Abstract
This systematic review aimed to evaluate the effects of therapeutic exercise on physical and psychosocial outcomes in community-dwelling adults aged 80 years or older. Databases were searched from inception to July 8, 2020. Randomized controlled trials (RCTs) were screened by two reviewers who extracted data and assessed study quality. Sixteen RCTs (1,660 participants) were included. Compared to nonexercise controls there was no evidence of an effect of exercise on performance based (standardized mean differences: 0.58, 95% confidence interval: [-0.19, 1.36]; I2: 89%; six RCTs; 290 participants; very low-quality evidence) or self-reported physical function (standardized mean differences: 1.35, 95% confidence interval: [-0.78, 3.48]; I2: 96%; three RCTs; 280 participants; very low-quality evidence) at short-medium term follow-up. Four RCTs reporting psychosocial outcomes could not be combined in meta-analysis and reported varying results. Exercise appeared to reduce the risk of mortality during follow-up (risk ratio: 0.47, 95% confidence interval: [0.32, 0.70]; I2: 0.0%; six RCTs; 1,222 participants; low-quality evidence).
Highlights
2 The global population is progressively ageing
Trials were conducted across 13 countries, most commonly in Northern Europe (4 studies (Bårdstu et al, 2020; Bechshoft et al, 2017; Hvid et al, 2016; Luukinen et al, 2006; Luukinen et al, 2007)) or Australia/New Zealand (3 studies (Campbell et al, 1997; Hamdorf & Penhall, 1999; Rosie & Taylor, 2007))
There was no evidence of a 14 difference in effect between therapeutic exercise and non-exercise comparators on self15 reported physical function at short-medium term follow-up (SMD: 1.35, 95% confidence intervals (CI): -0.78 to 3.48; 16 I2: 96%; 3 Randomised controlled trials (RCTs); 280 participants; Very low-quality evidence) (Figure 3)
Summary
3 million people in the United 3 Kingdom (UK) were aged 80 or older in 2018, and this group is projected to increase to almost 4 6 million by 2043, making it the fastest growing population group (Office for National 5 Statistics, 2018). Adults aged 80 years or older are the least physically active, and have the 6 highest healthcare expenditure (England., 2018; Manini & Pahor, 2009). More than 85% of 7 people aged 80 or older in the UK reside in the community, rather than in nursing homes 8 (Office for National Statistics, 2012). The benefits of therapeutic exercise for all adults, and for many age-related conditions such as osteoarthritis and frailty, are well established (Fransen et al, 2015; Fransen, McConnell, Hernandez-Molina, & Reichenbach, 2014; Heyn, Johnson, & Kramer, 2008; Silva, Aldoradin-Cabeza, Eslick, Phu, & Duque, 2017). Adults aged 80 17 years and older are significantly under-represented in existing trials, and findings among 18 adults aged in their 60’s and 70’s cannot necessarily be applied to those aged 80 years or 19 older (Izquierdo, Morley, & Lucia, 2020; Witham et al, 2020)
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