title: High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. The effect of functional circuit training on self-reported fear of falling and health status in a group of physically frail older individuals: a randomized controlled trial Effects of a 6-month multimodal training intervention on retention of functional fitness in older adults: A randomized-controlled cross-over design Ankle force and rate of force production increase following high intensity strength training in frail older adults Residual effects of muscle strength and muscle power training and detraining on physical function in community-dwelling prefrail older adults: a randomized controlled trial Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Effects of Exercise and Milk Fat Globule Membrane (MFGM) Supplementation on Body Composition, Physical Function, and Hematological Parameters in Community-Dwelling Frail Japanese Women: A Randomized Double Blind, Placebo-Controlled, Follow-Up Trial Effects of a Randomized Controlled Recurrent Fall Prevention Program on Risk Factors for Falls in Frail Elderly Living at Home in Rural Communities Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial.
abstract: The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Background and aim Physical frailty has been regarded as a precursor state to disability and dependence on others for daily activities . Frail individuals are considered to be the group of patients that presents the most complex and challenging problems to health care professionals . The purpose of this study was to evaluate whether a 12-week functional circuit training program ( FCT ) could reduce self-reported fear of falling and improve health status in a group of physically frail community-dwelling older individuals . Methods Fifty-one individuals ( 31 F , 20 M ) , mean age ( SD ) 84 ( 2.9 ) years old , were considered frail and tested at week 0 and r and omly assigned into two groups ( intervention group , FCT = 26 ; control group , CG = 25 ) . FCT underwent a structured 12-week FCT program , which focused on a combination of functional balance and lower-body strength-based exercises . CG met once a week for health education meetings . Measures of self-reported fear of falling ( Activities-specific Balance Confidence scale ) and health status ( SF-12 ) were assessed at week 0 , 12 and 36 . All longitudinal analyses for continuous variables that were measured at the three time points ( week 0 , 12 and 36 ) were performed using linear mixed modeling . Results FCT participants had greater improvements than those in the CG in fear of falling and self-reported physical function , physical composite score and mental composite score ; these improvements were maintained in the week 36 follow-up , with significant group-by-time interactions by the end of the study . Conclusions These data indicate that a FCT program is effective in improving self-reported measures of fear of falling and health status in a group of physically frail individuals Background Older adults have the highest rates of disability , functional dependence and use of healthcare re sources . Training interventions for older individuals are of special interest where regular physical activity ( PA ) has many health benefits . The main purpose of this study was to assess the immediate and long-term effects of a 6-month multimodal training intervention ( MTI ) on functional fitness in old adults . Methods For this study , 117 participants , 71 to 90 years old , were r and omized in immediate intervention group and a control group ( delayed intervention group ) . The intervention consisted of daily endurance and twice-a-week strength training . The method was based on a r and omized-controlled cross-over design . Short Physical Performance Battery ( SPPB ) , 8 foot up- and -go test , strength performance , six min walking test ( 6 MW ) , physical activity , BMI and quality of life were obtained at baseline , after a 6-month intervention- and control phase , again after 6-month crossover- and delayed intervention phase , and after anadditional 6-month follow-up . Results After 6 months of MTI , the intervention group improved in physical performance compared with the control group via Short Physical Performance Battery ( SPPB ) score ( mean diff = 0.6 , 95 % CI : 0.1 , 1.0 ) and 8-foot up- and -go test ( mean diff = −1.0 s , 95 % CI : -1.5 , -0.6 ) , and in endurance performance via 6-minute walking test ( 6 MW ) ( mean diff = 44.2 meters , 95 % CI : 17.1 , 71.2 ) . In strength performance via knee extension the intervention group improved while control group declined ( mean diff = 55.0 Newton , 95 % CI : 28.4 , 81.7 ) , and also in PA ( mean diff = 125.9 cpm , 95 % CI : 96.0 , 155.8 ) . Long-term effects of MTI on the particpants was assesed by estimating the mean difference in the variables measured between time-point 1 and 4 : SPPB ( 1.1 points , 95 % CI : 0.8 , 1.4 ) ; 8-foot up- and -go ( −0.9 s , 95 % CI : -1.2 , -0.6 ) ; 6 MW ( 18.7 m , 95 % CI : 6.5 , 31.0 ) ; knee extension ( 4.2 Newton , 95 % CI : -10.0 , 18.3 ) ; h and grip ( 6.7 Newton , 95 % CI : -4.4 , 17.8 ) ; PA ( −4.0 cpm , 95 % CI : -33.9 , 26.0 ) ; BMI ( −0.6 kg/m2 , 95 % CI : -0.9 , -0.3 ) and Icel and ic quality of life ( 0.3 points , 95 % CI : -0.7 , 1.4 ) . Conclusions Our results suggest that regular MTI can improve and prevent decline in functional fitness  in older individuals , influence their lifestyle and positively affect their ability to stay independent , thus reducing the need for institutional care . Trial registration This study was approved by the National Bioethics Committee in Icel and , VSNb20080300114/03 - Background and aims : The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling . Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults . Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly . This study evaluated the effect of a 10-week high intensity strength- training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults . Methods : Thirteen experimental and fourteen control subjects , all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips . Results : Following strength training the experimental group was significantly stronger than the control group . Mean ankle moments improved in the experimental group following strength training during forward sway ( Right : p=0.067 , Left : p=0.009 ) and backward sway ( Right : p=0.031 , Left : p=0.058 ) . For the backward sway condition the ankle rate of torque production increased significantly in the experimental group ( Right : p=0.016 , Left : p=0.031 ) . Conclusions : Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production , in response to balance threats Background Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining . The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining . Methods 69 prefrail community-dwelling older adults , aged 65–94 years were r and omly assigned into three groups : muscle strength training ( ST ) , muscle power training ( PT ) or controls . The exercise interventions were performed for 60 minutes , twice a week over 12 weeks . Physical function ( Short Physical Performance Battery = SPPB ) , muscle power ( sit-to-st and transfer = STS ) , self-reported function ( SF-LLFDI ) and appendicular lean mass ( aLM ) were measured at baseline and at 12 , 24 and 36 weeks after the start of the intervention . Results For the SPPB , significant intervention effects were found at 12 weeks in both exercise groups ( ST : p = 0.0047 ; PT : p = 0.0043 ) . There were no statistically significant effects at 24 and 36 weeks . In the ST group , the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged . No effects were found for muscle power , SF-LLFDI and aLM . Conclusions The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining . The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training . However , more research is needed on the residual effects of both interventions . Taken the drop-out rates ( PT : 33 % , ST : 21 % ) into account , muscle power training should also be used more carefully in prefrail older adults . Trial registration This trial has been registered with clinical trials.gov ( NCT00783159 This r and omized controlled trial examined the effects of multicomponent training on muscle power output , muscle mass , and muscle tissue attenuation ; the risk of falls ; and functional outcomes in frail nonagenarians . Twenty-four elderly ( 91.9 ± 4.1 years old ) were r and omized into intervention or control group . The intervention group performed a twice-weekly , 12-week multicomponent exercise program composed of muscle power training ( 8–10 repetitions , 40–60 % of the one-repetition maximum ) combined with balance and gait retraining .  Strength and power tests were performed on the upper and lower limbs . Gait velocity was assessed using the 5-m habitual gait and the time-up- and -go ( TUG ) tests with and without dual-task performance . Balance was assessed using the FICSIT-4 tests . The ability to rise from a chair test was assessed , and data on the incidence and risk of falls were assessed using question naires . Functional status was assessed before measurements with the Barthel Index . Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography . The intervention group showed significantly improved TUG with single and dual tasks , rise from a chair and balance performance ( P < 0.01 ) , and a reduced incidence of falls . In addition , the intervention group showed enhanced muscle power and strength ( P < 0.01 ) . Moreover , there were significant increases in the total and high-density muscle cross-sectional area in the intervention group . The control group significantly reduced strength and functional outcomes . Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty Objective To investigate the combined and separate effects of exercise and milk fat globule membrane ( MFGM ) supplementation on frailty , physical function , physical activity level , and hematological parameters in community-dwelling elderly Japanese women . Methods A total of 131 frail , elderly women over 75 years were r and omly assigned to one of four groups : exercise and MFGM supplementation ( Ex+MFGM ) , exercise and placebo ( Ex+Plac ) , MFGM supplementation , or the placebo group . The exercise group attended a 60-minute training program twice a week for three months , and the MFGM group ingested 1 g of the MFGM supplement in pill form , daily for 3 months . The primary outcome measure was change in frailty status based on Fried ’s frailty phenotype . Secondary outcome measures included body composition , physical function and hematological parameters , and interview survey components assessing lifestyle factors . Participants were followed for 4 months post-intervention . Results Significant group × time interactions were observed for usual walking speed ( P = 0.005 ) , timed up & go ( P<0.001 ) , and insulin-like growth factor-binding protein 3 / insulin-like growth factor 1 ratio ( P = 0.013 ) . The frailty components revealed that weight loss , exhaustion , low physical activity , and slow walking speed were reversed , but low muscle strength did not significantly changed . Frailty reversal rate was significantly higher in the Ex+MFGM ( 57.6 % ) than in the MFGM ( 28.1 % ) or placebo ( 30.3 % ) groups at post-intervention ( χ2 = 8.827 , P = 0.032 ) , and at the follow-up was also significantly greater in the Ex+MFGM ( 45.5 % ) and Ex+Plac ( 39.4 % ) groups compared with the placebo ( 15.2 % ) group ( χ2 = 8.607 , P = 0.035 ) . The exercise+MFGM group had the highest odds ratio ( OR ) for frailty reversal at post-intervention and follow-up ( OR = 3.12 , 95 % confidence interval ( CI ) = 1.13–8.60 ; and OR = 4.67 , 95 % CI = 1.45–15.08 , respectively ) . Conclusion This study suggests that interventions including exercise and nutrition can improve frailty status . Statistically significant additive effects of MFGM with exercise could not be confirmed in this population , and further investigation in larger sample s is necessary . Trial Registration The Japan Medical Association Clinical Trial Registry Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity , death , immobility , hospitalization , and early entry to long-term care facilities . The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas . Material / Methods This study adopted an assessor-blinded , r and omized , controlled trial methodology . Subjects were enrolled in a 12-week recurrent fall prevention program , which comprised strength training , balance training , and patient education .  Muscle strength and endurance of the ankles and the lower extremities , static balance , dynamic balance , depression , compliance with preventive behavior related to falls , fear of falling , and fall self-efficacy at baseline and immediately after the program were assessed . Sixty-two subjects ( mean age 69.2±4.3 years old ) completed the program – 31 subjects in the experimental group and 31 subjects in the control group . Results When the results of the program in the 2 groups were compared , significant differences were found in ankle heel rise test , lower extremity heel rise test , dynamic balance , depression , compliance with fall preventative behavior , fear of falling , and fall self-efficacy ( p<0.05 ) , but no significant difference was found in static balance . Conclusions This study shows that the fall prevention program described effectively improves muscle strength and endurance , balance , and psychological aspects in elderly women with a fall history OBJECTIVES To evaluate the effectiveness of exercise and amino acid supplementation in enhancing muscle mass and strength in community-dwelling elderly sarcopenic women . DESIGN R and omized controlled trial . SETTING Urban community in Tokyo , Japan . PARTICIPANTS One hundred fifty-five women aged 75 and older were defined as sarcopenic and r and omly assigned to one of four groups : exercise and amino acid supplementation ( exercise + AAS ; n = 38 ) , exercise ( n = 39 ) , amino acid supplementation ( AAS ; n = 39 ) , or health education ( HE ; n = 39 ) . INTERVENTION The exercise group attended a 60-minute comprehensive training program twice a week , and the AAS group ingested 3 g of a leucine-rich essential amino acid mixture twice a day for 3 months . MEASUREMENTS Body composition was determined using bioelectrical impedance analysis . Data from interviews and functional fitness parameters such as muscle strength and walking ability were collected at baseline and after the 3-month intervention . RESULTS A significant group × time interaction was seen in leg muscle mass ( P = .007 ) , usual walking speed ( P = .007 ) , and knee extension strength ( P = .017 ) . The within-group analysis showed that walking speed significantly increased in all three intervention groups , leg muscle mass in the exercise + AAS and exercise  groups , and knee extension strength only in the exercise + AAS group ( 9.3 % increase , P = .01 ) . The odds ratio for leg muscle mass and knee extension strength improvement was more than four times as great in the exercise + AAS group ( odds ratio = 4.89 , 95 % confidence interval = 1.89 - 11.27 ) as in the HE group . CONCLUSION The data suggest that exercise and AAS together may be effective in enhancing not only muscle strength , but also combined variables of muscle mass and walking speed and of muscle mass and strength in sarcopenic women OBJECTIVES To assess the effects of an 8-week exercise training program with a special focus on light- to moderate-intensity resistance exercises ( 30 - 70 % of one repetition maximum , 1RM ) and a subsequent 4-week training cessation period ( detraining ) on muscle strength and functional capacity in participants aged 90 and older . DESIGN R and omized controlled trial performed during March to September 2009 . SETTING Geriatric nursing home . PARTICIPANTS Forty nonagenarians ( 90 - 97 ) were r and omly assigned to an intervention or control group ( 16 women and 4 men per group ) . INTERVENTION Eight-week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity . MEASUREMENTS PRIMARY OUTCOME 1RM leg press . SECONDARY OUTCOMES h and grip strength , 8-m walk test , 4-step stairs test , Timed Up and Go test , and number of falls . RESULTS A significant group by time interaction effect ( P=.02 ) was observed only for the 1RM leg press . In the intervention group , 1RM leg press increased significantly with training by 10.6 kg [ 95 % confidence interval (CI)=4.1 - 17.1 kg ; P=.01 ] . Except for the mean group number of falls , which were 1.2 falls fewer per participant in the intervention group ( 95 % CI=0.0 - 3.0 ; P=.03 ) , no significant training effect on the secondary outcome measures was found . CONCLUSION Exercise training , even of short duration and light to moderate intensity , can increase muscle strength while decreasing fall risk in nonagenarians The purpose of this study was to evaluate whether a 12-wk functional circuit-training program ( FCT ) could alter markers of physical frailty in a group of frail community-dwelling adults . Fifty-one individuals ( 31 women , 20 men ) , mean age ( ± SD ) 84 ( ± 2.9 ) yr , met frailty criteria and were r and omly assigned into groups ( FCT = 26 , control group [ CG ] = 25 ) . FCT underwent a 12-wk exercise program . CG met once a week for health education meetings . Measures of physical frailty , function , strength , balance , and gait speed were assessed at Weeks 0 , 12 , and 36 . Physical-frailty measures in FCT showed significant ( p < .05 ) improvements relative to those in CG ( Barthel Index at Weeks 0 and 36 : 73.41 ( ± 2.35 ) and 77.0 ( ± 2.38 ) for the FCT and 70.79 ( ± 2.53 ) and 66.73 ( ± 2.73 ) for the CG . These data indicate that an FCT program  is effective in improving measures of function and reducing physical frailty among frail older adults
target: Conclusion Frequency of 1–6 sessions per week , training volume of 1–3 sets of 6–15 repetitions and intensity of 30–70%1-RM promoted significant enhancements on muscle strength , muscle power , and functional outcomes .
  Therefore , in agreement with previous studies , we suggest that supervised and controlled RT represents an effective intervention in frailty treatment
background: Aim Exercise is one of the most important components in frailty prevention and treatment .
  Therefore , we systematic ally review ed the effect of resistance training ( RT ) alone or combined with multimodal exercise intervention on muscle hypertrophy , maximal strength , power output , functional performance , and falls incidence in physically frail elderly .