exercise interventions for frail older adults living at home. Recent Findings Eight manuscripts met inclusion criteria. Research interventions consisted of a variety of modes (strength, strength/nutrition, strength/flexibility/balance/endurance), duration (12 weeks to 6 months), frequency (2-7 days/week), and delivery methods (volunteer-led, videos on a tablet, manuals/brochures). Investigators examined the effects of home-based exercise on a variety of outcomes to include feasibility, frailty status, physical performance, lean body mass, skeletal muscle mass, other physiological outcomes, mental health, nutritional status, and incidence of falls in frail. Summary This review demonstrates the feasibility and effectiveness of home-based exercise interventions to improve frailty, functional performance, nutritional status, and incidence of falls in frail older adults. However, the limited literature available provides conflicting reports regarding benefits for mental health outcomes and no evidence of a beneficial effect on skeletal muscle or lean mass. Future research is needed to shed light on the optimal components of home exercise programs most important for maximizing benefits for frail older adults, as well as the most effective delivery method.

Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial

“…There is an anticipated attrition rate with any study, not least studies involving an older, frail and multimorbid population [42]. Studies of home exercise interventions for older adults living with frailty have reported retention rates ranging from 53-98% [22]. In our study, decision to withdraw appeared to be influenced by perceived ineffectiveness and a fear of worsening symptom experience with physical activity.…”

“…However, the authors acknowledged that the generalisability of findings is "limited by age" as the "approximate mean age of participates in the included trials ranged from 50 to 65 years" [21]. Studies in older frail non-CKD populations suggest that home-based exercise interventions are feasible and may be associated with improved outcomes, in terms of frailty, functional performance, nutritional status and falls incidence [22]. However, research is needed to evaluate home-based exercise interventions tailored to the needs of older people living with frailty and CKD [23].…”

Utility and reliability of the Clinical Frailty Scale in patients scheduled for major vascular surgery: a prospective, observational, multicentre observer-blinded study

“…level one or two bed occupancy postoperatively. Identifying pre-frail as well as frail patients may allow for pre-habilitation to reduce frailty status (Stookey, 2020 ). This in turn may reduce surgical risk and improve patient outcomes (Hanna, 2019 ).…”

Construction and validation of a rehabilitation nursing program for fragile elderly

“…Although the implementation of these community programs is highly recommended, and physical activity of all types and combinations as well as rehabilitation significantly reduce the number or prevalence of markers of frailty (25) , the truth is that most programs focus on group activities of physical exercise, cognitive training and even emotional management (8) rehabilitation programs that individually meet the specific needs of each frail elderly are scarce (13) .…”

“…Studies highly recommend multicomponent exercise and gerontogeriatric rehabilitation for frailty in the elderly, especially during the pre-frail phase (8,(10)(11)(12) . However, through a review of the literature, it was found that there are few individualized rehabilitation programs developed in the community, especially in the home context with the elderly in situations of frailty, making it difficult to access and adhere to these programs (13) . Despite this, few studies show that interventions such as home visits and supervised home physical exercise in frail elderly improve functional capacity and decrease the number of falls (14)(15)(16) .…”