Abstract
Background
Exercise interventions are essential for maintaining functional independence in older adults, with systematic reviews guiding evidence-based practice. However, implementing these interventions requires detailed information about exercise parameters, progression strategies, and contextual adaptations that extend beyond basic intervention descriptions. The adequacy of systematic reviews in providing this practice-essential information remains unevaluated. We examined systematic reviews’ attention to exercise training principles, FITT-VP components, and implementation context in interventions for functional performance in community-dwelling older adults.
Methods
Six databases were searched for systematic reviews of exercise interventions published 2014–2024. Two reviewers independently screened studies and extracted data on FITT-VP components (Frequency, Intensity, Time, Type, Volume, Progression), fundamental exercise principles (specificity, overload, individualisation, reversibility, variation), and implementation context (setting adaptability, equipment, supervision, safety, adherence). Quality was assessed using the JBI critical appraisal tool.
Results
Twenty-five systematic reviews met inclusion criteria. While reporting of frequency (23/25, 92%) and type (19/25, 76%) were well-reported, critical parameters showed deficiencies in terms of complete reporting: intensity (6/25, 24%), time (11/25, 44%), volume (9/25, 36%), and progression (0/25 0%). Exercise principles received minimal attention in terms of specificity (2/25, 8% complete), individualisation (1/25, 4%), and overload (1/25, 4%). Diminishing returns were not discussed. Implementation context showed poorest reporting with equipment requirements (11/25, 44% complete), supervision protocols (2/25, 8%), and safety considerations (0/25, 0% complete). No review (25/25) considered the alignment of component-based interventions with integrated functional assessments. Temporal analysis revealed no improvement between pre-2020 reviews (n = 6, mean 4.2 complete items, 23%) and post-2020 reviews (n = 19, mean 3.4 complete items, 19%). Methodological quality (JBI scores) inversely correlated with reporting completeness (ρ = − 0.379, p = 0.062). Sensitivity analysis excluding four partially eligible reviews confirmed all findings were robust (largest change 5.9%).
Conclusions
Systematic reviews of exercise interventions for older adults demonstrate incomplete reporting of information necessary for implementation. Substantial gaps exist in progression protocols, training principles, and implementation context. Limited discussion of relationships between intervention approaches and functional assessments may contribute to challenges in translating research to practice. Enhanced reporting standards would benefit the field.
System review registration
PROSPERO registration number CRD42024592070.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13643-025-03049-x.
Keywords: Older adults, Exercise prescription, Reporting quality, Training principles, Umbrella review
Background
Exercise is widely recognised as a cornerstone intervention for maintaining functional independence in older adults [1]. Functional performance encompasses the physical capabilities required for independent living, including activities of daily living (ADL), instrumental activities of daily living (IADL), mobility, and balance. The global population aged ≥ 60 will reach 2.1 billion (22%) by 2050 [2]. This demographic transition presents unprecedented challenges, as approximately 16.5% of adults over 50 experience ADL limitations, with the prevalence increasing markedly from 3.4% among those aged 65–74 to 20.7% among adults aged 85 years and older [3, 4].
The economic burden of functional decline is substantial, with older adults with functional limitations experiencing healthcare expenditures that are nearly three times higher than those without functional limitations [5]. In the USA, individuals aged 65 years and older account for approximately 37% of personal healthcare spending, despite representing only 17% of the population [6]. This pattern extends beyond the USA to Europe, where older individuals with frailty significantly increase their primary and hospital care utilisation, even before the onset of disability, and the prevalence of frailty is expected to increase across most European countries [7]. However, accumulating evidence has established exercise as one of the most effective non-pharmacological interventions for addressing this challenge, particularly when combined with nutritional and cognitive support in multi-component programmes [1].
Recent evidence suggests that a weekly dose of 170 min/week of structured exercise significantly improves physical function in older adults [8]. Multicomponent programmes incorporating resistance, balance, and aerobic elements show robust effects, reducing fall risk by 23% and producing strength gains of 24–33% across major muscle groups [9, 10]. These findings have led to international consensus guidelines recommending structured exercise as the primary intervention for maintaining functional independence [11].
Although these guidelines establish exercise as essential for older adults, the effectiveness of exercise interventions depends on adherence to fundamental training principles: specificity, progressive overload, individualisation, reversibility, and variation, applied through the FITT-VP framework (Frequency, Intensity, Time, Type, Volume, Progression) [12]. Translating these guidelines into practice requires precise reporting. However, the evaluation of exercise reporting across the broader exercise science literature has revealed concerning patterns. Recent analyses have indicated that the completeness of reporting in sports and exercise medicine remains suboptimal, with frequent omissions of the intervention details [13, 14]. This issue extends across studies in clinical populations, where exercise is increasingly prescribed as a medicine, yet lacks the expected dosing precision. Reviews of exercise interventions across inflammatory myopathies, stroke rehabilitation, and oncology have demonstrated inadequate reporting of essential components, with adherence to FITT parameters rarely exceeding 10% [15–17]. These patterns persist in older adult populations, where a recent analysis of 75 RCTs found that while exercise type was well-reported, critical dosing parameters such as intensity and progression were documented in fewer than one-third of the studies [18].
The Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) were developed to address reporting deficiencies [19, 20]. However, these tools have some limitations. The CERT focuses on intervention descriptions but does not explicitly address fundamental exercise training principles such as specificity, reversibility, or individualisation. The TIDieR provides a general framework applicable across healthcare interventions, but lacks the details required for complex exercise prescriptions. Neither tool adequately captures the implementation context factors essential for translation, such as equipment alternatives, setting adaptability, or safety modifications for special populations [21].
Hansford et al. [13] demonstrated the persistence of these limitations in their overview of 28 systematic reviews. They found a median reporting completeness of only 24% using CERT and 49% using TIDieR across 1467 studies. Their conclusion that “If exercise is medicine, then how it is prescribed and delivered is unclear” highlights how generic reporting templates may inadequately capture the complexity of diverse exercise interventions. Ongoing challenges have prompted calls for the expansion and adaptation of CERT to specific populations and interventions. For instance, Slade et al. [22] developed CERT-PFMT, a pelvic floor muscle training variation of CERT, acknowledging that the original template inadequately captured the unique prescription components, progression protocols, and contextual factors specific to this type of intervention. This trend toward specialised reporting templates reflects both the persistent reporting deficiencies identified and the inherent challenge of creating universal tools for diverse fields of exercise prescription.
Numerous systematic reviews have examined exercise interventions for older adults yet differ in how they define and report exercise parameters. This reflects broader issues in exercise reporting where terminology lacks standardisation; “multicomponent exercise” may encompass vastly different combinations of resistance, aerobic, balance, and flexibility training with disparate doses, progressions, and implementation contexts [23, 24]. This issue becomes more complex when considering older adults, who present distinct challenges, including varied health status, functional capacity, and environmental constraints that influence the delivery of interventions [25], resulting in direct implications for practice.
Systematic reviews serve as the primary source of evidence for evidence-based practitioners across disciplines, from physiotherapists and exercise physiologists to community fitness professionals working with older adults. When systematic reviews fail to extract and report not only FITT-VP components but also fundamental training principles and implementation contexts, they perpetuate knowledge translation failures that compromise evidence-based practice [26, 27]. To date, no umbrella review has examined whether systematic reviews fulfil their responsibility to synthesise these essential elements in interventions for functional performance in older adults.
The alignment between prescribed exercises and functional outcome measures is a critical yet under-examined aspect of exercise intervention reporting. The principle of training specificity suggests that performance improvements are task specific [28], yet the relationship between exercise components and functional assessments is rarely made explicit in systematic reviews. This disconnect has implications for how the field conceptualises exercise prescription and may explain the limited transfer of training gains to real-world functions. Component-based training (isolated strength, balance, or aerobic exercises) dominates intervention design, while assessment relies on integrated functional tests, such as the Timed Up-and-Go (TUG) or Berg Balance Scale (BBS). These tests require complex coordination of multiple systems, strength, balance, cognition, and sensory integration; however, interventions typically train these components in isolation. The assumption that improving individual components automatically enhances integrated function contradicts the fundamental principles of motor learning and skill acquisition [28, 29]. Understanding how reviews conceptualise this relationship is essential for advancing both the intervention design and reporting standards.
This review had three objectives. First, we evaluated the reporting quality of fundamental exercise training principles and FITT-VP components in systematic reviews of exercise interventions for improving functional performance in community-dwelling older adults. Second, we assessed implementation context reporting including setting adaptability, equipment requirements, supervision needs, safety considerations, and adherence strategies. Third, we examined how reviews conceptualised the relationship between exercise interventions and functional outcome measures, documenting whether reviews explicitly discussed the alignment or misalignment between training components and assessment methods. Collectively, these objectives identify reporting deficiencies and patterns that can guide the development of improved standards, thereby bridging the gap between research and professional practice in exercise prescription for older populations.
Methods
Protocol registration
The protocol for this umbrella review was registered a priori with PROSPERO [registration number CRD42024592070] and was conducted following the Joanna Briggs Institute (JBI) methodology for umbrella reviews [30], adapted for journal formatting requirements. This umbrella review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [31] and the PRISMA 2020 Abstracts Checklist (Supplementary Tables 1A and 1B). An executive summary following the JBI guidelines is available as a supplementary material.
Eligibility criteria
Types of studies
Systematic reviews and meta-analyses of randomised controlled trials (RCTs) published in English between 2014 and 2024 were included. The focus on systematic reviews of RCTs ensured that the highest level of evidence was examined, providing insight into how methodologically rigorous exercise intervention research is synthesised and reported.
Participants
Reviews focused on community-dwelling adults aged ≥ 60 years were included. Reviews targeting specific clinical populations (e.g. frailty, diabetes, and post-stroke) were excluded to maintain population homogeneity when examining reporting practices. This allowed for a clearer evaluation of reporting quality in a relatively standardised population, avoiding the confounding effect of condition-specific exercise modifications. The focus on community-dwelling older adults aligns with this review’s practice orientation as these individuals represent a significant proportion of those receiving exercise interventions in community and primary care settings.
Interventions
Reviews examining structured exercise interventions, including resistance/strength training, aerobic/cardiovascular exercise, balance/stability training, multicomponent interventions combining multiple exercise modalities, and task-specific or functional training approaches, were included. Additionally, reviews of alternative exercise modalities such as Tai Chi, yoga, and other mind–body practices; technology-based interventions including virtual reality and exergaming platforms (e.g. Nintendo Wii Fit); aquatic/water-based exercise programmes; and dance-based interventions were also included. Exercise interventions required a clear description of the prescription parameters. Reviews examining general physical activities or unstructured movements were excluded (e.g. gardening, household activities, and recreational walking without prescribed parameters). This approach ensured that this review captured the full spectrum of exercise modalities that are commonly prescribed for older adults.
Comparators
Reviews incorporating any comparator were eligible, including no intervention control, usual care/standard treatment, alternative exercise modalities, different doses/intensities of the same exercise type, and waitlist control groups.
Outcomes
The outcomes included measures of functional performance and activities of daily living (ADL) performance using standardised assessments and physical function test scores (for example, Short Physical Performance Battery, Timed Up-and-Go), mobility measures, including gait speed and walking tests, and task-specific performance measures. Isolated measures of fitness components such as strength and power were omitted.
Search strategy
The search strategy adhered to the PRISMA-S extension for reporting literature searches in systematic reviews [32] and Peer Review of Electronic Search Strategies (PRESS) guidelines [33] (Supplementary Tables 2A-C.).
Search development
The search strategy was developed following the PRISMA-S guidelines, which incorporate both controlled vocabulary and free-text terms. Initial search strings were developed in PubMed using Medical Subject Headings (MeSH) and title/abstract terms. The primary search string combined population terms ("Aged"[Mesh] OR "Aging"[Mesh] OR "Aged, 80 and over"[Mesh] OR elder*[tiab] OR "older adult*"[tiab]) with intervention terms ("Exercise"[Mesh] OR "Exercise Therapy"[Mesh] OR "Physical Fitness"[Mesh]) and outcome measures ("Activities of Daily Living"[Mesh] OR "Physical Functional Performance"[Mesh]). These were combined with filters for systematic reviews and meta-analyses.
The search strategy facilitated the identification of reviews across a spectrum of exercise approaches and was developed in consultation with an experienced research librarian. It involved several iterations of testing and refinement to optimise sensitivity and specificity.
Database adaptation
The PubMed search strategy was translated to other databases with appropriate syntax modifications. For instance, in CINAHL, MeSH terms were replaced with appropriate CINAHL subject headings, and the search syntax was adjusted accordingly. Similar adaptations were made for other databases, while maintaining consistency across the core search concepts.
Search implementation
Searches were conducted across six major databases: PubMed, Cochrane Library, Web of Science, CINAHL, SPORTDiscus, and JBI Evidence Synthesis, on 22 November 2024 with an updated search on 20 May 2025. Supplementary searching included manual reference list checking of the included reviews and citation tracking using Connected Papers software (https://www.connectedpapers.com). Additionally, targeted searches of grey literature sources were conducted to identify relevant non-commercially published systematic reviews.
Study selection
Two reviewers (RM & LM) independently screened all records at the title/abstract and full-text stages using Covidence software [34]. An initial review team meeting was conducted to establish familiarity with the eligibility criteria and to ensure consistent application.
Disagreements at any stage of the screening process were addressed through discussion between the two reviewers with reference to the predetermined eligibility criteria. In cases in which consensus could not be reached through discussion, a third reviewer (CMD) was consulted to make the final decision. Inter-rater reliability was calculated using Cohen’s Kappa (κ) coefficient to quantify the level of agreement between reviewers. The selection process was documented using a PRISMA flow diagram (Fig. 1).
Fig. 1.
PRISMA flow diagram
Quality assessment
Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses [30]. It was selected for its specific design and validation for umbrella reviews, making it an appropriate instrument for our study design [35]. The 11-item instrument evaluates key methodological domains including search comprehensiveness, quality assessment methods, and synthesis approaches. The checklist was piloted in five studies (20%) before formal appraisal to ensure consistent application. Each review was independently assessed by two reviewers (RM & LM). No quality threshold was applied for inclusion because our purpose was to evaluate reporting practices across the full spectrum of published systematic reviews.
Data extraction
We used the JBI standardised data extraction tool for systematic reviews, which was modified to capture the exercise-specific elements (Supplementary Table 3 A). The tool was pilot tested on five randomly selected reviews (20%) before full implementation. Two reviewers (RM & LM) independently worked throughout the extraction process, and discrepancies were resolved through consensus.
Data synthesis
We used a descriptive analysis to evaluate reporting completeness. The results showed the frequencies and percentages of reviews reporting each exercise component and principle. We tabulated the results to show reporting patterns across three assessment domains: FITT-VP components, exercise training principles, and implementation context factors. Overall results were visualised using a stacked bar chart.
Narrative synthesis explored patterns in reporting completeness, examining how different exercise modalities were documented, and identifying common gaps in reporting exercise prescriptions. The synthesis also examined the alignment between interventions and outcome measures, assessing whether reviews considered the ecological validity of exercise programmes for improving functional performance in daily life. We intended to assess temporal patterns by comparing reporting completeness between earlier (2014–2019) and more recent (2020–2024) publications.
Assessment of exercise component reporting
We developed an Exercise Reporting Assessment tool to evaluate reporting completeness across the included reviews (development methodology in Supplementary File 1). The tool was constructed through systematic synthesis of established exercise prescription guidelines [12, 20, 36, 37] and encompasses three domains:
FITT-VP components: Frequency, Intensity, Time, Type, Volume, and Progression with modality-specific criteria
Exercise training principles: Specificity, progressive overload, individualisation, initial values, reversibility, diminishing returns, and variation
Implementation context: Setting adaptability, equipment requirements, supervision needs, safety considerations, and adherence strategies
Tool development
The tool was developed through a four-phase process: (1) targeted literature review identifying essential exercise prescription components from ACSM guidelines, CERT, and TIDieR frameworks; (2) collaborative team development with expertise in systematic review methodology and exercise science; (3) pilot testing on five randomly selected reviews (20% of sample); and (4) refinement of operational definitions based on pilot testing findings. Key refinements included clarifying progression scoring criteria (distinguishing acknowledgment from specific protocols), establishing modality-specific criteria for FITT-VP components, and defining assessment boundaries between review-level and primary study-level reporting.
Operational definitions
FITT-VP components were assessed through modality-specific criteria recognising different reporting norms across exercise types (resistance training, aerobic training, balance training, multicomponent/other). Training principles were evaluated by whether reviews provided theoretical discussion connecting intervention design to exercise science principles. Implementation context documented practical factors affecting real-world translation. Complete operational definitions are provided in Supplementary Table 3B, with scoring examples in Supplementary File 1.
Assessment rationale
FITT-VP components capture actual exercise parameters from primary studies (what was done), exercise training principles evaluate theoretical discussion (why it was done), and implementation context documents practical application details (how and where it can be delivered). This three-domain approach recognises that systematic reviews serve dual functions: extracting and synthesising intervention data for evidence synthesis and translating this evidence for implementation by contextualising it within established theory.
Reporting evaluation and reliability assessment
Each review was evaluated for completeness of reporting across all tool items. Elements were rated as complete (+) when sufficient detail was provided to support replication or informed decision-making, partial (±) when general information was provided without specific parameters, or absent (−) when no information was provided (Supplementary Tables 3 C – 3E).
Key scoring decisions
Review-level assessment
Reporting completeness was assessed at the systematic review level. Reviews received credit for attempting to extract components even when primary studies provided incomplete information, as our focus was evaluating systematic review conduct rather than primary study quality. This approach means findings reflect review methodology and reporting practices, not necessarily the quality of primary interventions.
This is appropriate for umbrella reviews because we evaluate how systematic reviews conduct their work, not how well primary studies were designed. A systematic review demonstrates good practice by attempting to extract exercise parameters even when primary studies report them incompletely. For example, if a review explicitly states “primary studies did not report progression protocols” and tabulates this gap, the review receives credit for assessing progression (partial rating) despite the absence of data. This contrasts with a review that ignores progression entirely (absent rating).
Partial scoring
The distinction between partial and absent was defined as: partial indicates the review acknowledged or mentioned a component without sufficient detail for replication; absent indicates the component was not addressed. For example, stating “progression occurred” without specifying criteria or timeline was coded as partial; no mention of progression was coded as absent.
Modality-specific assessment
For reviews including heterogeneous exercise types, each modality was assessed separately. Reviews could receive different scores for different exercise modalities based on reporting completeness for each type.
Inter-rater reliability
Two reviewers (RM & LM) independently assessed all reviews after pilot testing five randomly selected reviews (20% of sample) to establish consistency and refine decision rules. Overall inter-rater agreement (Cohen’s κ) was 0.752 (95% CI 0.69–0.81), with mean domain-specific reliability κ = 0.68 (of FITT-VP components), κ = 0.63 (training principles), and κ = 0.78 (implementation context).
Initial disagreements involved (1) distinguishing partial from absent ratings for training principles when brief mentions occurred, (2) determining whether progression detail warranted complete versus partial ratings, and (3) assessing modality-specific reporting adequacy in multicomponent interventions. Disagreements were resolved through discussion with a third team member (CMD). Item-level reliability statistics are provided in Supplementary Tables 6A-C.
Deviations from protocol
No major deviation from the registered protocol was observed. Minor adaptations included expanding the exercise modality categories to accommodate the diversity of identified interventions (e.g. technology-based interventions, mind–body practices) and refining the reporting assessment criteria based on pilot testing. Specifically, progression scoring criteria were clarified to distinguish between acknowledgment of progression (partial) versus provision of specific progression protocols (complete), and specificity assessment criteria were refined to require explicit rationale connecting exercise selection to functional outcomes for complete rating. These refinements improved inter-rater reliability and scoring consistency without changing the fundamental structure or domains of the assessment tool.
Results
Study selection process
The initial database searches yielded 2844 records, with two records found in the citation search. After removing 973 duplicates, 1870 records were subjected to title and abstract screening. Following a full-text assessment of 268 potentially eligible studies, 25 systematic reviews met the inclusion criteria. The selection process achieved an inter-rater reliability with Cohen’s kappa (κ) coefficient of 0.69. The primary reasons for exclusion were incorrect population characteristics (190 reviews), incorrect study designs (18 reviews), and incorrect outcomes (17 reviews) (Supplementary Table 4). The study selection process was illustrated using a PRISMA flow diagram, as shown in Fig. 1.
Although four reviews did not strictly satisfy all the eligibility criteria, they were included because they contained valuable information. This decision prioritised the synthesis of available evidence, while acknowledging this as a limitation. However, because this umbrella review focuses on reporting aspects, the inclusion of these reviews does not detract from the findings.
For example, Buitrago-Restrepo et al. [36] included one of ten studies with an age range of 55–70 years. Similarly, Byrne et al. [37] included one study with an age range of 20–90 years in their examination of the relationships between muscle power, muscle strength, and physical functional performance (an aspect not relevant to the present umbrella review). In de Campos et al. [38], six of their 39 studies were conducted in residential care settings, while Rogan et al. [39] included four studies from residential care settings among their 33 included studies. Characteristics of these four reviews are detailed in Supplementary Table 3F.
Characteristics of included reviews
The reviews were published between 2014 and 2024. Most reviews (18/25) employed meta-analysis, with the remainder providing narrative or systematic synthesis. The sample sizes varied considerably, ranging from 39 [40] to 2792 participants [41].
All reviews (25/25) targeted community-dwelling older adults with age thresholds typically set at 60 or 65 years. The mean age across the study population ranged from approximately 60 to 78 years. Most studies explicitly excluded participants with significant comorbidities or those residing in institutional settings, focusing on relatively healthy older adults living independently in the community.
The included reviews examined a wide range of exercise interventions. Seven reviews focused on resistance or strength training, including variations in volume [42], intensity [43], velocity [37, 44], and settings [45–47]. Combined or multicomponent exercise approaches were examined in five reviews [48–52]
Technology-based interventions were the focus of three reviews including exergames [53, 54], and broader ICT-based approaches [55]. Traditional Eastern movement disciplines featured in three reviews, examining Tai Chi [56] and various mind–body interventions including yoga, Qi Gong, and Pilates [38, 41]. Dance-based interventions were examined in two reviews [57, 58].
The relevant outcome measures for our review focused on the physical function and mobility domains. Balance was the most frequently evaluated outcome, assessed in 16 reviews using instruments, including the Berg Balance Scale, Functional Reach Test, Single Leg Stance, Centre of Pressure, and other static/dynamic balance assessments [36, 38, 39, 41, 44, 46, 49, 51–59].
Functional mobility and physical performance were examined in 22 reviews using measures, including the Timed Up-and-Go (TUG) test, Short Physical Performance Battery (SPPB), gait speed assessments, 6-Minute Walk Test (6MWT), and chair stand tests [36–38, 40–42, 44–48, 51–57, 60].
The comparison conditions varied across reviews, with most studies including both active comparators (alternative exercise) and inactive controls (usual care or no intervention). Eight reviews directly compared the different exercise modalities and parameters [36, 37, 42–44, 46], while the remainder compared exercise interventions to control conditions.
The methodological approach to synthesis reflects the heterogeneity of interventions and outcomes. Eighteen reviews employed meta-analyses, two of which specifically incorporated the GRADE assessment for certainty of evidence [36, 38]. Among the meta-analyses, random-effects models predominated, with several reviews employing subgroup analyses based on intervention characteristics, population factors, and methodological quality.
Seven reviews used alternative synthesis approaches when meta-analysis was not feasible or appropriate. These include narrative syntheses [37, 53], systematic review with descriptive analysis [45, 59], systematic assessment [57], critical review of content [40], and synthesis without meta-analysis (SWiM) methodology [60]. The choice of synthesis method typically reflects the degree of intervention heterogeneity, with narrative approaches employed where exercise protocols, outcomes, or study designs were too diverse for statistical pooling. Table 1 provides an overview of study characteristics.
Table 1.
Characteristics of included studies
| Author | Reference | Number of studies/participants | Population | Intervention approach | Intervention types | Relevant outcome | Main findings | JBI Quality Score (/11) | Analysis method |
|---|---|---|---|---|---|---|---|---|---|
| (Afridi et al. 2021) | [53] | 14 RCTs/n = 678 | Healthy community-dwelling older adults (> 60 years) | Integrated (I) | Wii Fit balance training | TUG, BBS, FRT, STS | Wii Fit is effective for balance training in healthy older adults without cognitive or neurological diseases | 8/11 | Narrative synthesis |
| (Alowaydhah et al. 2024) | [50] | 57 RCTs (30 with healthy participants)/n = 2370 healthy participants | Older adults ≥ 65 years, both healthy and frail | Mixed (M) | Physical exercise interventions (strength, endurance, flexibility, speed and agility) | SPPB, TUG, gait speed | Multicomponent exercise is most suitable for both healthy and frail older adults | 9/11 | Meta-analysis |
| (Bai et al. 2021) | [48] | 18 RCTs/n = 1256 | Healthy community-dwelling elderly (> 60 years) | Mixed (M) | Combined aerobic exercise (with resistance/strength, multi-component, or dance training) | TUG, functional reach, 30-s S-T-S, 6MWT | Combined training showed positive effects on physical performance compared to aerobic training alone | 9/11 | Meta-analysis |
| (Balachandran et al. 2022) | [44] | 20 RCTs/n = 566 | Healthy, community-living older adults (age ≥ 60 years, mean 70.1 years) | Component-based (CB) | Power training vs traditional strength training | 8 ft Get Up & Go, chair stands, SPPB, 6-min walk, balance | Power training showed modest improvements vs traditional strength training (SMD = 0.30; 95% CI, 0.05–0.54) | 9/11 | Meta-analysis |
| (Brandão Loureiro et al. 2020) | [59] | 17 RCTs/not explicitly reported | Healthy and independent participants aged 65 + years | Component-based (CB) | Exercise interventions for improving balance | Static balance tests, 30-s S-T-S, TUG, FRT | Statistically significant effects reported for static and dynamic balance improvements | 8/11 | Descriptive analysis |
| (Buitrago-Restrepo et al. 2024) | [36] | 10 RCTs, 603 participants | Older adults (aged 60 + years) | Integrated (I) | Aquatic exercise compared to control groups (no intervention) or land-based exercises | Chair stand, TUG, 8-ft Up-and-go, gait speed |
Aquatic exercise likely improved lower limb muscle power vs. control (mean difference 4.75 repetitions; 95% CI [0.07, 9.42]; I2 = 99%; very low-quality evidence) No superiority found when comparing aquatic exercise with land exercise on dynamic balance (mean difference − 0.12 s; 95% CI [− 0.37, 0.12]; I2 = 3%; very low-quality evidence) Uncertainty about optimal type and dosage of aquatic exercise on physical performance |
11/11 | Systematic review and meta-analysis with GRADE assessment of evidence |
| (Buyle et al. 2022) | [54] | 18 RCTs (16 in meta-analysis)/n = 909 | Healthy community-dwelling participants aged 65 + years (mean age 77.62 years) | Integrated (I) | Exergame interventions vs control (conventional exercises or no intervention) | TUG, BBS, FRT, gait speed, 30-s S-T-S, 6MWT | Small to medium positive effects for balance measures; small effects for cognitive outcomes | 7/11 | Meta-analysis |
| (Byrne et al. 2016) | [37] | 44 RCTs examining relationships between muscle power and physical function (n = not specified); 31 studies examining power training interventions (n = ~ 1250) | Community dwelling older adults (≥ 65 years) | Component-based (CB) | Power training (PT) interventions, categorised as (1) PT vs traditional resistance training (TRT), (2) different PT loads, and (3) various other PT interventions | TUG, SPPB, 6MWT, stair climb time, 2MWT 400 m walk test |
PT (concentric phase performed “as fast as possible”) shows superiority over TRT for improving muscle power and functional performance Low-load PT is as effective as higher load PT for improving functional performance |
5/11 | Narrative synthesis |
| (Clifford et al. 2023) | [58] | 22 RCTs (19 in meta-analysis)/n = 619 | Community dwelling older adults aged 60–90 years (mean age 76 years) | Integrated (I) | Dance programmes vs control or alternative exercise | BBS, TUG, FRT, single-leg stance, Fullerton Advanced Balance Scale, walking speed | Dance superior for mobility (SMD: − 0.90, 95% CI − 1.45 to − 0.34) and equivalent for balance and gait | 10/11 | Meta-analysis |
| (de Campos et al. 2024) | [38] | 39 RCTs, 1770 participants | Healthy older adults (aged 60 + years) | Integrated (I) | Pilates exercises performed on a mat or apparatus compared to control groups or other forms of exercise | Static balance, dynamic balance, general balance |
Pilates was significantly superior to control groups for dynamic postural balance (SMD = 1.60 to 0.72), static postural balance (SMD = 0.37 to 0.25), and general state of balance (SMD = 0.76) No significant difference for reducing number of falls or fear of falls Pilates was comparable to other forms of exercise for these outcomes |
11/11 | Systematic review and meta-analysis (GRADE used to assess certainty of evidence) |
| (da Silva et al. 2024) | [40] | 2 RCTs/n = 39 | Older adults (aged 60–90 years) | Component-based (CB) | Aerobic exercise with blood flow restriction vs control or exercise without restriction | 6MWT, 30-s sit-to-stand, TUG | Aerobic exercise with blood flow restriction improved functional capacity after 6 weeks | 9/11 | Critical review of content |
| (Ebner et al. 2021) | [41] | 30 RCTs/n = 2792 | Healthy community-dwelling older adults (> 65 years; mean age: 71.2 years) | Integrated (I) | Movement-based MBIs (Yoga, Qi Gong, Tai Chi, Pilates) vs active and inactive control | 6MWT, CoP sway, Y balance test, chair stand test, 8-ft up-and-go, TUG, BBS, single leg standing, 50-ft walk | MBIs induce small to moderate effects in relevant domains of physical fitness | 11/11 | Meta-analysis |
| (Fernández-Argüelles et al. 2015) | [57] | 7 RCTs/n = 354 | Healthy community-dwelling older adults over 60 years | Integrated (I) | Dance interventions vs control or physical activity | Balance, gait quality, trunk and lower limbs flexibility | Positive effects on risk of falls related factors but cannot confirm significant benefits based on evidence | 9/11 | Systematic assessment |
| (Flores-Bello et al. 2024) | [51] | 12 RCTs/n = 339 | Community-dwelling older adults with and without frailty | Mixed (M) | Exercise programmes (balance, strength, multicomponent training) vs control | SPPB, gait speed, balance tests | Exercise programmes effective in increasing and maintaining physical performance in older adults | 10/11 | Meta-analysis |
| (Kim et al. 2022) | [55] | 37 RCTs (23 in meta-analysis)/n = 2419 | Community-dwelling older adults (≥ 65 years) | Integrated (I) | ICT-based interventions (exergames, telecommunications, web-based, applications, robots) | SPPB, BBS, FRT, 30-s S-T-S, COP, 6-min walk, 5 S-T-S | Interventions using exergames, e-health, information applications, and robots enhanced senior physical mobility | 11/11 | Meta-analysis |
| (Lacroix et al. 2017) | [46] | 11 RCTs/n = 621 | Community-dwelling older adults (mean age 73.6 years) | Component-based (CB) | Supervised vs unsupervised balance and/or resistance training | Single leg stance, gait speed, TUG, COP after perturbation, BBS, 30-s-Chair-Stand, 5-Times-Chair-Rise | Supervised training superior to unsupervised for balance and strength outcomes (SMD ranging 0.24–0.53) | 10/11 | Meta-analysis |
| (Li et al. 2024) | [56] | 22 RCTs/n = 2170 | Adults aged 60 + years, who have not participated in Tai Chi within past year | Integrated (I) | Tai Chi intervention or Tai Chi combined with other activities vs conventional exercises | BBS, OLS-C, TUG, SPPB, Chair Stand Test | Positive effects on balance and physical function outcomes | 11/11 | Meta-analysis |
| (Moreira et al. 2019) | [47] | 28 RCTs/n = 921 | Community-dwelling older adults (≥ 65 years) | Component-based (CB) | Short-term strength training (up to 12 weeks) | TUG, 30-s chair-stand test | Moderate to large effects on muscle strength but not for functional capacity or body composition | 10/11 | Meta-analysis |
| (Pearson et al. 2022) | [43] | 12 RCTs/n = 371 | Community-dwelling older adults (≥ 60 years) | Component-based (CB) | Maximal-intent vs traditional resistance training | SPPB, TUG, 30-s sit-to-stand, 6MWT, 400 m walk test | No significant improvements in combined functional capacity or strength outcomes | 9/11 | Meta-analysis |
| (Rocha et al. 2024) | [42] | 31 RCTs/n = 1744 | Community-dwelling older adults (mean age 67.9–68.2 years) | Component-based (CB) | High volume vs low volume resistance training | 30-s chair stand, 6-min walk, sit and reach, walking speed, TUG | High-volume RT superior to low-volume RT for muscle strength but not body composition | 11/11 | Meta-analysis |
| (Rogan et al. 2017) | [39] | 33 RCTs (11 in meta-analysis)/n = ~ 2400 (some studies double counted) | Healthy older adults (> 65 years) | Component-based (CB) | Whole-body vibration (WBV), including vertical sinusoidal WBV (VS-WBV), side-alternating sinusoidal WBV (SS-WBV), and stochastic resonance WBV (SR-WBV) | Static balance, dynamic balance, functional balance |
WBV can be used to improve static balance in Go-Go elderly (SMD = 0.34, 95% CI 0.18, 0.49) - WBV has potential to positively influence dynamic balance in Slow-Go (SMD = − 0.15, 95% CI − 0.44, 0.15) and No-Go elderly (SMD = − 0.90, 95% CI − 1.63, − 0.17) - Observed effects range from small to large, with varying levels of heterogeneity |
11/11 | Systematic review and meta-analysis |
| (Santos et al. 2024) | [60] | 11 RCTs/n = 1004 | Community-dwelling older adults (> 60 years) | Mixed (M) | Home-based indoor physical activity programmes | SPPB, 30 s S-T-S, 4-m walk | Home-based exercise programmes can improve psychosocial outcomes and mobility | 11/11 | Synthesis without meta-analysis (SWiM) |
| (Shin and Wuensche 2023) | [49] | 18 RCTs/n = 1108 | Community-dwelling older adults (> 60 years) | Mixed (M) | Fall prevention exercises | Sit-to-stand, balance, TUG, gait speed | Combined programme including balance, coordination and resistance exercises most appropriate | 11/11 | Meta-analysis |
| (Thiebaud et al. 2014) | [45] | 8 RCTs/not explicitly reported | Community-dwelling older adults (≥ 65 years; mean age 76 years) | Component-based (CB) | Home-based resistance training | TUG, tandem walk, walk tests, stair climb, chair stand time | Home-based resistance training can improve strength and functional ability but improvements generally small | 5/11 | Descriptive analysis |
| (Wu et al. 2024) | [52] | 37 RCTs/n = 1213 | Community-dwelling older adults (≥ 60 years; mean age 60.2–76.4 years) | Mixed (M) | Combined aerobic and resistance training | TUG, 6MWT, 10 m walk, Maximum gait speed, One-leg balance | Combined training effective for improving multiple health outcomes | 11/11 | Meta-analysis |
KEY: Intervention Approach: CB Component-based (isolated training of specific fitness components), I Integrated (holistic movement approaches), M Mixed (multicomponent interventions combining different exercise types)
Functional Performance Measures: 2MWT 2-Minute Walk Test; 6MWT 6-Minute Walk Test, 30 s S-T-S 30-Second Sit-to-Stand, BBS Berg Balance Scale, COP Centre of Pressure, FRT Functional Reach Test, OLS-C One Leg Stand with Eyes Closed, SPPB Short Physical Performance Battery, TUG Timed Up-and-Go
Other Abbreviations: RCT Randomised Controlled Trial, SMD Standardised Mean Difference, CI Confidence Interval, GRADE Grading of Recommendations Assessment, Development and Evaluation
Exercise component reporting
Analysis of FITT-VP component reporting revealed a hierarchy of completeness across the included systematic reviews (Table 2).
Table 2.
Exercise component reporting
| Reference | FITT-VP components | Fundamental exercise principles | Implementation context | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Frequency | Intensity | Time | Type | Volume | Progression | SP | OV | IND | IV | DIM | REV | VAR | SET | EQ | SUP | SAF | ADH | ||
| (Afridi et al. 2021) | [53] | + | ± | ± | + | ± | ± | ± | - | - | - | - | - | ± | ± | ± | ± | ± | - |
| (Alowaydhah et al. 2024) | [50] | + | - | + | ± | + | ± | - | - | - | - | - | - | - | ± | + | ± | - | ± |
| (Bai et al. 2021) | [48] | + | ± | + | + | - | ± | - | - | - | - | - | - | - | - | ± | ± | - | - |
| (Balachandran et al. 2022) | [44] | + | + | - | + | + | ± | ± | - | - | ± | - | - | - | - | + | - | ± | ± |
| (Brandão Loureiro et al. 2020) | [59] | + | - | - | ± | - | - | + | - | ± | - | - | - | - | - | - | ± | - | ± |
| (Buitrago-Restrepo et al. 2024) | [36] | + | + | + | + | + | ± | - | - | ± | ± | - | ± | - | - | ± | ± | ± | ± |
| (Buyle et al. 2022) | [54] | + | - | + | + | + | ± | ± | ± | + | ± | - | ± | ± | + | + | ± | ± | + |
| (Byrne et al. 2016) | [37] | + | + | ± | + | ± | ± | - | + | ± | ± | - | ± | - | ± | + | ± | ± | ± |
| (Clifford et al. 2023) | [58] | + | ± | + | + | ± | ± | - | - | ± | - | - | - | ± | - | - | - | ± | ± |
| (de Campos et al. 2024) | [38] | + | - | + | ± | ± | - | ± | - | - | - | - | - | - | ± | ± | - | - | - |
| (da Silva et al. 2024) | [40] | + | + | + | + | + | ± | ± | ± | ± | - | - | - | - | - | ± | - | - | - |
| (Ebner et al. 2021) | [41] | ± | ± | + | + | ± | ± | - | ± | ± | - | - | - | ± | - | + | - | - | - |
| (Fernández-Argüelles et al. 2015) | [57] | + | - | + | ± | + | - | ± | - | - | - | - | - | - | - | - | - | - | ± |
| (Flores-Bello et al. 2024) | [51] | + | ± | ± | + | ± | ± | ± | - | ± | ± | - | ± | ± | ± | + | ± | ± | ± |
| (Kim et al. 2022) | [55] | + | ± | ± | + | ± | ± | - | - | ± | - | - | - | ± | ± | + | ± | ± | ± |
| (Lacroix et al. 2017) | [46] | + | ± | ± | + | ± | ± | - | - | - | - | - | - | - | ± | - | + | - | ± |
| (Li et al. 2024) | [56] | + | ± | + | + | - | - | - | - | ± | ± | - | - | ± | ± | + | - | - | ± |
| (Moreira et al. 2019) | [47] | + | + | - | + | ± | - | - | ± | - | ± | - | ± | ± | - | - | - | - | - |
| (Pearson et al. 2022) | [43] | + | + | - | + | ± | ± | ± | ± | - | - | - | - | ± | - | + | - | ± | ± |
| (Rocha et al. 2024) | [42] | + | ± | ± | + | + | ± | + | - | - | ± | - | - | ± | - | + | - | ± | ± |
| (Rogan et al. 2017) | [39] | + | ± | + | + | + | - | ± | ± | - | - | - | - | - | ± | ± | - | ± | ± |
| (Santos et al. 2024) | [60] | ± | ± | ± | + | ± | - | - | - | - | - | - | - | - | ± | - | ± | - | - |
| (Shin and Wuensche 2023) | [49] | + | ± | ± | ± | ± | ± | - | - | ± | - | - | - | - | ± | ± | - | - | ± |
| (Thiebaud et al. 2014) | [45] | + | ± | - | + | + | - | - | ± | ± | - | - | - | - | + | + | + | ± | + |
| (Wu et al. 2024) | [52] | + | ± | ± | - | - | - | ± | - | - | - | - | - | - | ± | - | - | - | - |
KEY: + complete, ± partial, - absent, SP Specificity, OV Overload, IND Individualisation, IV Initial Values, REV Reversibility, DIM Diminishing Returns, VAR Variation, SET Setting, EQ Equipment, SUP Supervision, SAF Safety, ADH Adherence
Frequency demonstrated the highest rate of complete reporting (23/25, 92%) [36–40, 42–59] with the remaining two reviews (2/25, 8%) providing partial information [41, 60].
Type was completely reported in 19 reviews (19/25, 76%) [36, 37, 39–48, 51, 53–56, 58, 60], partially reported in five reviews (5/25, 20%) [38, 49, 50, 57, 59], and absent in one review [52].
Time parameters were completely reported in 11 reviews (11/25, 44%) [36, 38–41, 48, 50, 54, 56–58], partially reported in 9 reviews (9/25, 36%) [37, 42, 46, 49, 51–53, 55, 60], and absent in five reviews (20%) [43–45, 47, 59].
Volume was completely documented in nine reviews (9/25, 36%) [36, 39, 40, 42, 44, 45, 50, 54, 57], partially reported in 12 reviews (12/25, 52%) [37, 38, 41, 43, 46, 47, 49, 51, 53, 55, 58, 60], and absent in four reviews (4/25, 12%) [48, 52, 56, 59].
Intensity showed the poorest complete reporting among the basic parameters, with six reviews (6/25, 24%) providing comprehensive intensity specifications [36, 37, 40, 43, 44, 47]. Fourteen reviews (14/25, 56%) included partial intensity information [39, 41, 42, 45, 46, 48, 49, 51–53, 55, 56, 58, 60], whereas five reviews (5/20, 20%) omitted intensity parameters entirely [38, 50, 54, 57, 59].
However, none of the reviews (0/25) achieved a complete reporting standard for progression. Reviews rated as “absent” for progression made no mention of load advancement or progression protocols (e.g. Thiebaud et al. [47] described home-based resistance training interventions reporting frequency, intensity, and volume parameters but provided no information on how resistance loads were modified over time). Reviews rated as “partial” acknowledged progression but lacked specificity. For instance, Buitrago-Restrepo et al. [38] extracted data showing repetition maximum (RM) strength with progression from 60 to 80% from primary studies without specifying progression criteria, timing, or decision rules for load advancement. Similarly, Clifford et al. [60] noted that dance interventions “offered different levels of difficulty and the possibility to increase level progressively” without defining progression triggers or advancement protocols. Complete progression reporting would require explicit protocols specifying criteria for advancement (e.g. successful completion of 2 sets of 12 repetitions with proper form), timing of progressions (e.g. reassessment every 2 weeks), and magnitude of increases (e.g. 5–10% load increments or advancement to next difficulty level). Sixteen reviews (16/25, 64%) provided partial progression information, typically mentioning progression without specific protocols [36, 37, 40–44, 46, 48–51, 53–55, 58], while nine reviews (9/25, 36%) failed to address progression[38, 39, 45, 47, 52, 56, 57, 59, 60].
Fundamental exercise principles reporting
Fundamental exercise training principles received minimal attention across the included reviews, with substantial variations in reporting completeness (Table 2).
Regarding specificity, two reviews (2/25, 8%) provided a comprehensive discussion that explicitly connected exercise selection with functional outcomes [42, 59], whereas 10 reviews (10/25, 40%) provided partial treatment [38–40, 43, 44, 51, 53, 54, 57, 58].
Similarly, individualisation was completely addressed in one review [54], with 11 reviews (11/25, 44%) providing partial consideration [36, 37, 41, 45, 49, 51, 52, 55, 56, 58, 59].
Progressive overload was addressed in eight reviews (8/25, 32%). Of these, one review (1/25) provided complete coverage [37], while seven (7/25) provided partial discussion [39–41, 43, 45, 47, 54].
Initial values partially appeared in eight reviews [36, 37, 42, 44, 47, 51, 54, 56].
Variation appeared in ten reviews (10/25, 40%), all of which provided partial treatment [41–43, 47, 51, 53–56, 58].
Reversibility received the least attention among the documented principles, appearing partially in five reviews (5/25, 20%) [36, 37, 47, 51, 54], with no complete discussion.
Most notably, diminishing returns were absent across all the 25 reviews. This complete omission represents a knowledge gap for practitioners managing long-term exercise programmes where adaptation plateaus are inevitable.
Implementation Context
Implementation context factors demonstrated the poorest reporting completeness across all the assessment domains (Table 2).
Equipment requirements showed the highest complete reporting among the implementation factors, with 11 reviews (11/25, 44%) providing comprehensive specifications [37, 41–45, 50, 51, 54–56]. Seven reviews (7/25, 28%) included partial equipment information [36, 38–40, 48, 49, 53], whereas seven reviews (7/25, 28%) entirely omitted equipment details [46, 47, 52, 57–60].
However, critical safety elements are poorly documented. Twelve reviews (12/25, 48%) included partial safety information, which was typically limited to general precautions [36, 37, 39, 42–45, 51, 53–55, 58], with the remaining 13 reviews (13/25, 52%) providing no safety considerations.
Supervision requirements were minimally addressed, with two reviews (2/25, 8%) providing complete details [45, 46]. Ten reviews (10/25, 40%) mentioned supervision without any specific details [36, 37, 48, 50, 51, 53–55, 59, 60], whereas the remaining 13 reviews (13/25, 52%) omitted supervision information.
Setting adaptability showed similar deficiencies, with two reviews (2/25, 8%) providing complete information for implementing interventions across different environments [45, 54]. Twelve reviews (12/25, 48%) partially addressed setting considerations, typically noting that exercises can be performed in various locations without specific details [36, 38, 39, 41, 46, 49–51, 53, 55, 56, 60], whereas the 11 remaining reviews (11/25, 44%) failed to address setting adaptability.
Adherence strategies were mentioned most frequently, but rarely comprehensively. Two reviews (2/25, 8%) reported complete adherence protocols to address barriers and facilitators [45, 54]. Fifteen reviews (15/25, 60%) mentioned the importance of adherence without specific strategies [36, 37, 39, 42–44, 46, 49–51, 55–59], whereas the remaining eight reviews (8/25, 32%) omitted adherence considerations entirely. Figure 2 shows the overall results of the assessment.
Fig. 2.
Completeness of exercise intervention reporting across 25 systematic reviews
Intervention-outcome alignment
All 25 reviews reported standardised functional outcome measures (e.g. TUG, BBS, SPPB), which represent valid and established methodology for evaluating overall functional capacity. Among the 25 reviews, 60% (n = 15) synthesised component-based exercise interventions (isolated strength, balance, or endurance training), while 40% (n = 10) examined integrated movement approaches (dance, Tai Chi, mind–body practices, and exergames). Despite this diversity in intervention approaches, all reviews employed similar compound functional tests without discussing the alignment between intervention characteristics and assessment methods.
Our analysis revealed that none of the 25 reviews (0/25) explicitly addressed whether their chosen outcome measures adequately captured the specific adaptations promoted by the interventions under examination. This manifested differently across intervention types. The 15 reviews examining component-based interventions did not discuss how training isolated capacities (e.g. strength, balance) would transfer to the integrated movements required by compound functional tests. Similarly, the 10 reviews examining integrated interventions (e.g. Tai Chi, dance, mind–body practices) did not address whether standardised functional tests adequately capture the holistic benefits of these practices, such as rhythm, spatial awareness, mindfulness, or breathing coordination. Technology-based interventions using exergames, which often simulate real-world movements, were evaluated through traditional clinical tests without discussion of ecological validity. Even multicomponent interventions were typically described as parallel training of separate fitness components rather than integrated functional task practice, with no explicit discussion of which components might be most relevant to observed functional outcomes.
This gap in reporting transparency warrants attention because functional performance in older adults is inherently complex and multifactorial. Functional tasks such as chair rising or stair climbing require coordination of strength, power, balance, proprioception, timing, and movement strategy [61, 62]. The principle of training specificity suggests that improvements in isolated components do not automatically transfer to complex integrated tasks unless training bears sufficient similarity to the target function. For example, improvements in leg press strength may not translate proportionally to chair-rise performance if the limiting factor is coordination, balance confidence, or movement strategy rather than raw force production. Conversely, ceiling effects may limit the functional relevance of component improvements when participants can already successfully complete a functional task, such that further increases in isolated strength or power may not manifest as measurable functional improvement. These considerations are particularly salient given the heterogeneity of functional limitations within older adult populations, where individuals may be limited by different physiological or biomechanical factors.
We emphasise that our observation is not a criticism of standardised assessments, which provide essential consistency for evidence synthesis. Rather, we identify a gap in reporting transparency that may obscure our understanding of intervention effectiveness. Explicit discussion of why specific functional assessments were considered appropriate given the training principles and physiological adaptations under investigation would enhance understanding of both intervention effectiveness and potential mechanisms of action. While inadequate reporting represents a limitation in transparency, we cannot conclude that it reflects underlying intervention quality or explains the modest effect sizes frequently observed in this literature.
Temporal trends
Publication dates were unevenly distributed: 6 reviews (24%) published in 2014–2019 and 19 reviews (76%) published in 2020–2024. This distribution limits formal trend analysis but permits exploratory comparison. Despite increased visibility of exercise reporting frameworks (CERT, TIDieR) since 2017–2019, we observed no improvement in reporting completeness between periods; indeed, complete reporting declined slightly (Supplementary Table 3G).
Pre-2020 reviews (n = 6) showed mean complete reporting of 4.2 items out of 18 (23%), compared to 3.4 items (19%) for post-2020 reviews (n = 19). Training principles received minimal attention (mean 0.2 items pre-2020 vs 0.2 items post-2020 out of 7), and implementation context remained poorly documented (mean 1.0 items pre-2020 vs 0.6 items post-2020 out of 5). FITT-VP component reporting declined from 3.0 to 2.6 complete items out of 6. The absence of improvement despite growing awareness of reporting standards suggests that existing frameworks may require broader adoption, enhanced journal enforcement, or supplementary guidance specific to exercise intervention reporting.
Methodological quality assessment
The JBI Critical Appraisal Tool evaluated reviews across 11 methodological domains (Supplementary Table 5). Quality scores ranged from 5 to 11 (median, 10). Ten reviews (10/25, 40%) achieved the highest methodological quality score [36, 38, 39, 41, 42, 49, 52, 55, 56, 60]. Four reviews (4/25, 16%) scored 10/11 [46, 47, 51, 58] and nine reviews (9/25, 36%) demonstrated moderate quality with scores between 7 and 9. Two reviews (2/25, 8%) received lower scores of 5/11 [37, 45].
All reviews (25/25) clearly specified their questions (Q1) and inclusion criteria (Q2). Similarly, all reviews (25/25) provided appropriate directives for future research (Q11), and 23 reviews (92%) provided well-supported recommendations based on their findings (Q10) and searched for appropriate sources (Q4).
However, several methodological weaknesses were also identified. There were 23 reviews (76%) deemed to have completely adequate search strategies (Q3), with six reviews (6/25, 24%) showing unclear or incomplete reporting of the search terms, limitations, or database coverage. Critical appraisal methodology was adequately reported in 19 reviews (19/25, 76%) (Q5), with six reviews (6/25, 24%) lacking clear quality assessment procedures. Independent reviews by multiple reviewers were clearly documented in 17 reviews (17/25, 68%) (Q6), with eight reviews (8/25, 32%) having unclear or absent documentation of this process.
Data extraction methods were clearly adequate in 16 reviews (64%) (Q7), while 20 reviews (80%) used appropriate methods for combining studies (Q8). Publication bias assessment (Q9) was conducted in 12 of the 19 applicable reviews (63%), noting that six reviews (24%) employed narrative synthesis approaches, where formal publication bias assessment was not methodologically feasible.
Reviews that achieved perfect methodological scores demonstrated comprehensive search strategies, rigorous quality assessment, and formal evaluation of publication bias. Conversely, for the two reviews that showed the lowest methodological quality [37, 45] (Score 5/11), this was due to limitations in search sources, critical appraisal procedures, and unclear study combination methods.
To examine whether methodological quality predicted exercise reporting completeness, we compared mean complete reporting across JBI quality score groups (Supplementary Table 3H). Spearman’s rank correlation revealed a moderate negative association between JBI quality scores and reporting completeness (ρ = − 0.379, p = 0.062). When analysed by quality categories (Low/Moderate/High), this relationship reached statistical significance (ρ = − 0.432, p = 0.031). Reviews with high methodological quality (JBI 10–11/11, n = 14) reported a mean of 16.3% complete items, compared to 22.2% for moderate quality (JBI 7–9/11, n = 9) and 33.3% for low quality (JBI 5–6/11, n = 2).
The limited representation of low-quality reviews (n = 2) suggests this finding should be interpreted with caution.
Sensitivity analysis
To assess the robustness of findings, we conducted sensitivity analysis excluding the four partially eligible reviews (Buitrago-Restrepo et al., 2024; Byrne et al., 2016; de Campos et al., 2024; Rogan et al., 2017). With the reduced sample (n = 21 versus n = 25), reporting patterns remained substantively unchanged (Supplementary Table 3i). For complete reporting, frequency reporting remained high at 90.5% (vs 92% in full sample), progression reporting remained absent at 0% in both analyses, and implementation context reporting remained consistently poor with equipment at 47.6% (vs 44%) and safety at 0% (vs 0%). The largest difference observed was Time, which changed by 5.9%, from 44.0 to 38.1%. All main conclusions regarding poor progression reporting, inadequate attention to training principles, and minimal implementation context documentation remained valid regardless of inclusion criteria strictness. This sensitivity analysis confirms that the inclusion of four partially eligible reviews did not materially influence study conclusions.
Discussion
Principal findings
This umbrella review provides the first evaluation of exercise intervention reporting in systematic reviews targeting functional performance in older adults. We identified systematic deficiencies that prevented scientific replication and practical implementation. The limited reporting of progression parameters, intensity specifications, and implementation context factors create barriers for practitioners attempting to translate research evidence into practice.
The present findings reflect systematic review methodology rather than primary study quality. Our umbrella review evaluates how well systematic reviews extract, synthesise, and report exercise prescription information, not how well primary studies designed interventions. Poor review-level reporting may reflect either inadequate primary study reporting or insufficient attention to these components during systematic review conduct. Both scenarios indicate gaps that compromise evidence translation.
These findings align with what 297 international experts identified in a 2024 Delphi consensus, who identified exercise intensity reporting as problematic, and “missing in most older adult studies and mostly not controlled” [63].
The inadequate documentation of fundamental exercise principles compounds these issues, with specificity and individualisation addressed to any degree in 12 reviews (48%).
While principles such as reversibility and diminishing returns may not be directly examined within the typical 8–12-week timeframes of primary RCTs, systematic reviews serve a unique synthesis function that extends beyond individual study designs. Reviews may consider the long-term implications of exercise interventions, including the need for continued engagement to prevent detraining (reversibility) and the reality of adaptation plateaus (diminishing returns). These discussions are particularly important for translating research into sustainable community-based programmes for older adults, where long-term adherence and maintenance remain critical challenges. The absence of these discussions in our sample suggests a gap between acute efficacy research and practical implementation considerations.
Our findings that implementation context factors, including setting adaptability, supervision requirements, and safety considerations, receive minimal attention across all reviews highlight a barrier to how exercise interventions are documented for real-world applications.
Comparison with previous literature
Our findings extend previous analyses of exercise-reporting deficiencies by identifying population-specific gaps in interventions for older adults [13]. The reporting issues we observed reflect broader issues, where standardised assessment tools reveal systematic inadequacies [14]. We find the limited attention that reviews give to individualisation and baseline functional status concerning given the heterogeneous nature of older adults, where functional capacity can vary substantially [64]. This necessitates detailed reporting that documents not only exercise parameters, but also how interventions are adapted to individual capabilities and progress based on responses.
Multiple barriers potentially contribute to these reported deficiencies. Journal word limits often restrict detailed intervention descriptions, forcing authors to prioritise outcomes over implementation details. Researchers may lack awareness of reporting standards or view detailed exercise prescriptions as secondary to demonstrating their effectiveness.
The complexity of exercise interventions, requiring the description of multiple components, their interactions, and adaptation strategies, exceeds what can be captured in the traditional methods sections. Additionally, the absence of mandatory reporting requirements means that adherence to guidelines such as CERT and TIDieR remains voluntary and inconsistent.
Minimal documentation of the implementation context represents a critical finding that was previously unexamined in systematic evaluations. Current frameworks, such as CERT and TIDieR, while addressing intervention components, inadequately capture the environmental and organisational factors essential for translation to practice (Dijkers, 2021). Our finding that two of the reviews provided sufficient supervision information highlights this gap. This is relevant, given the evidence that most community settings lack access to qualified exercise professionals [65, 66], creating a disconnect between research protocols and practice. Finally, systematic reviews in other health disciplines, such as infectious disease surveillance [67, 68] demonstrate that rigorous adherence to reporting frameworks is achievable, highlighting that the deficiencies we identified in exercise reviews are not inherent limitations of the systematic review method.
Reductionism in exercise prescription and reporting
Our findings revealed that current reporting practices reflect a reductionist approach that creates multiple disconnects between intervention design, assessment methods, and functional outcomes. This pattern manifests differently across intervention types but represents a pervasive limitation in the literature.
Among the 25 reviews, approximately 60% examined component-based interventions, focusing on isolated resistance, aerobic, or balance training. The remaining 40% investigated integrated movement approaches including dance, Tai Chi, mind–body practices, and exergames. Despite this diversity, all reviews (25/25) relied on standardised functional assessments (TUG, BBS, and SPPB), without discussing whether these tests adequately capture intervention-specific adaptations.
This universal reliance on standardised assessments reveals the fundamental assumption that diverse movement interventions can be evaluated using identical functional tests. Component-based interventions assume that improving isolated capacities will be transferred to integrated functional tasks, violating the specificity principles well-established in motor learning [28]. Current reviews fail to identify which specific attributes limit functional performance. Bean et al. [69] illustrated this critical distinction by comparing two chair-rise training approaches with the InVest study. Both groups practiced the movement, but those training the performance-limiting attributes of velocity and power through high-speed repetitions improved by 44%, compared to 29% for those using traditional slow-velocity training. This demonstrates that effective exercise prescription requires the identification and targeting of specific neuromuscular qualities that limit each functional task.
In integrated interventions, the disconnect operates through different mechanisms. While dance and Tai Chi develop the traditional fitness components of strength, muscular endurance, cardiovascular fitness, and flexibility, they simultaneously cultivate unique attributes critical for daily function. Dance develops rhythm, spatial awareness, and social engagement, while Tai Chi emphasises flowing movements, breathing coordination, and mindfulness. These integrated qualities may be particularly valuable for older adults, where successful daily navigation requires not only physical capacity but also cognitive-motor integration, spatial orientation, and confidence in movement [29].
However, standardised assessments, such as the TUG test, reduce these multidimensional interventions to isolated performance metrics. For example, Li et al. [56] reported positive effects of Tai Chi on balance and physical function using traditional measures, but could not assess whether improvements in mindfulness, breathing patterns, or movement flow contributed to reduced fall risk. Similarly, Clifford et al. [58] found dance superior for mobility using the TUG test, but their standardised assessments could not evaluate whether enhanced rhythm, spatial awareness, or social confidence explained these improvements.
This limitation is problematic for technology-based interventions. Exergames, which are designed to simulate real-world movements and provide immediate feedback, are evaluated through traditional clinical tests that cannot capture their contributions to movement confidence, cognitive engagement, or enjoyment. These factors may drive long-term adherence and functional independence in older populations [55].
The limitations of standardised assessments compounded these conceptual issues. The SPPB correlates poorly with accelerometer-measured daily activities (r < 0.3), showing limited ecological validity [70]. These tests demonstrate ceiling effects in community-dwelling adults [71]. Despite such evidence, none of the 25 reviews (0/25) questioned whether their chosen assessments validly measured the intended outcomes of their specific interventions.
This reductionist lens extends beyond intervention-assessment misalignment to how exercise principles are reported. While specificity appeared in 12 reviews (12/25, 48%), just two comprehensively discussed matching training to desired outcomes. Progressive overload appeared partially in eight reviews (8/25, 32%), typically lacking the decision criteria essential for implementation. The complete absence of diminishing returns across all reviews (25/25) proves problematic for practitioners managing long-term programmes where adaptation plateaus are inevitable.
Even well-reported components reveal reductionist limitations. Frequency appeared in 23 reviews (23/25, 92%), yet only Flores-Bello et al. [51] specified recovery patterns. This exemplifies how current reporting captures quantitative parameters while omitting qualitative aspects that determine success. For integrated interventions like Tai Chi or dance, reporting “3 sessions per week” provides less meaningful information than understanding movement quality, mindfulness components, or social engagement factors.
The failure to acknowledge these disconnects reveals the conceptual limitations that extend beyond reporting deficiencies. Reviews prescribe generic “strength training” without considering whether strength, power, balance, or coordination limit performance for their chosen outcomes. This conceptual gap between training stimuli and performance-limiting factors may explain why current interventions show modest transfers to functional assessment. Advancing the field requires not only better documentation but also a fundamental reconsideration of how exercise interventions for older adults are conceptualised, assessed, and reported.
We emphasise that our findings reflect reporting deficiencies in systematic reviews and cannot determine whether underlying interventions in primary studies were poorly designed or simply poorly described. The reporting gaps we identified indicate what practitioners cannot learn from the published literature, not necessarily flaws in the interventions themselves. Poor reporting may obscure effective interventions just as easily as it may conceal ineffective ones.
Implications for practice and policy
Current reporting deficiencies have created an evidence-practice gap, with consequences across healthcare delivery. Without essential implementation details, exercise practitioners must rely on clinical experience rather than on evidence-based protocols. This poses risks to older populations, where frailty and comorbidities reduce the margin of error [72]. The absence of guidance for managing adaptation plateaus forces practitioners to extrapolate protocols designed for younger populations, compromising both safety and effectiveness.
Professional educators also face similar challenges. Exercise science curricula rely on systematic reviews to teach evidence-based practice, yet they cannot adequately prepare students when reviews omit progression parameters, safety modifications, and adaptation strategies. Professionals must then develop protocols through trial and error, raising both efficacy and liability concerns in an increasingly challenging environment.
Healthcare organisations invest in exercise programmes for older adults with the expectation that evidence-based, standardised protocols will guide implementation. While population-level guidelines from the WHO and ACSM establish the importance of exercise for older adults, these broad recommendations cannot substitute for the specific implementation details required to safely and effectively deliver interventions to older populations with varying functional capacities. Systematic reviews of exercise interventions for older adults could bridge this gap by extracting and synthesising not only FITT-VP parameters but also progression strategies, safety modifications, and adaptation protocols essential for this heterogeneous population. Yet as our findings demonstrate, current reviews consistently fail to provide these critical details. This leaves practitioners without the evidence-based guidance necessary to translate research into practice.
Recommendations for enhanced reporting
Based on our findings, we propose several modifications to enhance exercise intervention reporting in systematic reviews. These recommendations address the three domains where deficiencies were most pronounced and provide guidance for future systematic review conduct.
For FITT-VP component reporting, progression protocols would benefit from enhancement. Reviews could document not only whether progression occurred, but specify the criteria used (e.g. percentage increases, repetition or set progressions), the timeframe for advancement (e.g. weekly, bi-weekly), and the method of assessment (e.g. perceived exertion, performance benchmarks). For example, rather than stating “intensity was progressively increased”, reviews could report “resistance was increased by 5–10% when participants could complete 3 sets of 12 repetitions with proper form”. Similarly, intensity specification needs greater precision. For resistance training, reviews could differentiate between relative intensity measures (%1RM, RPE) and absolute loads, noting how intensity was determined and adjusted across the intervention period. For aerobic training, reviews could specify both target heart rate zones and actual achieved intensities where reported, enabling readers to understand the dose delivered rather than merely the dose prescribed.
Reporting of fundamental training principles would also benefit from enhanced documentation. Reviews could explicitly discuss the rationale linking exercise selection to target outcomes, providing specificity justification through dedicated discussion of how intervention components (e.g. balance exercises) theoretically address outcome measures (e.g. fall risk, TUG performance). Additionally, individualisation documentation could specify what criteria were used to individualise programmes (e.g. baseline function, comorbidities, goal setting) and report the degree of individualisation employed (e.g. “fully individualised” vs “age-stratified protocols”). Such transparency would allow practitioners to understand the extent to which reported interventions can be adapted to individual client needs.
Implementation context factors demonstrated the poorest reporting completeness in our sample, yet these elements are crucial for translating research into practice. Reviews could document minimum safety standards, particularly for balance and high-intensity training in older adults, including supervision ratios, fall prevention strategies, emergency protocols, and contraindication screening procedures. Given that we found zero reviews reported comprehensive safety protocols despite the inherent fall risk in balance training for older adults, this represents a critical gap requiring attention. Furthermore, adherence strategy synthesis could move beyond noting dropout rates. Reviews could extract and synthesise the specific strategies used to promote adherence (e.g. motivational interviewing, social support, feedback mechanisms) and their reported effectiveness, enabling practitioners to implement evidence-based approaches to maintaining long-term engagement.
These recommendations could be integrated into existing frameworks (CERT, TIDieR) as supplementary guidance specific to systematic reviews of exercise interventions for older adults or developed into a companion checklist for systematic reviewers that extends beyond primary study reporting. Such integration would acknowledge that systematic reviews serve a unique synthesis function, requiring different reporting standards than primary studies. The level of detail we propose will assist systematic reviews to fulfil their role in translating primary research into actionable guidance for practitioners working with community-dwelling older adults. Future work could formally develop and validate such a checklist through expert consensus methods and pilot testing.
Our findings demonstrate that current reporting frameworks, while valuable for primary study documentation, may be insufficient for systematic reviews of exercise interventions where dose–response relationships, progression schemes, and individual adaptation are critical to both efficacy and safety. The reporting deficiencies we identified are not insurmountable; rather, they reflect the absence of field-specific guidance for systematic review authors. By providing actionable recommendations grounded in our findings, we aim to support future systematic reviews in delivering transparent, comprehensive intervention reporting that practitioners, policymakers, and researchers would welcome to advance evidence-based exercise prescription for older adults.
Future research directions
Our findings highlight critical gaps in how systematic reviews report and interpret the relationship between exercise interventions and functional outcomes in older adults. Future research should address these gaps across several domains.
Systematic reviews should explicitly discuss the conceptual relationship between intervention characteristics and chosen outcome measures. For component-based interventions, reviews should articulate the theoretical basis for expecting transfer from isolated training (e.g. leg press strength) to integrated functional performance (e.g. chair rising), acknowledging potential limitations such as ceiling effects and task-specificity constraints. For integrated interventions such as Tai Chi or dance, reviews should consider whether standardised functional tests adequately capture the full scope of adaptations these practices promote, including proprioceptive awareness, movement coordination, and cognitive-motor integration. Where multicomponent interventions are employed, reviews should discuss which components likely contribute most substantially to observed functional changes, particularly given the heterogeneity of functional limitations in older adult populations.
The field would benefit substantially from empirical studies examining whether component improvements reliably predict functional task performance in diverse older adult populations. Research should investigate under what conditions isolated strength or balance training transfers to complex functional tasks and identify participant characteristics that moderate this relationship. Such validation studies would provide evidence for the transfer assumptions implicit in current intervention designs. Ecological dynamics frameworks from sports science [73, 74], which document how practitioners manipulate task and environmental constraints to achieve functional goals [75], may offer complementary approaches. However, translating these frameworks from athletic performance contexts to older adult populations requires careful validation and adaptation to capture age-specific considerations such as safety, cognitive load, and heterogeneous functional limitations.
The absence of detail on managing diminishing returns represents another critical gap. Current trials typically span 8–12 weeks, yet older adults may exercise for years or decades. Longitudinal research examining adaptation patterns over extended timeframes is essential for developing strategies that maintain effectiveness as initial gains plateau. Without this evidence, practitioners lack guidance for most of a programme’s duration.
Recent initiatives, including the 2024 Global Consensus [76] and rehabilitation-specific reporting improvements [22, 77, 78] represents progress toward more comprehensive exercise reporting. However, future research should examine not merely what to report but how to present information in formats accessible to diverse stakeholders. Digital platforms, decision-support tools, and visual frameworks may assist exercise practitioners in translating complex exercise prescription principles into practice [79], though their effectiveness requires systematic evaluation.
Strengths and limitations
This umbrella review had several methodological strengths. We examined multiple dimensions of reporting quality, extending beyond previous assessments that focused solely on the intervention parameters. Our evaluation of implementation context factors, including supervision needs, equipment requirements, and adaptability, addressed critical barriers to research translation that were previously unexplored in systematic evaluations. Our methodology employed independent screening and data extraction and achieved good inter-rater reliability. Our multidimensional assessment tool, grounded in established exercise science principles, provided a tentative framework for the development of future reporting tools.
This study has several limitations that warrant consideration. The sample of 25 reviews is reflective of our specific inclusion criteria and may not reflect wider reporting across different ages, contexts, or outcomes. English language restrictions may have excluded relevant work from countries with different reporting traditions. Our focus on community-dwelling populations, while ensuring homogeneity, limits generalisability to institutional care studies. Although theoretically grounded, our assessment tool requires formal psychometric validation across evaluators and contexts.
We evaluated reporting completeness rather than intervention quality, recognising that adequate reporting is a prerequisite for quality assessment. The 10-year timeframe captured contemporary practice but may have excluded influential earlier work. We cannot determine whether poor reporting reflects inadequate intervention design or documentation failures, although both scenarios equally compromise evidence-based practices. Finally, the uneven temporal distribution of studies precluded our planned analysis of whether reporting guidelines influenced matters over time.
Finally, our assessment approach cannot distinguish between systematic reviews that failed to extract information versus those that extracted it but found primary studies lacking. However, this ambiguity does not affect our conclusions, as both scenarios indicate deficiencies in the evidence available to practitioners.
Conclusion
This umbrella review demonstrates that systematic reviews of exercise interventions for older adults consistently fail to report information necessary for implementation or replication. Critical deficiencies were identified across all assessment domains: no review completely reported progression parameters, fundamental exercise principles received minimal attention, and implementation details essential for practice were absent in over 50% of reviews.
A critical gap in reporting transparency emerged: while all 25 reviews employed standardised functional assessments regardless of intervention type, none discussed the conceptual relationship between intervention characteristics and outcome measures. This absence of explicit justification, whether for component-based training expected to transfer to integrated function, or integrated practices assessed through composite tests, obscures our understanding of intervention mechanisms and limits interpretation of this literature. High methodological quality scores (JBI 10–11/11) did not reflect completeness of exercise reporting, indicating that current quality assessment tools inadequately capture intervention reporting detail. This suggests the need for systematic review standards that specifically address intervention complexity.
To bridge the research-practice gap, systematic reviewers could consider extracting implementation details with the same rigor applied to outcome data. Journals might consider requiring more comprehensive reporting of exercise parameters as part of their submission guidelines. Without these changes, the translation of exercise research into effective interventions for older adults remains challenging.
Supplementary Information
Acknowledgements
Not applicable.
Abbreviations
- ACSM
American College of Sports Medicine
- ADL
Activities of Daily Living
- CERT
Consensus on Exercise Reporting Template
- FITT-VP
Frequency, Intensity, Time, Type, Volume, Progression
- IADL
Instrumental Activities of Daily Living
- JBI
Joanna Briggs Institute
- PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RCT
Randomised controlled trial
- SPPB
Short Physical Performance Battery
- TIDieR
Template for Intervention Description and Replication
- TUG
Timed Up and Go
- WHO
World Health Organization
Authors’ contributions
RM was responsible for conceptualisation, study design, database searches, and writing of the original draft. RM, LM, and CMcD completed the data analysis and manuscript preparation. RM, LM and CMcD approved the final manuscript.
Funding
This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
The complete assessment codebook with detailed scoring criteria, operational definitions, and worked examples demonstrating rating application is provided in Supplementary File 1. All review-level assessment data are presented in Table 2 and Supplementary Tables 3G-3I, including complete reporting frequencies, temporal trends, quality-reporting relationships, and sensitivity analyses. Item-level inter-rater reliability statistics for all assessment items are provided in Supplementary Tables 6A-6C.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The complete assessment codebook with detailed scoring criteria, operational definitions, and worked examples demonstrating rating application is provided in Supplementary File 1. All review-level assessment data are presented in Table 2 and Supplementary Tables 3G-3I, including complete reporting frequencies, temporal trends, quality-reporting relationships, and sensitivity analyses. Item-level inter-rater reliability statistics for all assessment items are provided in Supplementary Tables 6A-6C.