Table 1.
Summary of Controlled Exercise Interventions (Mostly Based on Resistance Exercises) in the Oldest Old
| Training | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Reference | Group | n (% women) | Mean age (SD or range in years) | Length (weeks) | Type | Frequency (sessions/week) | Sets | Exercises/session (repetitions per (×) exercise) | Intensity/duration | Effects |
| 356 | Exercise | 46 (72%) | 80 (7) | 24 | Low intensities+ | 3 | Flexibility, balance, coordination, movement speed and strength of all major muscle groups | 5–15 min (0–12 weeks) | ↑ Knee extension strength ↑ Fast walking speed ↑ Total free mass |
|
| Strength | 3 | 1–3 | 6–12× knee extension | 65–100% 1RM (12–24 weeks) |
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| 1–3 | 6–12× knee flexion | 65–100% 1RM (12–24 weeks) |
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| 1–3 | 6–12× seated bench press | 65–100% 1RM (12–24 weeks) |
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| 1–3 | 6–12× seated row | 65–100% 1RM (12–24 weeks) |
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| 1–3 | 6–12× leg press | 65–100% 1RM (12–24 weeks) |
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| 1–3 | 6–12× biceps curl | 65–100% 1RM (12–24 weeks) |
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| Control | 44 (77%) | 81 (8) | 24 | 3 | Flexibility, balance, coordination, movement speed and strength of all major muscle groups | ↑ Knee extension strength ↑ Fast walking speed ↑ Total free mass (Significantly less pronounced than in the exercise group) |
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| 357 | Exercise | 11 (91%) | 88.6 (86–95) | 12 | Strength | 3 | 8 8 |
8x 90° knee flexion 8x 90° knee extension |
50–80% 1RM 50–80% 1RM |
↑ Extensor and flexor muscle strength |
| Control | 12 (92%) | 90.6 (86–95) | 12 | No PA | 2 | Social activities, including group gatherings | ↑ Extensor and flexor muscle strength (Significantly less pronounced than in the exercise group) | |||
| 358 | Exercise | 11 (NA) | 93.4 (3.2) | 12 | Strength+ | 2 | 8–10x upper body (1 exercise: seated bench press) | 40–60% 1RM High velocity |
↑ Quadriceps femoris CSA ↑ Hand grip ↑ Hip flexion strength ↑ Knee extension strength ↑ Upper-body 1RM ↑ Lower-body 1RM ↑ Maximal power at 30% 1RM ↑ Maximal power at 60% 1 RM ↓ Falls incidence |
|
| Balance + Gait + Stretching (cold down) |
8–10x lower body (bilateral leg extension and bilateral knee extension) | 40–60% 1RM High velocity 10 min 5 min |
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| Control | 13 (NA) | 90.1 (1.1) | 12 | Mobility | 4 | Active and passive movements | 30 min | = Quadriceps femoris CSA ↓ Hand grip strength ↓ Hip flexion strength ↓ Knee extension strength |
||
| 359 | Lifestyle integrated functional exercise | 107 (55%) | 82.8 (4.48) | 48 | Functional exercise | Several | Set of exercise | Ankle strength, knee strength and function effects were significantly better than in control group | ||
| Exercise | 105 (54%) | 84.0 (4.38) | 48 | Strength + Balance |
3 | 6× lower limb strength 7 exercise |
“Hard zone” | Ankle strength, knee strength and function effects were significantly better than in control group | ||
| Control | 105 (55%) | 83.5 (3.81) | 48 | Gentle + | 2 sessions, 1 booster session and 6 follow-up phone calls | Ankle strength, knee strength and function effects were significantly lower than in exercise or functional exercise group | ||||
| Flexibility | e.g., hip rotations | |||||||||
| 360 | Exercise | 15 (NA) | 86.7 (6.1) | 10 | Warm-up+ | 3 | 10 min | ↑ Muscle-strength ↑ BMI ↑ Mean lean body mass (no significant) |
||
| (77–98) | Strength+ | 1 | 10–15× muscle group | Elastic therabands and soft weights | ||||||
| Balance+ | Balls, balance disc, and blocks | 10 min | ||||||||
| Cool-down | 5 min | |||||||||
| Control | 15 (NA) | 86.9 (5.7) (77–94) |
10 | No effect ↓ Mean lean body mass (no significant) |
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| 361 | Exercise | 25 (64%) | 86.2 (1.0) | 10 | Strength | 3 | 3 | 8× lhip extensor | 80% 1RM | ↑ Muscle-strength |
| (72–95) | 3 | 8× knee extensor | 80% 1RM | ↑ Thigh-muscle CSA | ||||||
| ↑ Stair-climbing power | ||||||||||
| Exercise+ | 25 (64%) | 87.2 (1.2) | 10 | Strength+ | 3 | 3 | 8× hip extensor | 80% 1RM | Idem exercise group | |
| Nutritional supplement | (76–98) | 240 mL liquid + CHO (60%) + fat (23%) + soy-based protein (17%) | 3 | 8× knee extensor | 80% 1RM | |||||
| Aerobic or flexibility activities | 3 activities (e.g., walking) |
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| Nutritional supplement +Placebo activities |
24 (71%) | 85.7(1.2) (75–97) |
10 | 240 ml liquid + CHO (60%) + fat (23%) + soy-based protein (17%) Aerobic or flexibility activities |
3 | No effect | ||||
| 3 activities (e.g., walking) |
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| Placebo activities +Placebo |
26 (54%) | 89.2 (0.8) (78–98) |
10 | Aerobic or flexibility activities | 3 | 3 activities (e.g., walking) |
No effect | |||
| supplement | Minimally nutritive (4 kcal) | |||||||||
| 362 | Exercise + Traditional balance training |
12 (50%) | 81.1 (6.0) (69–95) |
12 | Strength+ | 2 | Larger over extremity muscles (pulley stations) | 10–15 RM | ↑ Strength knee extension ↑ Sitting to standing test ↑ Static Balance |
|
| Large under extremity muscles (leg press and pulley stations) | 10–15 RM | |||||||||
| Step machine | 100 steps level 2 150 steps level 2 100 steps level 3 150 steps level 3 |
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| Aerobic + Balance |
Static cycle Standing, one-legged balance and walking on different surfaces (open and closed eyes) |
> 15 min and > 3km | ||||||||
| Exercise + Visual computer feedback |
15 (80%) | 81.5 (7.7) (69–95) |
12 | Strength+ | Larger over extremity muscles (pulley stations) | 10–15 RM | ↑ Strength knee extension ↑ 6 minute walk test ↑ Training-specific performance |
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| Large under extremity muscles (leg press and pulley stations) | 10–15 RM | |||||||||
| Step machine | 100 steps level 2 150 steps level 2 100 steps level 3 150 steps level 3 |
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| Aerobic+ | Static cycle | > 15 min and > 3km | ||||||||
| Balance | Visual computer feedback | |||||||||
| 363 | Exercise | 31 (NA) | 82.2 (4.1) (75–90) |
12 | Strength | 3 | 3 | 10x knee extensions | 70–90% of maximal | ↑ Leg extension strength ↑ Knee extension strength ↑ Knee flexion strength ↑ Ankle plantar flexion strength ↑ Handgrip strength ↑ Functional motor performance ↑ Balance Improvements persisted during 3-month follow-up with only moderate losses |
| 3 | 10× hip extension | 70–90% of maximal | ||||||||
| 2 | 10× left lifts | 70–90% of maximal | ||||||||
| 2 | 10× right lifts | 70–90% of maximal | ||||||||
| 2 | 15 lifts of bilateral plantar flexion (2–4 cm support) | |||||||||
| Functional-Balance training + Physiotherapy |
2 | Multifactorial activities e.g., massaging or stretching |
45 min per training session 25 min |
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| Control | 26 (NA) | 82.1 (4.8) (75–90) |
12 | Placebo activities + Physiotherapy |
3 | Motor activities (e.g., flexibility, calisthenics, ball games and memory tasks) | 1 hr | No effect during intervention and follow-up | ||
| 364 | Exercise | 62 (74%) | 82.3 (6.6) | 12 | Strength | 3 | Relevant muscle group | 70–80% 1RM | ↑ Knee extension strength ↑ Knee flexion strength ↑ Ankle flexion strength ↑ Handgrip strength ↑ Functional performance |
|
| Control | 60 (73%) | 82.9 (7.0) | 12 | Placebo activities | 2 | Flexibility exercise, calisthenics, low-intensity training with hand-held weights and ball games | No effect or ↓ | |||
| 365 | Exercise | 15 (80%) | 88.5 (1.0) (85–98) |
12 | Strength | 3 | 1 | Upper and lower extremities | 5–10 min | ↑ 1RM |
| 3 | 8x knee flexion+ | ↑ Isokinetic knee extension | ||||||||
| 8x knee extension | 50% 1RM (0–2 weeks) 80% 1RM (2–12 weeks) |
↑ Isometric knee extension | ||||||||
| Control | 15 (73%) | 90.9 (1.1) (85–98) |
12 | No PA | = 1RM = Isokinetic knee extension = Isometric knee extension |
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| 366 | Exercise in long-term care-high mobility | 22 (NA) | 81.3 (5.3)* | 4 | Warm-up/stretching+ | 5 min | ↑ Mobility ↑ Balance ↑ Flexibility ↑ Knee strength ↑ Hip strength |
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| Aerobic + Strength |
Walking | 10–15 min | ||||||||
| Balance Cool-down/stretching |
1–2 1–2 |
2–10× lower body 2–10× upper body |
Soft-weights and Theraband | |||||||
| 10 min 5 min |
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| Exercise in long-term care-low mobility | 14 (NA) | 81.3 (5.3)* | 4 | Warm-up/stretching + Aerobic+ |
5 min | ↑ Mobility ↑ Balance ↑ Flexibility ↑ Knee strength ↑ Hip strength |
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| Strength | Walking | < 1 min − 15 min | ||||||||
| Balance Cool-down/stretching |
1–2 1–2 |
2–10× lower body 2–10× upper body |
Soft-weights and Theraband 10 min 5 min |
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| Range of motion | 32 (94%) | 81.3 (5.3)* | 4 | Introductions | 10 min | ↑ Shoulder strength ↓ Hip Strength ↓ Mobility ↓ Functional ability |
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| Vocal exercises | 5 min | |||||||||
| Memory games | 5 min | |||||||||
| Range of motions | Fingers, hands, arms, knees, ankles | |||||||||
| Relaxation exercises | 5 min | |||||||||
| 367 | Exercise | 19 (95%) | 91.7 (6.3) | 12 | Aerobic | 5 | Walking | ↑ 10% weekly (maximum 30 min) (Baseline intensity defined by each participant) |
↑ Maximal walk endurance ↑ Maximal walk distance (significant) = Hand-grip strength = BMI |
|
| Control | 12 (100%) | 89.3 (4.4) | 12 | Social control | 1 | 30 min | = Maximal walk endurance ↑ Maximal walk distance (no significant) = Hand-grip strength = BMI |
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| 368 | Exercise | 36 (81%) | 83.7 (8) (67–98)* |
24 | Warm-up+ | 2 | 10 min | ↑ Quadriceps strength | ||
| Strength + Cool-down |
Isometric exercises major muscle groups | 25 min (Intensity was graduated by the n° of repetitions and the gravity-resistance) 10 min |
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| Control | 29 (90%) | 82 (9.6) (67–98)* |
24 | Reminiscence | 2 | Reminiscence therapy | 45 min | ↓ Quadriceps strength | ||
| 369 | Exercise | 21 (90%) | 81.4 (3.4) (75–96)* |
24 | Stretching + Range of movements exercises |
1 | 5–10× each exercise | Support of a chair or work surface |
No significant differences between the groups with regard to changes in any of the outcome variables (grip strength, ‘up & go’ test, ‘sit to stands' test, functional reach, spinal mobility, Barthel index, Philadelphia Geriatric Center Morale Scale) Trend toward improvement in comparison with control group (‘sit to stand ‘tests and ‘up & go’ tests) |
|
| Strength | 5–10× yellow-blue | Therabands | ||||||||
| Exercise | 20 (85%) | 82.9 (4.4) (75–96)* |
24 | Mobility | No significant differences between the groups with regard to changes in any of the outcome variables (grip strength, ‘up & go’ test, ‘sit to stand’ test, Functional reach, Spinal mobility, Barthel Index, Philadelphia Geriatric Center Morale Scale) Trend towards improvement in comparison with control group (‘sit to stand’ and ‘up & go’ tests) |
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| Control | 28 (89%) | 81.9 (4.7) (75–96)* |
24 | Health education | 30 min | No significant differences between the groups with regard to changes in any of the outcome variables (grip strength, ‘up & go’ test, ‘sit to stand’ test, functional reach, spinal mobility, Barthel index, Philadelphia Geriatric Center Morale Scale) | ||||
| 370 | Exercise | 39 (67%) | 82.2 (1.3) | 8 | Strength + Balance + Functional mobility |
3 | Combined progressive exercises | 1 hour | ↑ 6-min walk test | |
| WBV | 38 (68%) | 80 (1.4) | 8 | Vibration + Strength + Balance + Functional mobility |
3 | 5 | Whole body vibration | 1 min 15–30 Hz 2–8 mm peak-to-peak | ↑ 6-min walk test (greater improvements than exercise group) |
|
| 371 | Exercise | 94 (81%) | 87 (8) | 32 | Strength | 5 | Upper body resistance training (arm curls or arm raises) | Implement every 2 hr for a possible total of 4 care episodes per day | ↑ Arm raise ↑ Arm curl ↑ Stands 30 sec |
|
| Aerobic | Walking or wheeling | 75–90% of the maximal distance | ||||||||
| Control | 96 (86%) | 88 (7) | 32 | UCG | ↓ Meter walked or wheeled | |||||
| 92 | Exercise | 20 (80%) | 92 (2) (90–96) |
8 | Mobility exercise + Stretching+ |
2 | 1 | Major muscle groups | 40.45 min | ↑ 1RM leg press ↑ FAC (in participants with FAC > 3) ↓ Falls (1.2 fewer per participant than in the control group) |
| Aerobic + Strength | Rest periods | |||||||||
| 3 3 |
1 2-3 1-8 |
Cycling (cycle ergometer) Leg press exercise 10× biceps curls, arm extension, arm side lifts, shoulder elevations, seated bench presses and calf raises |
10–15 min; RPE:12–13 30–70% 1RM ( ↑ 5%weekly) 1–3 kg or low-medium resistance bands |
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| Control | 20 (80%) | 92 (2) (90–97) |
8 | UCG | 5 | 1 | Mobility exercises in major muscle groups | 40–45 min | 14 of 18 participants showed ↑ RM leg press | |
| 372 | Exercise | 34 (100%) | 83.5 (4.1) | 10 | Warm-up+ | 2 | 15 min | = Abilities to carry out instrumental activities of daily living | ||
| Strength+ | 1-2 | 8–30× knee extension 8–30× knee flexion 8–30× hip abduction 8–30× hip adduction |
Gradually increased | |||||||
| Functional exercises+ | 2 | 15× exercise (e.g., rising from a chair or elbow flexion using light loads (1–2 kg)) |
30 min | |||||||
| Relaxation | 15 min | |||||||||
| Control | 34 (100%) | 82.6 (3.7) | 10 | Home exercise program | 2–3 | 2 | 15× functional exercises | = Abilities to carry out instrumental activities of daily living | ||
Of note, the mean age of the subjects in all the studies was ≥ 80 years.
*
Data provided by the total number of participants.
BMI, Body mass index; CHO, carbohydrate; CSA, cross-sectional area; FAC, functional ambulation classification; NA, not available; PA, physical activity; RPE, rating of perceived exertion (Borg's conventional scale, 6–20 points); 1RM, one repetition maximum; SD, standard deviation; SO, social activities; TG, training group; UCG, usual care group; WBV, whole-body vibration.