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. 2023 Jun 16;16(3):377–382. doi: 10.1177/19417381231175665

Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review

Isis Kelly dos Santos 1, Ricardo Ney Cobucci 2, Jason Azevedo de Medeiros 3, Gilmara Gomes de Assis 4, Rafaela Catherine da Silva Cunha de Medeiros 5, Maria Irany Knackfuss 6, Breno Guilherme de Araújo Tinoco Cabral 7, Ronaldo Vagner Thomatieli dos Santos 8, Paulo Moreira Silva Dantas 9,*
PMCID: PMC11025514  PMID: 37329120

Abstract

Context:

Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity outside.

Objective:

To synthesize the effect of home-based indoor physical activity on psychosocial outcomes and mobility in community-dwelling older adults.

Data Sources:

A comprehensive search was conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases.

Study Selection:

A total of 11 studies (13 publications) were included involving a total of 1004 older adults.

Study Design:

A systematic review of randomized controlled trials was conducted using the aforementioned 7 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Level of Evidence:

Level 2.

Data Extraction:

Two authors independently selected studies, extracted data, and determined the risk of bias and evidence level using the Grading quality of evidence and strength of recommendations (GRADE) guidelines. We conducted a synthesis without meta-analysis (SWiM) to assess the outcome.

Results:

There is moderately certain evidence that home-based exercise programs reduced the fear of falling. Psychosocial (mental health and quality of life) and mobility outcomes may improve after participating in the intervention inside the home.

Conclusion:

The review found very low to certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggests that home-based exercises improved fear of falling.

Protocol Register Number:

CRD42020182008.

Keywords: exercise, older people, quality of life, systematic review

Home-based exercise programs have many benefits and may be a good strategy for people who cannot visit gyms, clinics, or have limited time for physical activity outside. Older adults may be less comfortable in gym settings or feel unsafe walking outside for fear of falling.6,32,33,35 Numerous studies have reported that home-based exercise programs can promote health, such as improved executive function and improved ability to complete activities of daily living while preventing falls and cognitive decline.4,11,23,36

In addition, the coronavirus pandemic has changed the daily life routines of all people worldwide. Social distancing, closed facilities, and working from home resulted in more sedentary behavior, negatively impacting people already at increased risk of developing chronic diseases. 39 Reduced community mobility and social isolation can negatively impact older adults, potentially diminishing their physical and psychosocial health.8,48 Regular physical activity is important part of daily routines, especially for the quality of life and autonomy of older adults. 9 Home-based exercise programs have been proposed as a good alternative to reduce prolonged sedentary behavior and improve physical fitness and balance during the pandemic.19,45

Recent reviews and meta-analyses indicate that home exercise is feasible, has lower associated costs, and has the potential to be sustained over a longer period.6,14 Furthermore, these previous analyses included exercises inside and outside (ie, walking) based on Otago protocols.13,28

Restrictions during the pandemic motivated the synthesis of available evidence on home-based physical activity programs on health-related outcomes of community-dwelling adults and older adults. Knowledge of this information is important for community-dwelling older adults. It may also be of interest for older adults who cannot leave home regularly or for people who may not have access to community resources (outside the pandemic). Therefore, the objective of this systematic review was to synthesize the available peer-reviewed evidence for the effectiveness of home-based exercises programs on psychosocial outcomes and mobility in community-dwelling older adults.

Methods

Protocol and Registration

This systematic review followed Cochrane Handbook guidelines, reported based on the guidelines of Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA), 34 and was registered on PROSPERO. We provided updates to the protocol when appropriate. The following PICO strategy was used for the search: Population: older adults; Intervention: home-based (indoor) physical activity programs; Comparator: usual care or no intervention; Outcomes: fear of falling, mental health (depression, anxiety, and wellness), quality of life, fitness, mobility, and physical functioning.

Search Strategy

Searches were conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases. The following search strategies using MeSH terms and keywords for combination of concepts were applied: “home-based exercises,” “health outcomes,” and “older adults.” The full strategy is reported in the Appendix (available in the online version of this article). There were no restrictions on the publication language. The reference lists of the included studies and reviews were also examined for potentially eligible studies. The first search was performed in June and July 2020 and last updated in November 2022.

Inclusion and Exclusion Criteria

The inclusion criteria were randomized controlled trials (RCTs) in all languages that included community-dwelling older adults (≥60 years old), such as interventions based on home-based indoor exercises programs, including balance and resistance, with exercise delivery by digital versatile disc (DVD) also being included. The outcomes of interest were fear of falling, mental health (depression, anxiety, and wellness), quality of life, fitness, mobility, and physical functioning. We excluded studies with certain clinical populations (ie, osteoporosis, hip fracture), interventions of home exercise programs conducted outside the home, such as running and walking or in other setting (ie, laboratories or university health centers).

Study Selection

Two authors independently screened titles and abstracts based on prespecified criteria (PICO) (Level 1). After this step, the authors screened the full articles according to the inclusion criteria (Level 2). Disagreement between authors was resolved independently by a third author. We used the Covidence systematic review software (Veritas Health Innovation) to perform these steps and documented all exclusion reasons.

Data Collection and Analysis

Two authors independently extracted data from the included manuscripts using the extraction form developed for the review, and another author verified the data accuracy. We collected information on study design, participant characteristics (mean age, gender, description, group allocation, etc), description of the intervention and control groups (type of intervention, frequency, duration, volume, and level of supervision), outcome measures, and follow-up period. We contacted the study authors by email to provide additional information when necessary.

Data Synthesis

Due to the variety of interventions and heterogeneity of studies, it was not statistically appropriate to combine all the included studies in a meta-analysis. Therefore, we conducted a narrative synthesis without meta-analysis (SWiM). 10 We divided by type of exercise protocol and converted all measures of treatment into effect size estimates (Cohen’s d) with corresponding 95% CIs. The evidence certainty was determined for each outcome (fear of falling, mental health, quality of life, and mobility) using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. 50

Risk of Bias for Included Studies

We used the Cochrane Risk of Bias Version 2.0 tool (RoB 2.0), 18 which includes 5 domains related to bias from: (1) the randomization process, (2) classification of interventions, (3) missing outcome data, (4) measurement of the outcome, and (5) bias in the selection of the reported result. Two authors independently evaluated and confirmed the risk of bias in all studies.

Results

The search strategy identified a total of 5137 articles. After removing duplicates, 2737 articles were screened for titles and abstracts. Next, 171 full-text studies were assessed for eligibility after screening. As a result, we included 11 studies (13 publications) in the systematic review (Figure 1). All studies were RCTs, 3 studies were conducted in the United States (US),5,14,22 2 in Australia,17,31 and 1 each in Brazil, 7 Canada, 25 Finland, 30 Spain, 3 Switzerland, 1 Germany, 16 and the United Kingdom (UK). 27

Figure 1.

Figure 1.

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PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Participant Characteristics

A total of 1004 participants (484 and 520 in the intervention and control groups, respectively) were included in this review. The sample sizes ranged from 18 to 307 community-dwelling participants aged >60 years. Most participants were female (74%), and 2 studies recruited only female participants.3,30 The majority of participants were physically independent, none of the participants had any history of diagnosed orthopaedic or neurological disorders (at least if some older adults had these conditions, it did not preclude them from participating in the studies). In addition, all studies used questionnaires such as the Mini Mental State Examination Test (MMSE) for screening of cognitive impairment. The participants in all studies needed to have the ability to perform home-based exercise programs, and all participants were capable of walking independently without any assistive device. A summary of these studies is presented in Appendix Table A1, available online.

Interventions

All home-based exercise programs were completed indoors and included the following activities: a combination of aerobic and muscle strengthening, balance, coordination, and flexibility exercises; exergames (DVD delivery), Pilates, progressive exercise programs, rocking-chair training, Thai yoga, and Tai Chi. Most studies reported a frequency between 2 and 5 times per week, while the duration of interventions ranged from 5 weeks to 6 months. The level of supervision during home-based programs varied from being supervised by telephone, visit a physiotherapist, and unsupervised. The following comparisons (all indoors) were used as a comparator within studies: control group (usual care), advice (via telephone), and a DVD. The characteristics of the included studies are summarized in Appendix Table A1, available online.

Fear of Falling

Two studies included demonstrating that home-based exercises may improve fear of falling in older adults with moderately certain evidence.3,17 All studies used the same Fall Efficacy Scale-International (FES-I) instrument,3,17 and both observed lower fear of falling after the interventions (ie, Pilates and iStoppFalls exercise program).3,17 After 12 weeks, the Pilates group showed higher values than the control group for balance confidence and improvement in response to conditions with eyes open and closed, 3 as presented in Appendix Table A2, available online.

Mental Health

Three studies reported effects of home-based exercises programs on mental health outcomes (depression, anxiety, and stress) using validated scales: the Hospital Anxiety and Depression Scale (HADS); Patient Health Questionnaire (PHQ-9); and Center for Epidemiological Studies of Depression (CES-D).2,17,22,31 Aguiñaga et al 2 (6 months of DVD intervention) reported reductions in elevated symptoms of depression and anxiety compared with the control group; however, there were no significant changes in depressive symptoms after participation in home-based exercise programs among healthy older adults in 2 studies with iStoppFalls and Thai yoga interventions (Appendix Table A2, available online).17,31

Quality of Life

There is very low certain evidence from 4 studies that home-based exercise may improve quality of life.7,25,26,31 Five studies measured self-reported quality of life as an outcome using the Short Form Health Survey (SF-36), European Quality of Life 5 Dimensions (EQ-5D), 17 and World Health Organization Quality of Life Group-Old (WHOQoL-OLD). 7 Quality of life was measured in 3 studies using health-related quality of life, and the results showed an increase in the total score of quality of life for the intervention groups.7,25,31 Only 1 study reported no significant improvement in health-related quality of life (P = 0.74) in Appendix Table A2, available online. 17

Mobility

Five studies tested the effect of home-based activity on mobility using different outcomes: (1) functional mobility using the Timed Up and Go (TUG) test, (2) gait (walking) speed, (3) muscle strength through handgrip strength, and (4) strength endurance (curl-up test).7,22,25,30,41 All studies reported positive and significant improvements in physical functioning, muscle strength, strength endurance, changes in usual walking speed, and an average decrease in TUG. There is very low certain evidence these results indicate an improvement in functional mobility in community-dwelling older adults (Appendix Table A2, available online).7,22,25,30,41

Adverse Events

The majority of studies reported no injuries or adverse events associated with the performance of the exercise intervention. However, 2 studies reported events as a “critical experience” (ie, tripping) during strength exercises in a lunge position or durations rotations 1 ; feeling dizziness, slight pain, and slight knee and/or back pain during specific movements. 27

Risk of Bias Within Studies

Of the 11 included studies, 6 were rated overall as “unclear” due to missing information; 4 were rated overall as “high risk” bias, and 2 as “low risk” bias. The risk of bias assessment is shown in Figure 2. Four studies did not report details about the randomization process. Due to the characteristics of the interventions, none of the studies described possible blinding of the participants and professionals. The majority of studies did not describe the blinding of outcome assessors, intention-to-treat analysis, or details of the registration protocol.

Figure 2.

Figure 2.

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Risk of bias.

Discussion

This review summarizes peer-reviewed evidence for the effect of home-based indoor-only exercise (both intervention and control groups) on mental health, quality of life, and mobility in community-dwelling older adults. This synthesis of randomized clinical trials identified very low- certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggested that home-based exercises improved fear of falling.

These findings extend previous meta-analyses in which home-based exercise improved walking speed14,29,45 and reduced of the fear of falling in older adults. 42 Although home-based exercise may improve physical function, several factors, including the intensity of activity, social interaction, and level of supervision, may play an important role in psychosocial outcomes. 47 Furthermore, other studies highlight that activity supervised by health providers may play an important role in outcomes for home-based exercise programs.24,44 In contrast, a combination of home-based psychological intervention with exercise, or psychological intervention alone, may improve well-being. 43

Extensive studies have shown that home-based exercise programs appear to be effective in improving strength and balance components, reducing falls and sedentary behaviors.12,20 This systematic review identified these results; however, the limited number of studies, and the heterogeneity in characteristics of interventions, restricted carrying out a meta-analysis.

We observed improved mobility outcomes and, specifically, a clinically important improvement in walking speed with a home-based exercise program. 46 Furthermore, there was a clinical improvement in overall mobility, as measured by the TUG (-1.48 seconds), which favors home-based exercise (clinically important change, 1.4−3.4 seconds). 49 Our work corroborates another study in which home-based exercise programs were applied, 38 which also observed an increase in walking speed and a significant decrease in TUG time compared with a control condition. Therefore, high-quality clinical trials are required to determine the effect of home-based exercise programs on function and psychosocial outcomes. Furthermore, our review suggested very-low certain evidence about this outcome, there were limitations, and inconsistent risk of bias in most of the included studies.

The studies in this review reported that differences were observed between the groups in terms of mental health or quality of life. Moreover, Junior et al 21 reported that adult participants who participated in home-based exercise during the COVID-19 pandemic had a better quality of life and reduced anxiety, depression, and stress levels compared with a control group. In another study of older adults, home-based prescribed exercise (defined as a minimum of two-thirds of a combined exercise program completed at home) was reported to show significant improvements in mental health compared with the control group who received no intervention and/or usual care. 15 Furthermore, the home-based exercise, nutrition, and combination (nutrition plus home-based exercise) groups had similar effects on mental health. 20 Therefore, although there is evidence on the beneficial effects of home exercise programs on quality of life, plausible reasons for our observations may be related to different exercise prescriptions and delivery within included studies. For example, the lack of follow-up for home-based exercise may be related to negative outcomes, 40 since social support was associated with positive mental health and well-being in older adults.37,47

There are several significant limitations to this systematic review of studies examining home-based exercises (alone). Although we only included randomized clinical trials, there is heterogeneity between characteristics of interventions. A small number of included studies, unclear and high risk of bias limit our ability to draw definitive conclusions. A meta-analysis could not be performed due to heterogeneous interventions. However, despite these limitations, we followed standard protocols to perform the synthesis, and the data were from RCTs only.

Conclusion

There is very low-certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggested that home-based exercises improved fear of falling. However, the lower quality of evidence precludes drawing firm conclusions on the benefits of home-based exercise only for the health of older adults. Thus, it is important to conduct further studies with heterogeneity and standardized exercise prescription to specifically test the effect of home-based exercise on psychosocial outcomes.

Supplemental Material

sj-docx-1-sph-10.1177_19417381231175665 – Supplemental material for Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review
sj-docx-1-sph-10.1177_19417381231175665.docx (27.6KB, docx)

Supplemental material, sj-docx-1-sph-10.1177_19417381231175665 for Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review by Isis Kelly dos Santos, Ricardo Ney Cobucci, Jason Azevedo de Medeiros, Gilmara Gomes de Assis, Rafaela Catherine da Silva Cunha de Medeiros, Maria Irany Knackfuss, Breno Guilherme de Araújo Tinoco Cabral, Ronaldo Vagner Thomatieli dos Santos and Paulo Moreira Silva Dantas in Sports Health

Footnotes

The authors report no potential conflicts of interest in the development and publication of this article.

Contributor Information

Isis Kelly dos Santos, Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.

Ricardo Ney Cobucci, Graduate Program of Biotechnology and Medical School, Universidade Potiguar (UnP), Natal, Rio Grande do Norte, Brazil.

Jason Azevedo de Medeiros, Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.

Gilmara Gomes de Assis, Department of Molecular Biology, Gdansk University of Physical Education and Sports, Gdansk, Poland, and Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Science, Poland.

Rafaela Catherine da Silva Cunha de Medeiros, Department of Physical Activity, State University of Rio Grande do Norte, Natal, Brazil.

Maria Irany Knackfuss, Department of Physical Activity, State University of Rio Grande do Norte, Natal, Brazil.

Breno Guilherme de Araújo Tinoco Cabral, Graduate Program in Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil.

Ronaldo Vagner Thomatieli dos Santos, Department of Biosciences, Federal University of São Paulo, Santos, São Paulo, Brazil.

Paulo Moreira Silva Dantas, Graduate Program in Health Sciences and Graduate Program in Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil.

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Supplementary Materials

sj-docx-1-sph-10.1177_19417381231175665 – Supplemental material for Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review
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Supplemental material, sj-docx-1-sph-10.1177_19417381231175665 for Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review by Isis Kelly dos Santos, Ricardo Ney Cobucci, Jason Azevedo de Medeiros, Gilmara Gomes de Assis, Rafaela Catherine da Silva Cunha de Medeiros, Maria Irany Knackfuss, Breno Guilherme de Araújo Tinoco Cabral, Ronaldo Vagner Thomatieli dos Santos and Paulo Moreira Silva Dantas in Sports Health

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