J. S Oliveira1, M. B Pinheiro1, N. Fairhall1, S. Walsh1, T. Chesterfield Franks1, W. Kwok1, A. Bauman1, C. Sherrington1
1The University of Sydney, Sydney, Australia
Background: Frailty and sarcopenia are common age-related conditions associated with adverse outcomes such as falls, mobility disorders, the need for long-term care, and death. Physical activity has been identified as a potential preventive strategy for both frailty and sarcopenia.
Purpose: We aimed to investigate the association between physical activity and prevention of frailty and sarcopenia in people aged 65+ years. Additionally, we investigated if there was any dose-response association as well as it this association varied by type of physical activity. We conducted this review to inform the World Health Organization (WHO) Guideline Development Group (GDG) in the update the WHO Global Recommendations on Physical Activity and Sedentary Behaviour.
Methods: We initially searched for systematic reviews and meta-analysis (January 2008 to November 2019). Since we did not find any eligible systematic reviews, we identified reviews that included potentially eligible studies. Additionally, we conducted an updated and expanded search in PubMed from January 2010 to March 2020. Eligible studies were randomised controlled trials and longitudinal studies that investigated the effect of physical activity on frailty and/or sarcopenia in people aged 65+. We used the Prevention of Falls Network Europe (ProFANE) taxonomy to classify the physical activity and exercise programs in the included studies. The PEDro scale was used to assess the methodological quality and the GRADE approach to rate certainty of evidence.
Results: Meta-analysis showed that physical activity probably prevents frailty (four studies; frailty score pooled standardised mean difference, 0.24; 95% CI 0.04 to 0.43; p=0.017, I2=57%, moderate-certainty evidence). Only one trial investigated physical activity for sarcopenia prevention and did not provide conclusive evidence (RR 1.08; 95% CI 0.10 to 12.19). Five observational studies showed positive associations between physical activity and frailty or sarcopenia prevention. We were unable to make clear statements about the optimal type of exercise or dose response associations. Studies that detected impacts on relevant outcomes involved resistance training, combinations of resistance, balance and endurance exercise, as well as overall physical activity.
Conclusion(s): This review provides moderate-certainty evidence that physical activity is an effective intervention for preventing frailty among people aged 65 years and older. We found limited evidence of any effect of physical activity on sarcopenia but promising results from observational studies. Further research is warranted to determine the impact, ideal dose and modality of physical activity on frailty and sarcopenia. Future studies are also needed to explore the long-term sustainability of physical activity interventions.
Implications: The findings suggest that physical activity may be used as a strategy to prevent frailty and potentially prevent sarcopenia in people aged 65 years and older. Therefore, physiotherapists should consider encouraging increased physical activity among their patients by identifying their activity levels and referring them to available physical activity promotion services.
Funding, acknowledgements: This review was funded by the WHO to contribute to the development of the Guidelines on physical activity (2020).
Keywords: Exercise, Frailty, Sarcopenia
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Institution: The University of Sydney
Committee: Human Research Ethics Committee (HREC)
Reason: It is a systematic review
All authors, affiliations and abstracts have been published as submitted.
