Restricted accessResearch articleFirst published online 2021-7
The Effect of Unsupervised Home-Based Exercise Training on Physical Functioning Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Exercise training such as balance, aerobic, and resistance training is able to improve physical functioning of older adults. Delivering such exercise regimes at home without supervision may be useful for older adults because they do not have to leave their homes.
Objective:
This systematic review and meta-analysis of randomized controlled trials aimed to establish the effect of unsupervised home-based exercise training regimes on physical functioning (balance and muscle strength) in older adults.
Data sources:
PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included investigations were searched.
Study selection:
Thirteen randomized controlled trials (RCTs) of exercise training impact on balance and upper body strength with concurrent control groups were included in the analysis.
Results:
Our analyses revealed that in older adults, unsupervised home-based various exercise training was effective in improving measures of proactive balance (mean difference (MD) = −1.37 s; 95% confidence interval (CI), −2.24, −0.51 s; p = 0.002) and balance test battery (MD: 1.80; 95% CI, 0.46, 3.14 s; p = 0.009). There were no significant differences between the experimental and control groups for upper body strength (p > 0.05).
Conclusion:
Unsupervised home-based exercise training improves balance in older adults. Future investigations are needed to clarify the mechanisms underlying unsupervised home-based exercise training’s effect on this population’s physical functioning outcomes.
AlghadirA.AnwerS.BrisméeJ.-M. (2015). The reliability and minimal detectable change of timed up and go test in individuals with grade 1–3 knee osteoarthritis. BMC Musculoskeletal Disorders, 16(1), 174.
2.
AlmeidaT. L.AlexanderN. B.NyquistL. V.MontagniniM. L.SantosA. C.RodriguesG. H.NegrãoC. E.TrombettaI. C.WajngartenM. (2013). Minimally supervised multimodal exercise to reduce falls risk in economically and educationally disadvantaged older adults. Journal of Aging and Physical Activity, 21(3), 241–259.
3.
Benavent-CaballerV.Sendín-MagdalenaA.LisónJ. F.Rosado-CalatayudP.Amer-CuencaJ. J.Salvador-ColomaP.Segura-OrtíE. (2016). Physical factors underlying the timed “up and go” test in older adults. Geriatric Nursing, 37(2), 122–127.
4.
BjerkM.BrovoldT.SkeltonD. A.Liu-AmbroseT.BerglandA. (2019). Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: A randomised controlled trial. Age and Ageing, 48(2), 213–219.
5.
BoongirdC.KeesukphanP.PhiphadthakusolkulS.RattanasiriS.ThakkinstianA. (2017). Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled trial. Geriatrics & Gerontology International, 17(11), 2157–2163.
6.
BordeR.HortobágyiT.GranacherU. (2015). Dose–response relationships of resistance training in healthy old adults: A systematic review and meta-analysis. Sports Medicine, 45(12), 1693–1720.
7.
ColadoJ. C.TriplettN. T. (2008). Effects of a short-term resistance program using elastic bands versus weight machines for sedentary middle-aged women. The Journal of Strength & Conditioning Research, 22(5), 1441–1448.
8.
EggerM.SmithG. D.SchneiderM.MinderC. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315(7109), 629–634.
9.
FoxB.HenwoodT.SchaapL.BruyèreO.ReginsterJ.-Y.BeaudartC.BuckinxF.RobertsH.CooperC.CherubiniA. (2015). Adherence to a standardized protocol for measuring grip strength and appropriate cut-off values in adults over 65 years with sarcopenia: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 50–59.
10.
GeraedtsH.ZijlstraA.BulstraS. K.StevensM.ZijlstraW. (2013). Effects of remote feedback in home-based physical activity interventions for older adults: A systematic review. Patient Education and Counseling, 91(1), 14–24.
11.
GranacherU.MuehlbaueT.ZahnerL.GollhoferA.KressigR. W. (2011). Comparison of traditional and recent approaches in the promotion of balance and strength in older adults. Sports Medicine, 41(5), 377–400.
12.
HalsaaK. E.BrovoldT.GraverV.SandvikL.BerglandA. (2007). Assessments of interrater reliability and internal consistency of the Norwegian version of the berg balance scale. Archives of Physical Medicine and Rehabilitation, 88(1), 94–98.
13.
HaskellW. L. (1994). JB Wolffe memorial lecture. Health consequences of physical activity: Understanding and challenges regarding dose-response. Medicine and Science in Sports and Exercise, 26(6), 649–660.
14.
HigginsJ. P.ThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557–560.
15.
HillK. D.HunterS. W.BatchelorF. A.CavalheriV.BurtonE. (2015). Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas, 82(1), 72–84.
16.
KamideN.ShibaY.ShibataH. (2009). Effects on balance, falls, and bone mineral density of a home-based exercise program without home visits in community-dwelling elderly women: A randomized controlled trial. Journal of Physiological Anthropology, 28(3), 115–122.
17.
KingA. C.HaskellW. L.YoungD. R.OkaR. K.StefanickM. L. (1995). Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. Circulation, 91(10), 2596–2604.
18.
KirklandJ. L.PetersonC. (2009). Healthspan, translation, and new outcomes for animal studies of aging. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 64(2), 209–212.
19.
KisO.BuchA.SternN.MoranD. S. (2019). Minimally supervised home-based resistance training and muscle function in older adults: A meta-analysis. Archives of Gerontology and Geriatrics, 84, 103909.
20.
LacroixA.HortobagyiT.BeurskensR.GranacherU. (2017). Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: A systematic review and meta-analysis. Sports Medicine, 47(11), 2341–2361.
21.
LacroixA.KressigR. W.MuehlbauerT.GschwindY. J.PfenningerB.BrueggerO.GranacherU. (2016). Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: A randomized controlled trial. Gerontology, 62(3), 275–288.
22.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GøtzscheP. C.IoannidisJ. P.ClarkeM.DevereauxP. J.KleijnenJ.MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Journal of Clinical Epidemiology, 62(10), e1–e34.
23.
Liu-AmbroseT.DonaldsonM. G.AhamedY.GrafP.CookW. L.CloseJ.LordS. R.KhanK. M. (2008). Otago home-based strength and balance retraining improves executive functioning in older fallers: A randomized controlled trial. Journal of the American Geriatrics Society, 56(10), 1821–1830.
24.
MarquesA.CruzJ.QuinaS.RegêncioM.JácomeC. (2016). Reliability, agreement and minimal detectable change of the timed up & go and the 10-meter walk tests in older patients with COPD. Journal of Chronic Obstructive Pulmonary Disease, 13(3), 279–287.
25.
MartinsW. R.SafonsM. P.BottaroM.BlasczykJ. C.DinizL. R.FonsecaR. M. C.Bonini-RochaA. C.de OliveiraR. J. (2015). Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: A randomized clinical trial. BMC Geriatrics, 15(1), 99.
26.
MedicineA. C. o. S. (1998). The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine & Science in Sports & Exercise, 30, 975–911.
27.
MikóI.SzerbI.SzerbA.PoorG. (2017). Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: A randomized controlled trial. Clinical Rehabilitation, 31(2), 217–224.
28.
MorrisR.HarwoodR. H.BakerR.SahotaO.ArmstrongS.MasudT. (2007). A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study. Age and Ageing, 36(1), 78–83.
29.
NelsonM. E.LayneJ. E.BernsteinM. J.NuernbergerA.CastanedaC.KalitonD.HausdorffJ.JudgeJ. O.BuchnerD. M.RoubenoffR. (2004). The effects of multidimensional home-based exercise on functional performance in elderly people. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(2), M154–M160.
30.
NICEC. f. C. P. a. (2013). The assessment and prevention of falls in older people. In Falls: Assessment and Prevention of Falls in Older People. National Institute for Health and Care Excellence (UK).
31.
Panel on Prevention of Falls in Older Persons, A. G. S., & Society, B. G. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148–157.
32.
ParavlićA.MarušičU.GerževičM.UrziF.ŠimuničB. (2016). The effects of different exercise-based interventions on functional fitness of older adults. Annales Kinesiologiae, 7(2), 117–137.
33.
PodsiadloD.RichardsonS. (1991). The timed “up & go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148.
34.
PunlomsoS.SrimuangP.TudporK. (2020). Fall prevention by Otago exercise program based on health belief model in community-dwelling older persons. Indian Journal of Physiotherapy and Occupational Therapy, 14(1), 245–252.
35.
SchutzerK. A.GravesB. S. (2004). Barriers and motivations to exercise in older adults. Preventive Medicine, 39(5), 1056–1061.
36.
Shumway-CookA.BrauerS.WoollacottM. (2000). Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Physical Therapy, 80(9), 896–903.
37.
SmartN. A.WaldronM.IsmailH.GiallauriaF.VigoritoC.CornelissenV.DiebergG. (2015). Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. International Journal of Evidence-Based Healthcare, 13(1), 9–18.
38.
SuttanonP.HillK. D.SaidC. M.WilliamsS. B.ByrneK. N.LoGiudiceD.LautenschlagerN. T.DoddK. J. (2013). Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: A pilot randomized controlled trial. Clinical Rehabilitation, 27(5), 427–438.
39.
ThiamwongL.SuwannoJ. (2014). Effects of simple balance training on balance performance and fear of falling in rural older adults. International Journal of Gerontology, 8(3), 143–146.
40.
TsekouraM.BillisE.TsepisE.DimitriadisZ.MatzaroglouC.TyllianakisM.PanagiotopoulosE.GliatisJ. (2018). The effects of group and home-based exercise programs in elderly with sarcopenia: a randomized controlled trial. Journal of Clinical Medicine, 7(12), 480.
41.
United Nations. (2002). World population prospects-the 2004 revision population database. New York, United Nations Population Division.
42.
YamauchiT.IslamM. M.KoizumiD.RogersM. E.RogersN. L.TakeshimaN. (2005). Effect of home-based well-rounded exercise in community-dwelling older adults. Journal of Sports Science & Medicine, 4(4), 563.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
