Skip to main content
SpringerLink
Log in

Frailty and exercise interventions

Evidence and barriers for exercise programs

Frailty und Trainingsinterventionen

Evidenz und Barrieren für Bewegungsprogramme

  • Beiträge zum Themenschwerpunkt
  • Published:
Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Abstract

Background

Due to the worldwide demographic transition healthcare systems are facing new demands and are increasingly confronted with an older population with specific medical needs related to multiple chronic disorders. The majority of older persons have an increased risk of frailty. In addition to pharmaceutical interventions another beneficial approach for counteracting frailty might be exercise or physical activity intervention.

Objective

The first goal was to narratively investigate the state of the art effective exercise interventions for frail older persons and briefly discuss the importance of exercise intervention for frailty. The second goal was to give recommendations to overcome barriers in the recruitment process and how to increase adherence of frail older persons in exercise programs.

Results

Several systematic reviews came to the same conclusion that exercise has beneficial effects in frail older persons although uncertainty exists on the optimal exercise program with regard to frequency, type of exercise and duration. Furthermore, all reviews demonstrated the superior nature of multicomponent exercise programs as opposed to single component exercise programs. With regard to barriers different levels have to be taken into account and addressed: older persons themselves with self-efficacy and attitudes, the healthcare personnel involved and the provider of the intervention program.

Conclusion

Exercise seems a promising approach to counteract frailty but including frail older persons in research programs is challenging. Researchers have to be aware of the different levels of possible barriers ranging from older frail persons and medical personnel to researchers.

Zusammenfassung

Hintergrund

Bedingt durch den demographischen Wandel steigt der Anteil älterer Menschen mit Komorbiditäten deutlich an. Insbesondere der eindimensionale Ansatz des Gesundheitswesens, sich auf isolierte Erkrankungen zu fokussieren, wird dem multiplen Erkrankungsspektrum des älteren, oft fragilen Menschen nicht gerecht. Übergreifende Interventionsansätze wie körperliche Aktivität und Training, die auf die überwiegende Anzahl von Erkrankungen und Risikofaktoren des alten, fragilen Menschen eine positive Wirkung ausüben, können hier eine Lösung darstellen.

Ziele

Als erstes Ziel wird im Rahmen einer narrativen Übersicht der Stellenwert effektiver Trainingsinterventionen im Spannungsfeld „Frailty“ kurz dargestellt und damit die Bedeutung von Trainingsprogrammen hervorgehoben. Als zweites Ziel werden Handlungsempfehlungen bei der Rekrutierung von komorbiden älteren Menschen gegeben, basierend auf bekannten Barrieren und eigenen Erfahrungen aus entsprechenden Forschungsprojekten. Hierbei liegt der Fokus auf der Rekrutierung älterer Menschen mit funktionellen Einschränkungen in die angebotenen Bewegungsprogramme und der anschließenden Adhärenz zum Training.

Ergebnisse

Die Mehrzahl der vorliegenden Untersuchungen im Fachbereich kommen übereinstimmend zu dem Ergebnis, dass multivariates körperliches Training zumeist positive Effekte auf die Mehrzahl der Frailty-Kompenenten ausübt, wenngleich die optimale Komposition der Belastungskomponenten und -inhalte bislang nicht identifiziert werden konnte. Mit Blick auf Limitationen und Fallgruben von Trainingsinterventionen sind mögliche Fehlerquellen auf unterschiedlichen Ebenen und seitens verschiedener Akteure zu finden.

Schlussfolgerung

Körperliches Training ist grundsätzlich ein vielversprechender Ansatz um den Frailty-Prozess zu modifizieren. Trainingsinterventionen sind jedoch sehr komplexe Prozesse, die mit besonderen Herausforderungen verbunden sind und oft schwieriger und zeitintensiver als erwartet verlaufen. Forscher sollten daher bereits im Vorfeld der Untersuchung mögliche Schwierigkeiten und Besonderheiten auf allen relevanten studienbeteiligten Ebenen antizipieren und einplanen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Turner G, Clegg A (2014) Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 43(6):744–747

    Article  PubMed  Google Scholar 

  2. Cesari M (2011) The multidimensionality of frailty: Many faces of one single dice. J Nutr Health Aging 15(8):663–664

    Article  CAS  PubMed  Google Scholar 

  3. Cesari M, Canevelli M (2014) Horse-racing effect and clinical trials in older persons. Front Aging Neurosci 6:175

    PubMed  PubMed Central  Google Scholar 

  4. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762

    Article  PubMed  Google Scholar 

  5. Gill TM, Gahbauer EA, Allore HG, Han L (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166(4):418–423

    Article  PubMed  Google Scholar 

  6. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM (2010) Towards an integral conceptual model of frailty. J Nutr Health Aging 14(3):175–181

    Article  CAS  PubMed  Google Scholar 

  7. Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL et al (2016) Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 26:53–61

    Article  PubMed  Google Scholar 

  8. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008) The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12(1):29–37

    Article  CAS  PubMed  Google Scholar 

  9. Caspersen CJ, Powell K, Christenson GM (1985) Physical activity, exercise, and physical fitness: Definitions and distinctions of health-related research. Public Health Rep 100(2):126–131

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Montero-Fernandez N, Serra-Rexach JA (2013) Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med 49(1):131–143

    CAS  PubMed  Google Scholar 

  11. Goisser S, Kemmler W, Porzel S, Volkert D, Sieber CC, Bollheimer LC et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons – a narrative review. Clin Interv Aging 10:1267–1282

    PubMed  PubMed Central  Google Scholar 

  12. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ et al (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41(7):1510–1530

    Article  PubMed  Google Scholar 

  13. Tudor-Locke C, Craig C, Aoyagi Y, Bell R, Croteau K, De Bourdeaudhuij I et al (2011) How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 8(1):80

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chin A, Paw MJM, van Uffelen JGZ, Riphagen I, van Mechelen W (2008) The functional effects of physical exercise training in frail older people: A systematic review. Sports Med 38(9):781–793

    Article  Google Scholar 

  15. Daniels R, van Rossum E, de Witte L, Kempen G, van den Heuvel W (2008) Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 8(1):278

    Article  PubMed  PubMed Central  Google Scholar 

  16. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA et al (2011) The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011:1–19. doi:10.4061/2011/569194

    Article  Google Scholar 

  17. Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M (2013) Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 16(2):105–114

    Article  PubMed  PubMed Central  Google Scholar 

  18. de Vries NM, van Ravensberg CD, Hobbelen JSM, Olde Rikkert MGM, Staal JB, Nijhuis-van der Sanden MWG (2012) Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Res Rev 11(1):136–149

    Article  PubMed  Google Scholar 

  19. Giné-Garriga M, Roqué-Fíguls M, Coll-Planas L, Sitjà-Rabert M, Salvà A (2014) Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis. Arch Phys Med Rehabil 95(4):753–769

    Article  PubMed  Google Scholar 

  20. de Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millan-Calenti JC (2015) Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 15:154

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chou C‑H, Hwang C‑L, Wu Y‑T (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Arch Phys Med Rehabil 93(2):237–244

    Article  PubMed  Google Scholar 

  22. Pedersen BK, Saltin B (2015) Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 25(Suppl 3):1–72

    Article  PubMed  Google Scholar 

  23. Harris R, Dyson E (2001) Recruitment of frail older people to research: lessons learnt through experience. J Adv Nurs 36(5):643–651

    Article  CAS  PubMed  Google Scholar 

  24. Knechel NA (2013) The challenges of enrolling older adults into intervention studies. Yale J Biol Med 86(1):41–47

    PubMed  PubMed Central  Google Scholar 

  25. Ridda I, Lindley R, MacIntyre RC (2008) The challenges of clinical trials in the exclusion zone: The case of the frail elderly. Australas J Ageing 27(2):61–66

    Article  PubMed  Google Scholar 

  26. Ross S, Grant A, Counsell C, Gillespie W, Russell I, Prescott R (1999) Barriers to participation in randomised controlled trials: A systematic review. J Clin Epidemiol 52(12):1143–1156

    Article  CAS  PubMed  Google Scholar 

  27. Campbell MK, Snowdon C, Francis D, Elbourne D, McDonald AM, Knight R et al (2007) Recruitment to randomised trials: strategies for trial enrollment and participation study. The STEPS study. Health Technol Assess 11(48):iii–105

    Article  CAS  Google Scholar 

  28. Ridda I, MacIntyre CR, Lindley RI, Tan TC (2010) Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions. Vaccine 28(4):901–906

    Article  CAS  PubMed  Google Scholar 

  29. Yardley L, Beyer N, Hauer K, McKee K, Ballinger C, Todd C (2007) 2007 Recommendations for promoting the engagement of older people in activities to prevent falls. Qual Saf Health Care 16(3):230–234

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Yardley L, Donovan-Hall M, Francis K, Todd C (2007) Attitudes and beliefs that predict older people’s intention to undertake strength and balance training. J Gerontol B Psychol Sci Soc Sci 62(2):P119–P125

    Article  PubMed  Google Scholar 

  31. Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C (2014) Multiple levels of influence on older adults’ attendance and adherence to community exercise classes. Gerontologist 54(4):599–610

    Article  PubMed  Google Scholar 

  32. Freiberger E, Vreede P (2011) Falls recall-limitations of the most used inclusion criteria. Eur Rev Aging Phys Act 8(7):105–108

    Article  Google Scholar 

  33. Kemmler W, von Stengel S, Weineck J, Lauber D, Kalender W, Engelke K (2005) Exercise effects on menopausal risk factors of early postmenopausal women: 3‑yr Erlangen fitness osteoporosis prevention study results. Med Sci Sports Exerc 37(2):194–203

    Article  PubMed  Google Scholar 

  34. Provencher V, Mortenson WB, Tanguay-Garneau L, Belanger K, Dagenais M (2014) Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: a systematic review. Arch Gerontol Geriatr 59(1):18–24

    Article  PubMed  Google Scholar 

  35. Tinetti E, Powell L (1993) Fear of falling and self-efficacy: a cause of dependence in elderly persons. J Gerontol 48(special):35–38

    Article  PubMed  Google Scholar 

  36. Rochat S, Bula CJ, Martin E, Seematter-Bagnoud L, Karmaniola A, Aminian K et al (2010) What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years? Arch Phys Med Rehabil 91(6):879–884

    Article  PubMed  Google Scholar 

  37. Malini FM, Lourenco RA, Lopes CS (2016) Prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors: The Frailty in Brazilian Older People-Rio de Janeiro Study. Geriatr Gerontol Int 16(3):336–344

    Article  PubMed  Google Scholar 

  38. Freiberger E, Blank WA, Salb J, Geilhof B, Hentschke C, Landendoerfer P, Halle M, Siegrist M (2013) Physiological and psychological effects of a multi-modal intervention on fall risk: A cluster randomized controlled trial in the general practitioner setting [PreFalls NCT01032252]. Clin Interv Aging 8:1079–1108

    Article  PubMed  PubMed Central  Google Scholar 

  39. Phillips EM, Katula J, Miller ME, Walkup MP, Brach JS, King AC et al (2010) Interruption of physical activity because of illness in the Lifestyle Interventions and Independence for Elders Pilot trial. J Aging Phys Act 18(1):61–74

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bleijenberg N, Ten Dam VH, Steunenberg B, Drubbel I, Numans ME, De Wit NJ et al (2013) Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed-methods study. J Adv Nurs 69(10):2262–2273

    Article  PubMed  Google Scholar 

  41. Drey M, Zech A, Freiberger E, Bertsch T, Uter W, Sieber CC et al (2011) Effects of strength training versus power training on physical performance in prefrail community-dwelling older adults. Gerontology 58(3):197–204

    Article  PubMed  Google Scholar 

  42. Drey M, Pfeifer K, Sieber CC, Bauer JM (2011) The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology 57(1):11–18

    Article  CAS  PubMed  Google Scholar 

  43. Kemmler W, von Stengel S, Engelke K, Sieber C, Freiberger E (2016) Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOsA study. Osteoporos Int 27(1):275–281

    Article  CAS  PubMed  Google Scholar 

  44. Hawley-Hague H, Horne M, Skelton DA, Todd C (2016) Older adults’ uptake and adherence to exercise classes: instructors’ perspectives. J Aging Phys Act 24(1):119–128

    Article  PubMed  Google Scholar 

  45. Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany

    E. Freiberger & C. Sieber

  2. Osteoporosis Research Centrum, FAU Erlangen-Nürnberg, Erlangen, Germany

    W. Kemmler

  3. Department for Prevention, Rehabilitation and Sports Medicine (PRS), Technische Universität München, Munich, Germany

    M. Siegrist

  4. Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder, Regensburg, Germany

    C. Sieber

Authors
  1. E. Freiberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Kemmler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Siegrist
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Sieber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Freiberger.

Ethics declarations

Conflict of interests

E. Freiberger, W. Kemmler, M. Siegrist and C. Sieber declare that they have no conflict of interests.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Freiberger, E., Kemmler, W., Siegrist, M. et al. Frailty and exercise interventions. Z Gerontol Geriat 49, 606–611 (2016). https://doi.org/10.1007/s00391-016-1134-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00391-016-1134-x

Keywords

Schlüsselwörter

Search

Navigation