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Table 1 Description of included studies

From: What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials

Author (Year) Sample Size Age Mean ± SD Frailty criteria Frailty status at baseline Intervention Duration and frequency Setting Follow up Outcome(s) measured Summary of findings
[6] 53 (I) 49 (C) 84 84 Gait speed of less than 0.8 m/s PASE score of less than 64 for men and 52 for women. Mixed (NF, PF, F). Self-administered exercise (mobility, strength, balance, and endurance training) and nutritional supplement program supervised by home helpers. 1 x daily 20 min exercise session over 4 months. 2 doses of 10 g amino acids taken over 1.5 months. Primary care 4 months Physical Activity (PASE) Functional status Walking time and distance Nutritional status Significant between-group difference in maximum walking time and distance in good compliers at 4 months (p < 0.05). No significant intervention effects for other measures of frailty.
[8] 120 (I) 121(C) 83.4 ± 5.81 83.2 ± 5.9 ≥3 CHS criteria Frail Individually tailored physical activity and nutrition program (protein supplements were offered to those whose BMI was less than 18.5). 10 physiotherapy sessions delivered over 12 months. Nutritional component as needed. Primary care 3 months 12 months Frailty (CHSC) Mobility (SPPB) Disability Service use Significantly lower prevalence of frailty and better mobility in intervention vs. control at 12 months (p < 0.05). No difference on any other outcome measures.
[20] 120 (I) 121 (C) 83.4 ± 5.81 83.2 ± 5.9 ≥3 CHS Criteria Frail Individually tailored physical activity and nutrition program (protein supplements were offered to those whose BMI was less than 18.5.) 10 physiotherapy sessions delivered over 12 months. Nutritional component duration/frequency not described. Primary care 3 months 12 months Fall rates Risk factors for falls (PPA) Mobility (SPPB) 4 min walk test No difference in fall rates between groups. Improvement in risk factors for falls including quadriceps strength and sway, gait speed and mobility were reported at 12 months for the intervention group (all p < 0.05).
[24] 22 (1) 19 (C) 84.1 ± 3.0 83.9 ± 2.8 ≥10s to perform a rapid-gait test. Unable to stand up 5x from seated position). Self-reported exhaustion. Frail Physical Activity (Functional balance and lower body strength based exercise) 2x weekly group classes of 45 min duration over a 12 week period. Primary care 12 weeks 36 weeks Balance (semi-tandem and tandem stands and single leg balance) Physical function (MTUG) Gait speed Lower body Strength ADL (measured using Barthel Index) Significant sustained improvements in balance, mobility and physical function for intervention group at 36 weeks (p < 0.05)
[35] 196 (I) 50 (C) 69.7 ± 4.23 70.15 ± .2.0 CHS frailty criteria Mixed (pre-frail to frail) Physical activity Nutrition Cognitive Training Or Combination Physical activity 90mins 2x weekly group sessions for 12 wks. Given daily exercises to do at home Nutritional supplements (iron, B6, B12, calcium, vitamin D) daily for 24 wks. Cognitive training 2 h weekly sessions for first 12 weeks, then 2 weekly booster sessions for remaining 12 wks. Primary care 3,6,12 months BMI Physical activity levels Knee extension strength Frailty Gait speed Functional ability (ADL) Hospitalisation Falls Frailty scores and status were improved in all groups including control at 12 months: Significantly greater improvements for the intervention groups (combination, physical activity, nutrition and cognitive gps respectively). Strength was significantly improved in the physical activity, cognitive training and combination gps. Physical activity was significantly improved in the nutritional gp. Gait speed improvements were reported for physical activity group only. (all p < 0.05). Improvements were sustained at 12 months.
[48] 175 (I) 142 (C) 83.1 ± 5.8 83 ± 6.3 CGA Mixed (NF, PF, F). Physical activity (Individualised mobility plan following surgery for hip fracture) Day 1post operation, patients were mobilised with assistance. Day 2–4 based on individual progression Physical assessment on day 4 for 24 h. Questionnaire data assessed day 5. Secondary care 5 days following surgery Upright time (standing, and walking) Need for assistance (CAS) Mobility (SPPB) Intervention group had significantly more upright times, higher number of upright events, and better Short Physical Performance Battery scores than the control participants (p < 0.05). No difference on need for assistance(p > 0.05)
[49] 198 (I) 199 (C) 83.4 ± 5.4 83.2 ± 6.4 CGA Mixed (NF, PF, F) Physical activity (Individualised mobility plan plus home exercise plan post discharge) Daily evaluations in hospital and at home rehabilitation arranged 2 weeks post hospital discharge. Assessments at 4 and 12 months. Secondary care 4 and 12 months GAITRite (Gait speed Step length Cadence Rhythm Postural control Gait asymmetry). Nottingham E-ADL Significant improvements in the 4 min gait speed test at 4 and 12 months and gait characteristics including pace, rhythm, postural control, and less gait asymmetry at both time points for the intervention gp. A significantly higher proportion of participants in the intervention group were able to walk independently at 12 mths (p < 0.05).
[50] 31 (I) 34 (C) 78 ± 1 81 ± 1 > 1 CHS Frailty Criteria Mixed (prefrail and frail) Nutrition Intervention - 2x drinks daily for 24 weeks2 containing 15 g protein, 7.1 g lactose, 0.5 g fat, and 0.4 g calcium). Control – 2x Placebo drinks daily for 24 weeks (no protein, 7.1 g lactose, 0.4 calcium) Primary care 24 weeks Body composition and bone mineral density Physical performance (SPPB) Strength (Leg press and extensions, hand grip strength) No significant differences reported on body composition /bone mineral density parameters or strength outcomes. Physical performance increased for the intervention group at 24 weeks. Specifically, the intervention group were significantly faster at the chair rise test (p < 0.05).
[51] 76 (I) 76 (C) 79.1 ± 6.4 80.7 ± 6.0 BBS ≤49/56 ≤ 1 falls in past 6 months. Mixed (prefrail and frail) Physical activity (Tai chi vs standard physiotherapy) 2 × 60 min weekly group sessions for 15 weeks. Secondary 15 weeks Falls Balance (BBS Foam and dome test) No significant difference between groups on any outcome measure.
[52] 77 (WN) 70 (W) 75 (C) 76.3 ± 5.9 75.8 ± 5.2 75.7 ± 6.5 CHS Frailty Criteria Mixed (NF, PF, F). Physical activity (walking) plus/minus nutrition. Walking and nutrition (WN). Daily nutrition supplements containing protein (10 g), vitamin D (12.5 mg), calcium (300 g), plus daily walking program every day lasting for 6 months. Steps to be increased 10% each month. (W) Daily walking for 6 months (C) No intervention Primary 6 months Walking Biochemical (Anabolic hormones) SMI In both the W/N and W groups, the average daily steps were significantly increased compared to control (p < .01). Significant improvements in interventions groups on skeletal muscle mass and anabolic hormone production (p < .05) compared to control.