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Multicomponent exercise training improves physical functioning in frail older adults

Cadore EL, Rodriguez-Manas L, Sinclair A, et al. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: A systematic review Rejuvenation Res. 2013;162:105-114.

Review question

What type of supervised exercise training program leads to the greatest improvements in muscle strength, balance, and walking ability, and reduces fall risk among frail older adults?


Frailty is a syndrome composed of several aspects, including: physical impairments, weight loss, low physical activity, and loss of muscle mass (sarcopenia). Frailty is often assumed to be an inevitable consequence of aging, but it does not have to be. Exercise has been shown to improve physical function in frail older adults.

How the review was done

This is a summary of a systematic review of 20 randomized controlled trials published between 1994 and 2012 with a total of 3503 participants.

Participants were seniors who had physical frailty or severe functional declines. They were between 70 and 90 years old.

Exercise interventions included multi-component exercise training (combines strength training, endurance training, and balance training - 10 studies), resistance training (6 studies), endurance training (1 study), and balance training (3 studies).  Training involved 2 or more sessions per week for 10 weeks up to 1 year. The participants in the exercise interventions were compared with control participants who either did no exercise or did home-based stretching and relaxation exercises.

Outcomes of interest included lower body strength, fall risk, balance, and walking ability.

What the researchers found

Lower body strength: 9 out of 13 studies showed increases in muscle strength. Average strength improvements ranged from 6 to 60%.

Fall risk: 7 out of 10 studies found a lower rate of falling. The decrease in falls ranged from 22% to 50%.

Balance: 7 out of 10 studies demonstrated enhanced balance performance. Average balance improvements were 5 to 80%.

Walking ability: 6 out of 11 studies showed improvements in walking ability. Average improvement ranged from 4% to 50%.


A multi-component exercise program (one that consists of strength, endurance, and balance training) improves walking ability, balance, and strength, and reduces the rate of falls among frail older people.


Based on this review, older people should:

  • Engage in an exercise program consisting of strength, endurance, and balance training
  • Perform exercises that simulate daily activities
  • Vary the endurance and balance training exercises
  • Gradually increase the volume, intensity, and complexity of the exercises
  • Do exercises that combine strength, endurance, and balance in a single activity



Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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