Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

• Published in: Sports medicine (Auckland) Vol. 50; no. 6; pp. 1095 - 1106
• Main Authors: García-Hermoso, Antonio, Ramirez-Vélez, Robinson, Sáez de Asteasu, Mikel L., Martínez-Velilla, Nicolás, Zambom-Ferraresi, Fabricio, Valenzuela, Pedro L., Lucia, Alejandro, Izquierdo, Mikel
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2020; Springer Nature B.V
• Subjects: Accidental Falls - prevention & control; Age; Aged; Bias; Clinical trials; Cognition & reasoning; Cognitive ability; Exercise; Exercise Therapy; Falls; Fitness training programs; Health care; Hospitalization; Humans; Influence; Institutionalization; Intervention; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Older people; Physical fitness; Physical training; Population; Quality of Life; Randomized Controlled Trials as Topic; Sports Medicine; Systematic Review; United States > US
• ISSN: 0112-1642; 1179-2035; 1179-2035
• DOI: 10.1007/s40279-020-01259-y

Background Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old). Objective To analyze the safety and effectiveness of long-term exercise interventions in older adults. Methods We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). Results Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses ( n  = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95–1.17) or mortality (RR = 0.93, 95% CI 0.83–1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48–0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants’ baseline characteristics (age, physical function, and cognitive status) and exercise frequency. Conclusions Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.