Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial

Effectiveness of resistance training on body composition, muscle strength, and biomarker in sarcopenic older adults: A meta-analysis of randomized controlled trials

This study analyzed 22 randomized controlled trials involving 959 participants to determine the impact of resistance training (RT) on body composition, muscle strength, and biomarkers in sarcopenic older adults. Regarding body composition, RT had a small effect size on relative muscle mass (RMM, SMD = 0.25[0.06,0.45]) and absolute muscle mass (AMM, SMD = 0.28[0.06,0.50]) but no effect on reducing body fat percentage (BF%). Meta-regression analysis pinpointed key predictors (p < 0.05): training period, number of sets, contraction speed, and average age. Subgroup analysis revealed that 3 sets over an 8-12 weeks training period, with slower muscle contraction speed at a 60-70 % 1-repetition maximum (1RM) training intensity, produced the most significant effects on reducing BF% and increasing RMM, respectively. Regarding muscle strength, RT had a large effect size on handgrip strength (HS, SMD = 0.83[0.43,1.23]), knee extension strength (KES, SMD = 0.90[0.50,1.30]), but no effect on chair stand test. Meta-regression analysis pinpointed key predictors (p < 0.05): training intensity, number of sets, body mass index, and sample size. Subgroup analysis revealed that the number of sets ≥ 3 and training intensity >70 % 1RM produced the most significant effect of RT on HS. Regarding biomarkers, RT had a medium effect size on insulin-like growth factor-1 (SMD = 0.70[0.10,1.30]), interleukin-10 (SMD = 0.61[0.09,1.13]), follistatin (SMD = 0.56[0.16,0.96]), but no effect on interleukin-6, tumor necrosis factor-alpha, and myostatin. It concludes that RT is an effective way to improve muscle strength and the level of synthetic hormones and anti-inflammatory factors in sarcopenic older adults, with a slight impact on body composition and no impact on pro-inflammatory factors.

Sarcopenia interventions in long-term care facilities targeting sedentary behaviour and physical inactivity: A systematic review

BACKGROUND

Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement.

METHODS

Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal.

RESULTS

The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4 years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness).

CONCLUSIONS

The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.

Effects of 12 weeks of inspiratory muscle training and whole body vibration on the inflammatory profile, BDNF and muscular system in pre-frail elderly women: A randomized controlled trial

AIM

to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women.

METHODS

this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS).

RESULTS

after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups.

CONCLUSIONS

IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.

Non-Pharmacological Strategies for Managing Sarcopenia in Chronic Diseases

This article focuses on a range of non-pharmacological strategies for managing sarcopenia in chronic diseases, including exercise, dietary supplements, traditional Chinese exercise, intestinal microecology, and rehabilitation therapies for individuals with limited limb movement. By analyzing multiple studies, the article aims to summarize the available evidence to manage sarcopenia in individuals with chronic diseases. The results strongly emphasize the role of resistance training in addressing chronic diseases and secondary sarcopenia. Maintaining the appropriate frequency and intensity of resistance training can help prevent muscle atrophy and effectively reduce inflammation. Although aerobic exercise has limited ability to improve skeletal muscle mass, it does have some positive effects on physical function. Building upon this, the article explores the potential benefits of combined training approaches, highlighting their helpfulness for overall quality of life. Additionally, the article also highlights the importance of dietary supplements in combating muscle atrophy in chronic diseases. It focuses on the importance of protein intake, supplements rich in essential amino acids and omega-3, as well as sufficient vitamin D to prevent muscle atrophy. Combining exercise with dietary supplements appears to be an effective strategy for preventing sarcopenia, although the optimal dosage and type of supplement remain unclear. Furthermore, the article explores the potential benefits of intestinal microecology in sarcopenia. Probiotics, prebiotics, and bacterial products are suggested as new treatment options for sarcopenia. Additionally, emerging therapies such as whole body vibration training, blood flow restriction, and electrical stimulation show promise in treating sarcopenia with limited limb movement. Overall, this article provides valuable insights into non-pharmacological strategies for managing sarcopenia in individuals with chronic diseases. It emphasizes the importance of a holistic and integrated approach that incorporates exercise, nutrition, and multidisciplinary interventions, which have the potential to promote health in the elderly population. Future research should prioritize high-quality randomized controlled trials and utilize wearable devices, smartphone applications, and other advanced surveillance methods to investigate the most effective intervention strategies for sarcopenia associated with different chronic diseases.

Influence of physical exercise on respiratory muscle function in older adults: A systematic review and meta-analysis

Respiratory function decreases with aging. The literature showed that non-ventilatory specific exercise could have a positive impact on respiratory muscles. A systematic literature review was conducted to assess the effects of non-ventilatory specific exercise on maximal inspiratory (MIP) and expiratory pressure (MEP) and peak expiratory flow (PEF) in older adults. The included 9 trials investigated the effects of resistance training, yoga, Pilates, physical activity based on walking, and whole-body vibration training. The meta-analysis showed no statistically significant differences in MIP, MEP, and PEF after implementation of a non-ventilatory specific exercise program in older individuals. Between-study heterogeneity was substantial for MIP and MEP outcomes but it was not statistically significant for PEF. Further RCTs will be necessary to determine the effects of physical exercise interventions. PROSPERO registry CRD42023478262.

Effect of Different Exercise Interventions on Grip Strength, Knee Extensor Strength, Appendicular Skeletal Muscle Index, and Skeletal Muscle Index Strength in Patients with Sarcopenia: A Meta-Analysis of Randomized Controlled Trials

Sarcopenia is a systemic skeletal muscle disease that is more prevalent in older adults. The role of exercise in improving the disease has been demonstrated. However, due to the variety of exercise modalities, it is not clear what type of exercise provides the best benefit. The aim of this meta-analysis was to analyze the effects of different exercise modalities on grip strength, appendicular skeletal muscle index, skeletal muscle index, and knee extensor strength in elderly patients with sarcopenia. The protocol for this evaluation was registered on the PROSPERO website and the databases PubMed, WOS, Cochrane Library, and Embase were searched. Thirteen studies were included in the analysis. The results showed that exercise interventions had positive effects on grip strength and knee extension muscle strength, with resistance training being the most effective. There was no significant improvement in appendicular skeletal muscle index or skeletal muscle index. This study still has limitations. For example, age group and exercise duration were not considered. Future studies should further explore benefits in age groups as well as other relevant outcome indicators.

"Inspiratory muscle weakness in acutely hospitalized patients 75 years and over": a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training

PURPOSE

The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay.

DESIGN AND METHODS

This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW.

RESULTS

In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention.

CONCLUSION

IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NTC03604640. May 3, 2018.

Functional and emotional impact of COVID-19 lockdown on older adults with sarcopenia living in a nursing home: A 15-month follow-up

This study aimed to detect the functional and emotional impact of COVID-19 lockdown on institutionalized older adults with sarcopenia during a 15-month follow-up. A prospective longitudinal cohort study was conducted in a nursing home. Participants were screened for sarcopenia, and those with a score of ≥4 points according to SARC-F questionnaire were included. Assessments were performed pre-lockdown (T1), 12 months (T2) after, and at a 15-month follow-up (T3). Functional measurements included chair stand test, handgrip, biceps brachii and quadriceps femoris strengths, appendicular skeletal mass, gait speed, Short Physical Performance Battery, and Timed Up-and-Go test. Emotional assessments included Short-Form Health Survey, Geriatric Depression Scale-Short Form, and the Mini-Mental State Examination. The analyzed sample showed a reduction in bicep strength, and other upper and lower limb strength variables showed a decreasing trend with no changes regarding muscle mass. Physical performance showed a change, specifically a deterioration in the subtest related to balance. Cognitive and emotional components were affected and quality of life was decreased. It is of paramount importance to focus on sarcopenic older adults since their characteristics can deteriorate when isolation measures are conducted.

Optimal exercise to improve physical ability and performance in older adults with sarcopenia: a systematic review and network meta-analysis

OBJECTIVE

The study aimed to pool and analyze the effects of different forms of exercise on muscle strength (handgrip strength [HGS]), and physical performance (timed up and go test [TUGT], gait speed [GS] and chair stand test [CS]) in older adults with sarcopenia.

METHODS

The effect sizes of all studies retrieved and included by the four databases were analyzed using the network meta-analysis and expressed as standardized mean differences (SMD) and the corresponding 95% confidence intervals (CI).

RESULTS

Twenty studies were included in this study with 1347 older adults with sarcopenia. Compared with control and other intervention groups, resistance training (RT) improved HGS [SMD=3.8, 95% CI (1.3, 6.0), p<0.05] and TUGT [SMD = -1.99, 95% CI (-2.82, -1.16), p<0.05] significantly. comprehensive training (CT) [SMD = -2.04, 95% CI (-3.05, -1.06), Pp<0.05] and Comprehensive training under self-management (CT_SM) [SMD = -2.01, 95% CI (-3.24, -0.78), p<0.05] improved TUGT significantly.

CONCLUSION

In older adults with sarcopenia, RT could improve HGS and TUGT, CT and CT_SM could improve TUGT. There were no significant changes in CS and GS with any of the exercise training modes.

Increasing Muscle Mass in Elders through Diet and Exercise: A Literature Review of Recent RCTs

This study aimed to review the current evidence on the independent and combined effects of diet and exercise and their impact on skeletal muscle mass in the elderly population. Skeletal muscle makes up approximately 40% of total body weight and is essential for performing daily activities. The combination of exercise and diet is known to be a potent anabolic stimulus through stimulation of muscle protein synthesis from amino acids. Aging is strongly associated with a generalized deterioration of physiological function, including a progressive reduction in skeletal muscle mass and strength, which in turn leads to a gradual functional impairment and an increased rate of disability resulting in falls, frailty, or even death. The term sarcopenia, which is an age-related syndrome, is primarily used to describe the gradual and generalized loss of skeletal muscle mass (mainly in type II muscle fibers) and function. Multimodal training is emerging as a popular training method that combines a wide range of physical dimensions. On the other hand, nutrition and especially protein intake provide amino acids, which are essential for muscle protein synthesis. According to ESPEN, protein intake in older people should be at least 1 g/kgbw/day. Essential amino acids, such as leucine, arginine, cysteine, and glutamine, are of particular importance for the regulation of muscle protein synthesis. For instance, a leucine intake of 3 g administered alongside each main meal has been suggested to prevent muscle loss in the elderly. In addition, studies have shown that vitamin D and other micronutrients can have a protective role and may modulate muscle growth; nevertheless, further research is needed to validate these claims. Resistance-based exercise combined with a higher intake of dietary protein, amino acids, and/or vitamin D are currently recognized as the most effective interventions to promote skeletal muscle growth. However, the results are quite controversial and contradictory, which could be explained by the high heterogeneity among studies. It is therefore necessary to further assess the impact of each individual exercise and nutritional approach, particularly protein and amino acids, on human muscle turnover so that more efficient strategies can be implemented for the augmentation of muscle mass in the elderly.

Fat infiltration and muscle hydration improve after high-intensity resistance training in women with sarcopenia. A randomized clinical trial

BACKGROUND

Resistance training is recommended for preventing sarcopenia, but the benefits for the quality and quantity of muscle mass are uncertain.

OBJECTIVE

To assess the effects of high-intensity resistance training (HIRT) on clinical and magnetic resonance imaging (MRI) parameters in women with sarcopenia.

METHODS

A researcher-blinded randomized clinical trial was conducted. Community-dwelling older women with sarcopenia were randomized to six months of HIRT or a control group (CG). Body composition was assessed with bioimpedance equipment, and participants underwent strength and functional performance tests (short physical performance battery [SPPB] and gait speed). MRI scans of the thigh were taken to quantify muscle mass and quality.

RESULTS

Thirty-eight women completed the study (20 in the HIRT group). Sarcopenia remitted in 50 % of the HIRT group. HIRT elicited a significant group × time interaction effect for muscle mass (p = 0.027; Ƞ² = 0.129), muscle mass index (p = 0.023; Ƞ² = 0.135), fat mass (p = 0.048; Ƞ² = 0.103) and all strength variables (p < 0.05; Ƞ² > 0.120). Moreover, the HIRT group obtained higher scores on the SPPB (mean difference [MD] 1.2; p = 0.005) and the 5 times sit-to-stand test (MD = 0.7; p = 0.009). Regarding MRI parameters, infiltrated microscopic fat decreased significantly (HIRT: MD = -0.01; p < 0.05), while hydration (T2) decreased in the CG (MD = 3.6 ms; p = 0.053) at six months. There were significant between-group differences at six months for water diffusion (HIRT: 1.09 × 10^-3 mm²/s vs CG: 1.26 × 10^-3 mm²/s) and total muscular volume (HIRT: 832.4 L vs CG: 649.2 L).

CONCLUSIONS

HIRT led to the remission of sarcopenia in half of the older women, as seen in muscle mass, strength, and functional performance and MRI biomarkers, with significant increases in muscle quality. REGISTERED IN CLINICALTRIALS.GOV: NCT03834558.

Resistance training of peripheral muscles benefits respiratory parameters in older women with sarcopenia: Randomized controlled trial

PURPOSE OF THE RESEARCH

Ageing entails a decrease in muscle mass and strength, known as sarcopenia, which also affects respiratory function. Physical exercise is an appropriate intervention to treat both conditions. This study aims to assess the efficacy of high-intensity resistance training (HIRT) on clinical parameters of respiratory function and health-related quality of life (QoL) in community-dwelling older women with sarcopenia.

METHODS

Fifty-one sarcopenic community-dwelling women aged 70 years and older were randomized to either six months of HIRT (n = 24) or control (n = 27). At baseline and post-intervention, participants were assessed for skeletal-muscle sarcopenia; respiratory sarcopenia status; respiratory function: spirometry (FEV₁, FVC, FEV₁/FVC, and FEF_25-75) and expiratory (MEP) and inspiratory (MIP) respiratory muscle strength parameters; and health-related QoL (EURO-QOL 5D-3 L).

RESULTS

A group-by-time interaction effect for MEP (p = 0.044, Ƞ²=0.108) was observed. CG showed a significant decrease in FEV₁ (mean difference [MD] -0.12 L; 95% confidence interval [CI] -0.20, -0.05; p = 0.002); and FVC (MD -0.18 L; 95% CI -0.33, -0.03; p = 0.024) after six months, whereas the HIRT maintained respiratory function without change. Post-intervention, mean EQ-VAS increased in the HIRT and decreased in CG, resulting in a significant between-group difference (mean 73.0 standard deviation [SD] 16.99 vs 61.1 SD 18.2 points, respectively; p = 0.044). Respiratory sarcopenia status was reverted in the HIRT.

CONCLUSIONS

HIRT increased muscle strength and halted age-related respiratory function decline in sarcopenic old women. A strength intervention could benefit health-related QoL and physical well-being. REGISTERED IN CLINICALTRIALS.GOV: NCT03834558.

Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders

Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).

Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).

Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).

Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.

Efficacy of Exercise on Muscle Function and Physical Performance in Older Adults with Sarcopenia: An Updated Systematic Review and Meta-Analysis

This study aimed to analyze the efficacy of exercise interventions on muscle strength, muscle mass, and physical performance in older adults with sarcopenia. Randomized controlled studies assessing exercise effects on sarcopenia were searched in Web of Science, PubMed, Cochrane Library, ProQuest, EBSCOhost, Scopus, EMBASE, and VIP and CNKI up to 31 March 2022. Data were expressed as weighted/standardized mean difference (MD/SMD) with 95% confidence intervals (CI). I² index was employed for heterogeneity. The initial search identified 5379 studies, and 23 studies involving 1252 participants met the inclusion criteria for further analysis. Results revealed that exercise interventions can significantly improve grip strength (MD = 2.38, 95%CI = 1.33–3.43), knee extension strength (SMD = 0.50, 95%CI = 0.36–0.64), muscle mass of lower extremities (MD = 0.28, 95%CI = 0.01–0.56), walking speed (SMD = 0.88, 95%CI = 0.49–1.27), and functional mobility (MD = −1.77, 95%CI = −2.11–−1.42) among older adults with sarcopenia. No significant exercise effects were found on fat-free muscle mass, appendicular muscle mass, skeletal muscle mass, and muscle mass of the upper extremities. The results of subgroup analysis indicated that both resistance training and multicomponent exercise could significantly increase the muscle strength, while aerobic exercise did not. The findings suggest that exercise intervention can effectively improve muscle function and physical performance in older adults with sarcopenia, but has limited effects on the muscle mass of the upper extremities. In addition, it is highly recommended to apply group-based and supervised resistance training and multicomponent exercise in the prevention and treatment of sarcopenia among the older population.

Measuring the outcomes for aged care residents' participation in physical activity interventions: A systematic review of randomised controlled trials

OBJECTIVES

Lack of physical activity presents substantial health risks to older adults living in residential aged care facilities. The objective of this review was to examine the suitability of physical activity outcome measurement instruments among cognitively sound residents.

METHODS

Search terms were used to explore health, nursing and social science databases to identify applicable English-language research from January 2000 to July 2020.

RESULTS

Sixteen papers met the inclusion criteria. The findings show that a diverse range of outcome measurement instruments have been used to evaluate physical activity intervention effectiveness. Most were found not to be validated for use specifically with residential aged care populations.

CONCLUSIONS

A range of Outcome Measurement Instruments (OMI) appear to effectively measure physical activity intervention outcomes among residential aged care older adults. Results highlighted the need for greater rigour in study design and selection of valid and population-appropriate instruments for use with this population.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Inspiratory muscle training in addition to whole body vibration for functional and physical outcomes in pre-frail older women: a randomized controlled trial

BACKGROUND

to investigate the efficacy of addition of inspiratory muscle training (IMT) to the whole body vibration (WBV) on functional outcomes, physical performance, muscle strength and metabolism in pre-frail older women.

METHODS

this study was a randomized double-blind trial. Forty-two older women aged 60-80 years who meet the Cardiovascular Health Study frailty criteria for pre-frailty were randomly allocated to IMT + WBV, IMTsham + WBV or Sham groups. IMT + WBV group received 12 weeks of both trainings, whereas IMTsham + WVB received 12 weeks of WBV alone. Sham group received 12 weeks of IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: 6-min walk test distance (6MWD), balance using Tinetti test, functional mobility using timed up and go test (TUG), handgrip strength (HGS) and peripheral muscle metabolism (glucose and lactate levels).

RESULTS

after the training, both groups IMT + WBV and IMTsham + WBV improved 6MWD [mean percentage changes = 20.31 (SD = 14.62) and 13.02 (SD = 12.14), respectively] compared with Sham [0.27 (SD = 6.51)], P <0.01. There was also a significant decrease of mean percentage changes on time of the TUG for IMT + WBV [-21.87 (SD = 7.87)] and IMTsham + WBV [-11.15 (SD = 13.64)] compared with Sham [-4.25 (SD = 13.25)], P <0.01. IMT + WBV group improved balance when compared with IMTsham + WBV and Sham groups (P <0.05 and < 0.01, respectively). HGS and levels of lactate and glucose were similar between groups.

CONCLUSIONS

the addition of IMT to the WBV was effective to improve functionality, balance and physical performance in pre-frail older women.

Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis

OBJECTIVE

We conducted a systematic review and meta-analysis to clarify the effects of different exercise modes (resistance training [RT], whole body vibration training [WBVT], and mixed training [MT, resistance training combined with other exercises such as balance, endurance and aerobic training]) on muscle strength (knee extension strength [KES]) and physical performance (Timed Up and Go [TUG], gait speed [GS] and the Chair Stand [CS]) in older people with sarcopenia.

METHOD

All studies published from January 2010 to March 2021 on the effects of exercise training in older people with sarcopenia were retrieved from 6 electronic databases: Pubmed, Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), and Wanfang Database. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Pooled analyses for pre- and post- outcome measurements were performed using Review Manager 5.4 with standardized mean differences (SMDs) and fixed-effect models.

RESULT

Twenty-six studies (25 randomized controlled trails [RCTs] and one non-randomized controlled trail) were included in this study with 1191 older people with sarcopenia (mean age 60.6 ± 2.3 to 89.5 ± 4.4). Compared with a control group, RT and MT significantly improved KES (RT, SMD = 1.36, 95% confidence intervals [95% CI]: 0.71 to 2.02, p < 0.0001, I2 = 72%; MT, SMD = 0.62, 95% CI: 0.29 to 0.95, p = 0.0002, I2 = 56%) and GS (RT, SMD = 2.01, 95% CI: 1.04 to 2.97, p < 0.0001, I2 = 84%; MT, SMD = 0.69, 95% CI: 0.29 to 1.09, p = 0.008, I2 = 81%). WBVT showed no changes in KES (SMD = 0.65, 95% CI: - 0.02 to 1.31, p = 0.06, I2 = 80%) or GS (SMD = 0.12, 95% CI: - 0.15 to 0.39, p = 0.38, I2 = 0%). TUG times were significantly improved with all exercise training modes (SMD = -0.66, 95% CI: - 0.94 to - 0.38, p < 0.00001, I2 = 60%). There were no changes in CS times with any of the exercise training modes (SMD = 0.11, 95% CI: - 0.36 to 0.57, p = 0.65, I2 = 87%).

CONCLUSIONS

In older people with sarcopenia, KES and GS can be improved by RT and MT, but not by WBVT. All three training modes improved TUG times, but not improved CS times.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review

BACKGROUND

The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).

METHOD

This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.

RESULTS

Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.

CONCLUSIONS

There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.

TRIAL REGISTRATION

Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).

Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We conducted a meta-analysis to analyze the effects of resistance training on measures of body composition, muscle strength, and muscle performance in older people with sarcopenia.

METHODS

All randomized controlled trials on the effects of resistance training on outcome variables in older people with sarcopenia were searched on Pubmed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), and Wanfang. Data from January 2010 to October 2020 were reviewed. Two researchers extracted data and evaluated the quality of the studies that met the inclusion criteria independently. Meta-analysis for pre-post changes were calculated as standardized mean difference (SMD) with 95% confidence intervals (CI).

RESULTS

Fourteen studies meeting inclusion criteria included 561 healthy older adults (age 65.8 to 82.8) with sarcopenia. Compared with the control group, resistance training had positive effects on body fat mass (SMD = -0.53, 95% CI - 0.81 to - 0.25, p = 0.0002, I² = 0%), handgrip strength (SMD = 0.81, 95%CI 0.35 to 1.27, p = 0.0005, I² = 81%), knee extension strength (SMD = 1.26, 95% CI 0.72 to 1.80, p < 0.0001, I² = 67%), gait speed (SMD = 1.28, 95%CI 0.36 to 2.19, p = 0.006, I² = 89%), and the timed up and go test (SMD = -0.93, 95% CI - 1.30 to - 0.56, p < 0.0001, I² = 23%). Resistance training had no effects on appendicular skeletal muscle mass (SMD = 0.25, 95% CI - 0.27 to 0.78, p = 0.35, I² = 68%), skeletal muscle mass (SMD = 0.27, 95% CI - 0.02 to 0.56, p = 0.07, I² = 0%) and leg lean mass (SMD = 0.12, 95% CI - 0.25 to 0.50, p = 0.52, I² = 0%). Old people with sarcopenia of different ages, genders or diagnostic criteria and weights have different gains in muscle mass, handgrip strength, knee extension strength and muscle performance after different intervention duration, frequencies, mode and intensity resistance training.

CONCLUSION

Resistance training is an effective treatment to improve body fat mass, muscle strength, and muscle performance in healthy older people with sarcopenia.

Diagnostic accuracy of quadriceps strength-based criteria compared to handgrip-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults

AIM

. Handgrip strength (HS) is an established parameter for sarcopenia diagnosis; however, a considerable proportion of older adults have some kind of hand abnormality or limitation that can prevent reliable hand muscle power testing. This study set forth to investigate the diagnostic accuracy of quadriceps strength (QS)-based criteria compared to handgrip strength (HS)-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults.

SETTING AND PARTICIPANTS

. A total of 381 subjects aged ≥60 years who attended the outpatient geriatric clinic at Siriraj Hospital (Bangkok, Thailand) during 2015-2017 were recruited via convenience sampling. Patients who were ambulatory, able to communicate, and without metallic prosthesis or pacemaker were eligible for inclusion.

METHODS

. All consenting subjects underwent HS and QS testing, muscle mass measurement by bioelectrical impedance analysis, and gait speed analysis. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria were used as reference standard.

RESULTS

. The prevalence of sarcopenia and severe sarcopenia by HS-based criteria was 13.9% and 6.8%, respectively. In comparison, the prevalence of sarcopenia and severe sarcopenia by QS-based criteria was 14.7% and 10.2%, respectively. The sensitivity and specificity of QS-based criteria for diagnosing sarcopenia was 100% (95% confidence interval [CI]: 93.3-100%) and 99.1% (95%CI: 97.4-99.8%), respectively. The sensitivity and specificity of QS-based criteria for diagnosing severe sarcopenia was 88.5% (95%CI: 69.9-97.6%) and 95.5% (95%CI: 92.8-97.4%), respectively.

CONCLUSIONS

. With very high sensitivity and specificity, QS-based diagnostic criteria could be used to diagnose sarcopenia and severe sarcopenia in older adults whose HS measurements could not be reliably obtained. THAI CLINICAL TRIALS REGISTRY REGISTRATION NUMBER: . TCTR 20200717004.

Effects and Moderators of Exercise on Sarcopenic Components in Sarcopenic Elderly: A Systematic Review and Meta-Analysis

Background: Sarcopenia is a muscle disease in loss of muscle strength, mass, and function associated with aging. Although protective effects of exercise on muscle mass and function are generally recognized, research findings in sarcopenic adults are inconsistent. It is necessary to conduct a systematic review to determine the effects of exercise on muscle strength, body composition, and physical performance in older adults with sarcopenia, and to examine the potential moderators including sociodemographic characteristics and exercise-related factors.

Methods: Six electronical academic databases (Medline, Embase, CINAHL, Scopus, Cochrane Library, and SPORTDiscus) were used to retrieve the eligible studies from inception to May 2020. Two reviewers independently selected and extracted the data from each included study, and effect sizes were calculated by employing random-effect models with 95% confidential interval (CI). The Physiotherapy Evidence Database (PEDro) scale was used to assess study quality.

Results: Seventeen studies (985 participants with sarcopenia, aged 67.6–86 years) were included in this review study. The meta-analytic results showed significant improvements in muscle strength [grip strength, SMD = 0.30, 95% CI (0.15, 0.45), I² = 6%, p < 0.01; knee extension, SMD = 0.32, 95% CI (0.15, 0.50), I² = 0%, p < 0.01; and chair and stand, SMD = 0.56, 95% CI (0.30, 0.81), I² = 36%, p < 0.01], in physical performance [timed up and go, SMD = 0.74, 95% CI (0.48, 1.00), I² = 0%, p < 0.01; and gait speed, SMD = 0.59, 95% CI (0.35, 0.82), I² = 62%, p < 0.01], and in body composition [skeletal muscle mass index, SMD = 0.37, 95% CI (0.15, 0.58), I² = 16%, p < 0.01; and appendicular skeletal muscle, SMD = 0.31, 95% CI (0.13, 0.49), I² = 20%, p < 0.01]. However, there were no significant differences in other body composition (SMD = 0.20–0.36). Additionally, meta-regression revealed that the higher percent of female participants was significantly associated with improved gait speed (β = 0.0096, p = 0.03) and decreased skeletal muscle mass index (β = −0.0092, p = 0.01).

Conclusions: The current meta-analysis suggests that exercise is a beneficial therapy, which has protective effects for older adults with sarcopenia. Some beneficial effects may be moderated by gender and exercise intensity.

Inspiratory muscle training for improving inspiratory muscle strength and functional capacity in older adults: a systematic review and meta-analysis

BACKGROUND

The ageing process can result in the decrease of respiratory muscle strength and consequently increased work of breathing and associated breathlessness during activities of daily living in older adults.

OBJECTIVE

This systematic review and meta-analysis aims to determine the effects of inspiratory muscle training (IMT) in healthy older adults.

METHODS

A systematic literature search was conducted across four databases (Medline/Pubmed, Web of Science, Cochrane Library CINAHL) using a search strategy consisting of both MeSH and text words including older adults, IMT and functional capacity. The eligibility criteria for selecting studies involved controlled trials investigating IMT via resistive or threshold loading in older adults (>60 years) without a long-term condition.

RESULTS

Seven studies provided mean change scores for inspiratory muscle pressure and three studies for functional capacity. A significant improvement was found for maximal inspiratory pressure (PImax) following training (n = 7, 3.03 [2.44, 3.61], P = <0.00001) but not for functional capacity (n = 3, 2.42 [-1.28, 6.12], P = 0.20). There was no significant correlation between baseline PImax and post-intervention change in PImax values (n = 7, r = 0.342, P = 0.453).

CONCLUSIONS

IMT can be beneficial in terms of improving inspiratory muscle strength in older adults regardless of their initial degree of inspiratory muscle weakness. Further research is required to investigate the effect of IMT on functional capacity and quality of life in older adults.

Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Sarcopenia and frailty are age-related syndromes with negative effects on the quality of life of older people and on public health costs. Although extensive research has been carried out on the effects of physical exercise and physical syndromes, there is a knowledge gap when it comes to the effect of resistance training on muscular strength, physical performance, and body composition at early (prevention) and late (treatment) stages in both syndromes combined. We conducted this systematic review and meta-analysis (CRD42019138253) to gather the evidence of randomized controlled trials examining the effects of resistance training programs lasting ≥8 weeks on strength, physical function, and body composition of adults ≥65 years old diagnosed with pre-sarcopenia, sarcopenia, pre-frailty, or frailty. A search from the earliest record up to and including December 2020 was carried out using the PubMed, Scopus, Web of Science, and Cochrane Library databases. A total of 25 studies (n = 2267 participants) were included. Meta-analysis showed significant changes in favour of resistance training for handgrip (ES = 0.51, p = 0.001) and lower-limb strength (ES = 0.93, p < 0.001), agility (ES = 0.78, p = 0.003), gait speed (ES = 0.75, p < 0.001), postural stability (ES = 0.68, p = 0.007), functional performance (ES = 0.76, p < 0.001), fat mass (ES = 0.41, p = 0.001), and muscle mass (ES = 0.29, p = 0.002). Resistance training during early stages had positive effects in all variables during early stages (ES > 0.12), being particularly effective in improving gait speed (ES = 0.63, p = 0.016) and functional strength (ES = 0.53, p = 0.011). Based on these results, resistance training should be considered as a highly effective preventive strategy to delay and attenuate the negative effects of sarcopenia and frailty in both early and late stages.

Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.

Exercise, Nutrition, and Combined Exercise and Nutrition in Older Adults with Sarcopenia: A Systematic Review and Network Meta-analysis

It is unclear whether the combined effects of exercise and nutrition are better than those of exercise alone or nutrition alone in older adults with sarcopenia. This paper assesses the comparative effects of exercise, nutrition, and the combination of exercise and nutrition on muscle mass, muscle strength, and physical performance in older adults with sarcopenia. In this systematic review and network meta-analysis, 11 electronic databases were searched up to November 2020. Inclusion criteria were: (1) adults aged 65 years and older with sarcopenia; (2) interventions of exercise, nutrition, or the combination of both; (3) the outcomes include at least one of the following: muscle mass, muscle strength (hand grip and knee extension strength), or physical performance (gait speed and dynamic balance); and (4) randomized control trials. For each outcome measurement, a network meta-analysis was conducted to determine the direct and indirect effects of each intervention compared with each of the other interventions. A total of 26 studies were included in the network meta-analysis. Compared with the control group, exercise alone and the combination of exercise and nutrition significantly increased handgrip strength (1.12 kg, 95% CI: 0.12, 2.11; 2.03 kg, 95% CI: 1.10, 2.97) and improved dynamic balance (-1.76 seconds, 95% CI: -2.24, -1.28; -1.02 seconds, 95% CI: -1.64, -0.39). Both exercise alone and the combination of exercise and nutrition have beneficial effects on muscle strength and physical performance in older adults with sarcopenia.

Resistance Exercise, Electrical Muscle Stimulation, and Whole-Body Vibration in Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials

It has been shown that resistance exercise (RT) is one of the most effective approaches to counteract the physical and functional changes associated with aging. This systematic review with meta-analysis compared the effects of RT, whole-body vibration (WBV), and electrical muscle stimulation (EMS) on muscle strength, body composition, and functional performance in older adults. A thorough literature review was conducted, and the analyses were limited to randomized controlled trials. In total, 63 studies were included in the meta-analysis (48 RT, 11 WBV, and 4 EMS). The results showed that RT and WBV are comparably effective for improving muscle strength, while the effects of EMS remains debated. RT interventions also improved some outcome measures related to functional performance, as well as the cross-sectional area of the quadriceps. Muscle mass was not significantly affected by RT. A limitation of the review is the smaller number of WBV and particularly EMS studies. For this reason, the effects of WBV and EMS could not be comprehensively compared to the effect of RT for all outcome measures. For the moment, RT or combinations of RT and WBV or EMS, is probably the most reliable way to improve muscle strength and functional performance, while the best approach to increase muscle mass in older adults remains open to further studies.

Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis

Sarcopenia is an age-related condition that is characterized by progressive and generalized loss of muscle mass and function. Exercise treatment has been the most commonly used intervention among elderly populations. We performed a systematic review and meta-analysis to evaluate the available literature related to the effects of exercise interventions/programs on muscle mass, muscle strength and physical performance in older adults with sarcopenia. We searched PubMed, EMBASE, MEDLINE and the Web of Science for randomized controlled trials and controlled clinical trials exploring exercise in older adults with sarcopenia published through July 2019 without any language restrictions. Pooled analyses were conducted using Review Manager 5.3, with standardized mean differences (SMDs) and fixed-effect models. A total of 3898 titles and abstracts were initially identified, and 22 studies (1041 individuals, 80.75% females, mean age ranged from 60.51 to 85.90 years) were included in the meta-analysis. The exercise programs in the studies consisted of 30 to 80 min of training, with 1 to 5 training sessions weekly for 6 to 36 weeks. Muscle strength (grip strength [SMD 0.57, 95 % CI 0.42 to 0.73, P <0.00001] and timed five chair stands [SMD -0.56, 95 % CI -0.85 to -0.28, P < 0.0001]) and physical performance (gait speed [SMD 0.44, 95 % CI 0.26 to 0.61, P < 0.00001] and the timed up and go test [SMD -0.97, 95 % CI -1.22 to -0.72, P < 0.00001]) showed significant improvement following exercise treatment, while no differences in muscle mass (ASM [SMD 0.15, 95 % CI -0.05 to 0.36, P = 0.15] and ASM/height² [SMD 0.21, 95 % CI -0.05 to 0.48, P = 0.12]) were detected. Exercise programs showed overall significant positive effects on muscle strength and physical performance but not on muscle mass in sarcopenic older adults.

Chronic Kidney Disease is Associated with Physical Impairment

Background

Physical impairment or frailty due to sarcopaenia is common in patients with chronic kidney disease and those receiving dialysis. This study examined the association between muscle weakness and kidney function in Japanese patients with chronic kidney disease.

Methods

A total of 23 stable outpatients were enrolled in the study. Several indices were used to assess muscle function; hand grip strength, isometric knee extension strength, Timed Up and Go test (TUG), and the short physical performance battery. The relationships between these indices and estimated glomerular filtration rate (eGFR) as a measure of kidney function were analysed statistically.

Results

Patients' characteristics were as follows: mean age 73.9 years (standard deviation (SD) 13); 12 males, 11 females; body mass index (BMI) 22.5 kg/m² (SD 3.2); serum creatinine (sCr) 4.6 mg/ dl (SD 3.7); estimated glomerular filtration rate (eGFR) 19.1 ml/min (SD 16). Their physical performance indices were: hand grip strength 20.8 kg (SD 7.9); isometric knee extension strength 19.1 kgf/kg (SD 10.6); TUG 14.9 s (SD 6.0); and short physical performance battery score 7.0 (SD 4.3). Multiple regression analysis adjusted for age revealed significant associations between isometric knee extension strength/body weight and eGFR (F [2,19] = 8.38, p = 0.002) and TUG and eGFR (F=4.98 [2,18], p = 0.02).

Conclusion

Deterioration in muscle function or maintenance of posture is associated with chronic kidney disease.

Time Effects on Physical Performance in Older Adults in Nursing Home: A Narrative Review

OBJECTIVES

To gather available evidence about overtime changes on physical performance in institutionalized elderly.

DESIGN, SETTING AND PARTICIPANTS

An electronic search was performed on PubMed database on May 2018. We selected articles reporting the evolution of physical performance in older adults living in care institutions. We looked for data from observational longitudinal studies; data from clinical trials were extracted only for subjects who did not receive exercise intervention. All types of performance-based tests, for upper- and/or lower-body, were scrutinized.

RESULTS

Seventeen studies were reviewed; mean age varied from 78.3 to 88 years old. Fourteen studies were randomized controlled trials (RCTs), other three studies were non-randomized trials and a longitudinal observational study. Different tests assessing physical performance were examined: upper limb strength and lower limb strength, static balance, dynamic balance and mobility showed a tendency to decline over time. On average hand grip strength decreased by 2.2% per month, chair stand test by 3.5%, Berg balance scale by 2%, timed up-and-go test by 2.8%, gait speed by 2.1% and short physical performance battery by 2.8%. A minority of studies have shown an improvement in lower limb muscle strength, endurance and gait speed: in these studies, participants did not attend any kind of physical training but took part to social activities or cognitive interventions.

CONCLUSION

This review shows how physical performance decreases over time in nursing home residents and quantifies their decline. However, in active controls, there was an improvement in some physical performance measures, which indicates that intervention other than exercise might prevent some loss in physical performance.