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W H O L E    T I T L E :   What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials.

 

 

S O U R C E :    BMC

 

 

 

 

 

ABSTRACT

 

 

Background

With life expectancy continuing to rise in the United Kingdom there is an increasing public health focus on the maintenance of physical independence among all older adults. Identifying interventions that improve physical outcomes in pre-frail and frail older adults is imperative.

  Methods

A systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with PROSPERO (no. CRD42016045325).

  Results

Ten RCT trials fulfilled selection criteria and quality appraisal. The study quality was moderate to good. Interventions included physical activity; nutrition, physical activity combined with nutrition. Interventions that incorporated one or more physical activity components significantly improved physical outcomes in pre-frail and/or frail older adults.

  Conclusions

Physical activity interventions are key to maintaining independence in pre-frail and frail older adults. A lack of consensus regarding the definition of frailty, and an absence of core measures to assess this means any attempt to create an optimal intervention will be impeded. This absence may ultimately impact on the ability of older and frail adults to live well and for longer in the community.

 

 

BACKGROUND

 

Frailty, a geriatric syndrome characterized by unintentional weight loss, low muscle strength, feeling of exhaustion, reduced physical activity capacity and slow walking speed [22, 34, 46], affects 4–60% adults aged ≥65 years [11] and is associated with significantly increased risk of poor physical health, hospitalization, nursing home care and mortality [18, 29, 41]. In an aging society the rapidly increasing number of frail older adults and associated rise in healthcare expenditure [19] is seen as a major challenge facing health and social care [1].

 

Despite growing interest in this topic a widely accepted definition and clear criteria for frailty is lacking [7]. Currently, the Cardiovascular Health Study (CHS) frailty phenotype, also known as the Fried Criteria [22], which focuses on physical phenotype, is the most widely used tool for assessing frailty status [21].

 

There is a growing consensus that interventions targeting the physical phenotype associated with increased risk for adverse outcomes in older adults; particularly mobility, strength, balance, nutrition and physical activity, may offer the best opportunity to prevent, delay, or reverse existing symptoms of physical frailty [3, 9]. Evidence from two recent systematic reviews identified a range of interventions, i.e. physical activity, nutrition, geriatric assessment or a blend of these delivered in primary care, community settings or at home, and found those that incorporated a physical activity component were consistently the most effective at improving frailty status, physical outcomes (e.g. body mass index, muscle mass, strength, gait speed, exhaustion, physical activity) and/or functional ability [14, 39]. However, caution must be applied when interpreting change in frailty or functional ability as a primary outcome measure, as there is still a lack of agreement regarding clinically meaningful reduction in frailty or functional ability [2, 37, 38]. In contrast, performance based physical outcome measures such as mobility, balance, body mass and activity levels, have consistently reported strong associations with future health, functional ability, and service use in older and frail adults [25, 27, 47].

 

Identifying effective interventions, with the potential to promote successful aging and, minimise the burden of care on health care services is therefore crucial [3]. Building on previous work, by focusing only on randomised controlled trail (RCT) interventions that specifically measure one or more physical performance outcomes, a systematic review was undertaken to explore potential preventative applications of these interventions in pre frail and frail older adults.

 

 

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