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Multicomponent or Resistance Training for Nursing Home Residents: A Systematic Review With Meta-Analysis

  • Édila Penna Pinheiro
    Correspondence
    Address correspondence to Édila Penna Pinheiro, MSc, La Salle University, Avenida Victor Barreto, 2288, Canoas, Rio Grande do Sul, Brazil 92010-000.
    Affiliations
    University La Salle, Canoas, Rio Grande do Sul, Brazil
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  • Rafaela Cavalheiro do Espírito Santo
    Affiliations
    Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil

    Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil

    Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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  • Leonardo Peterson dos Santos
    Affiliations
    Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil

    Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil

    Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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  • Wesley Vaz Gonçalves
    Affiliations
    Methodist University Center, Porto Alegre, Rio Grande do Sul, Brazil
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  • Luiz Alberto Forgiarini Junior
    Affiliations
    Postgraduate Program in Health and Human Development, La Salle University, Canoas, Rio Grande do Sul, Brazil
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  • Ricardo Machado Xavier
    Affiliations
    Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil

    Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil

    Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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  • Lidiane Isabel Filippin
    Affiliations
    Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil

    Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil

    Postgraduate Program in Health and Human Development, La Salle University, Canoas, Rio Grande do Sul, Brazil
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      Abstract

      Objectives

      To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities.

      Design

      Systematic review with meta-analysis of randomized controlled trials.

      Setting and Participants

      Older adults age over 60 years who are nursing home residents in long-term care.

      Methods

      Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses.

      Results

      A total of 30 studies were included in the qualitative review (n = 1887, mean age 82.68 years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points; +2 points), 30-second chair-stand (approximately +3 repetitions; both), and Timed Up and Go (−4 seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated.

      Conclusions and Implications

      The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.

      Keywords

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      References

        • Assumpção C.O.
        • De Souza T.M.F.
        • Urtado C.B.
        Treinamento resistido frente ao envelhecimento: uma alternativa viável e eficaz.
        Anuário da Produção Acadêmica Docente. 2009; 2: 451-476
        • Hughes V.A.
        • Frontera W.R.
        • Wood M.
        • et al.
        longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health.
        J Gerontol Ser A. 2001; 56: B209-B217
        • Malmstrom T.K.
        • Miller D.K.
        • Simonsick E.M.
        • Ferrucci L.
        • Morley J.E.
        SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes.
        J Cachexia Sarcopenia Muscle. 2016; 7: 28-36
        • Lauzé M.
        • Martel D.D.
        • Aubertin-Leheudre M.
        Feasibility and effects of a physical activity program using gerontechnology in assisted living communities for older adults.
        J Am Med Dir Assoc. 2017; 18: 1069-1075
        • Escribà-Salvans A.
        • Jerez-Roig J.
        • Molas-Tuneu M.
        • et al.
        Sarcopenia and associated factors according to the EWGSOP2 criteria in older people living in nursing homes: a cross-sectional study.
        BMC Geriatr. 2022; 22: 350
        • Liu C.J.
        • Latham N.K.
        Progressive resistance strength training for improving physical function in older adults.
        Cochrane Database Syst Rev. 2009; 3: CD002759
        • Crocker T.
        • Forster A.
        • Young J.
        • Brown L.
        • et al.
        Physical rehabilitation for older people in long-term care.
        Cochrane Database Syst Rev. 2013; 2: CD004294
        • Lee A.M.
        • Sénéchal M.
        • Hrubeniuk T.J.
        • Bouchard D.R.
        Is sitting time leading to mobility decline in long-term care residents?.
        Aging Clin Exp Res. 2020; 32: 183-186
        • Reid N.
        • Eakin E.
        • Henwood T.
        • et al.
        Objectively measured activity patterns among adults in residential aged care.
        Int J Environ Res Public Health. 2013; 10: 6783-6798
        • Souto P. De
        • Mb Morley J.E.
        • Chodzko-Zajko W.
        • et al.
        Recommendations on physical activity and exercise for older adults living in long-term care facilities: a taskforce report.
        J Am Med Dir Assoc. 2016; 17: 381-392
        • Chodzko-Zajko W.J.
        • Proctor D.N.
        • Fiatarone Singh M.A.
        • et al.
        American College of Sports Medicine position stand. Exercise and physical activity for older adults.
        Med Sci Sports Exerc. 2009; 41: 1510-1530
        • dos Reis Caldas L.R.
        • Albuquerque M.R.
        • de Araújo S.R.
        • et al.
        Sixteen weeks of multicomponent physical training improves strength, agility and dynamic balance in the elderly woman.
        Rev Bras Ciências do Esporte. 2019; 41: 150-156
        • Fleck S.J.
        • Kraemer W.J.
        Fundamentos do Treinamento de Força Muscular.
        3rd ed. Artmed, 2006: 376
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: 71
        • Schardt C.
        • Adams M.B.
        • Owens T.
        • Keitz S.
        • Fontelo P.
        Utilization of the PICO framework to improve searching PubMed for clinical questions.
        BMC Med Inform Decis Mak. 2007; 7: 16
        • Wan X.
        • Wang W.
        • Liu J.
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        BMC Med Res Methodol. 2014; 14: 135
        • Maher C.G.
        • Sherrington C.
        • Herbert R.D.
        • Moseley A.M.
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Shiwa S.R.
        • Costa L.O.
        • Costa L.D.C.M.
        • et al.
        Reproducibility of the Portuguese version of the PEDro Scale.
        Cad Saude Publica. 2011; 27: 2063-2068
        • Gonzalez G.Z.
        • Moseley A.M.
        • Maher C.G.
        • Nascimento D.P.
        • Costa L.D.C.M.
        • Costa L.O.
        Methodologic quality and statistical reporting of physical therapy randomized controlled trials relevant to musculoskeletal conditions.
        Arch Phys Med Rehabil. 2018; 99: 129-136
      1. Higgins JPT, Thomas J, Chandler J, et al, eds. Cochrane Handbook for Systematic Reviews of Interventions version 6.2. Cochrane; 2021. Accessed January 10, 2022. www.training.cochrane.org/handbook

        • Rikli R.E.
        • Jones C.J.
        Development and validation of a functional fitness test for community-residing older adults.
        J Aging Phys Activity. 1999; 7: 129-161
        • Steffen T.
        • Hacker T.
        • Mollinger L.
        Age- and gender-related test performance in community-dwelling elderly people: Six-minute walk test, berg balance scale, timed up go test, and gait speeds.
        Phys Ther. 2002; 82: 128-137
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: An emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Terracciano L.
        • Brozek J.
        • Compalati E.
        • Schünemann H.
        GRADE system: New paradigm.
        Curr Opin Allergy Clin Immunol. 2010; 10: 377-383
        • Arrieta H.
        • Rezola-Pardo C.
        • Gil S.M.
        • et al.
        Effects of multicomponent exercise on frailty in long-term nursing homes: A randomized controlled trial.
        J Am Geriatr Soc. 2019; 67: 1145-1151
        • Arrieta H.
        • Rezola-Pardo C.
        • Zarrazquin I.
        • et al.
        A multicomponent exercise program improves physical function in long-term nursing home residents: A randomized controlled trial.
        Exp Gerontol. 2018; 103: 94-100
        • Barthalos I.
        • Dorgo S.
        • Kopkáné Plachy J.
        • et al.
        Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.
        J Sport Med Phys Fit. 2016; 56: 1249-1257
        • Baum E.E.
        • Jarjoura D.
        • Polen A.E.
        • Faur D.
        • Rutecki G.
        Effectiveness of a group exercise program in a long-term care facility: A randomized pilot trial.
        J Am Med Dir Assoc. 2003; 4: 74-80
        • Benavent-Caballer V.
        • Rosado-Calatayud P.
        • Segura-Ortí E.
        • Amer-Cuenca J.J.
        • Lisón J.F.
        Effects of three different low-intensity exercise interventions on physical performance, muscle CSA and activities of daily living: A randomized controlled trial.
        Exp Gerontol. 2014; 58: 159-165
        • Bischoff L.L.
        • Cordes T.
        • Meixner C.
        • Shoene D.
        • Voelcker-Rehage C.
        • Wollesen B.
        Can cognitive-motor training improve physical functioning and psychosocial well-being in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project.
        Aging Clin Exp Res. 2020;
        • Cadore E.L.
        • Casas-herrero A.
        • Zambom-ferraresi F.
        • et al.
        Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.
        Am Aging Assoc. 2013; 36: 773-785
        • Casilda-Lopez J.
        • Torres-Sanchez I.
        • Garzon-Moreno V.M.
        • Cabrera-Martos I.
        • Valenza M.C.
        Results of a physical therapy program in nursing home residents: A randomized clinical trial.
        Rev Esp Geriatr Gerontol. 2015; 50: 174-178
        • Cheung K.K.W.
        • Au K.Y.
        • Lam W.W.S.
        • Jones A.Y.M.
        Effects of a structured exercise programme on functional balance in visually impaired elderly living in a residential setting.
        Hong Kong Physiother J. 2008; 26: 45-50
        • Corcoran M.P.
        • Nelson M.E.
        • Sacheck J.M.
        • et al.
        Efficacy of an exercise and nutritional supplement program on physical performance and nutritional status in older adults with mobility limitations residing at senior living facilities.
        J Aging Phys Act. 2017; 25: 453-463
        • De Souto Barreto P.
        • Cesari M.
        • Denormandie P.
        • Armaingaud D.
        • Vellas B.
        • Rolland Y.
        Exercise or social intervention for nursing home residents with dementia: A pilot randomized, controlled trial.
        J Am Geriatr Soc. 2017; 65: E123-E129
        • Ferreira C.B.
        • Teixeira P.D.S.
        • Alves Dos Santos G.
        • et al.
        Effects of a 12-week exercise training program on physical function in institutionalized frail elderly.
        J Aging Res. 2018; 2018: 7218102
        • García-Gollarte F.
        • Mora-Concepción A.
        • Pinazo-Hernandis S.
        • et al.
        Effectiveness of a supervised group-based Otago exercise program on functional performance in frail institutionalized older adults: A multicenter randomized controlled trial.
        J Geriatr Phys Ther. 2021; (Epub ahead of print)
        • Hewitt J.
        • Goodall S.
        • Clemson L.
        • Henwood T.
        • Refshauge K.
        Progressive resistance and balance training for falls prevention in long-term residential aged care: A cluster randomized trial of the sunbeam program.
        J Am Med Dir Assoc. 2018; 19: 361-369
        • Hruda K.V.
        • Hicks A.L.
        • McCartney N.
        Training for muscle power in older adults: Effects on functional abilities.
        Rev Can Physiol Appl [Canadian J Appl Physiol [Internet]. 2003; 28 (2 CC-Effective Practice and Organisation of Care CC-Bone, Joint and Muscle Trauma CC-Stroke):178–189
        • Kocic M.
        • Stojanovic Z.
        • Nikolic D.
        • et al.
        The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65 years: A randomized controlled trial.
        Arch Gerontol Geriatr. 2018; 75: 112-118
        • Kovacs E.
        • Jonasne I.S.
        • Karoczi C.K.
        • Korpos A.
        • Gondos T.
        Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: A randomized controlled single-blind study.
        Eur J Phys Rehabil Med. 2013; 49: 639-648
        • Lazowski D.A.
        • Ecclestone N.A.
        • Myers A.M.
        • et al.
        A randomized outcome evaluation of group exercise programs in long-term care institutions.
        J Gerontol A Biol Sci Med Sci. 1999; 54: M621-M628
        • Menezes A.V.
        • da Silva de Aguiar A.
        • Alves E.F.
        • de Quadros L.B.
        • Bezerra P.P.
        Efetividade de uma intervenção fisioterapêutica cognitivo-motora em idosos institucionalizados com comprometimento cognitivo leve e demência leve.
        Ciênc saúde coletiva. 2016; 21: 3459-3467
        • Moreira N.B.
        • Gonçalves G.
        • da Silva T.
        • Zanardini F.E.H.
        • Bento P.C.B.
        Multisensory exercise programme improves cognition and functionality in institutionalized older adults: A randomized control trial.
        Physiother Res Int. 2018; 23: e1708
        • Oesen S.
        • Halper B.
        • Hofmann M.
        • et al.
        Effects of elastic band resistance training and nutritional supplementation on physical performance of institutionalized elderly—a randomized controlled trial.
        Exp Gerontol. 2015; 72: 99-108
        • Rezola-Pardo C.
        • Rodriguez-Larrad A.
        • Gomez-Diaz J.
        • et al.
        Comparison between multicomponent exercise and walking interventions in long-term nursing homes: A randomized controlled trial.
        Gerontologist. 2020; 60: 1364-1373
        • Sahin U.K.
        • Kirdi N.
        • Bozoglu E.
        • et al.
        Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly.
        Int J Rehabil Res. 2018; 41: 211-217
        • Santana-Sosa E.
        • Barriopedro M.I.
        • López-Mojares L.M.
        • Pérez M.
        • Lucia A.
        Exercise training is beneficial for Alzheimer’s patients.
        Int J Sports Med. 2008; 29: 845-850
        • Serra-Rexach J.A.
        • Bustamante-Ara N.
        • Hierro Villarán M.
        • et al.
        Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: A randomized controlled trial.
        J Am Geriatr Soc. 2011; 59 (4 CC-Stroke CC-Bone, Joint and Muscle Trauma):594–602
        • Sousa N.
        • Mendes R.
        Comparison of effects of resistance and multicomponent training on falls prevention in institutionalized elderly women.
        J Am Geriatr Soc. 2015; 63: 396-397
        • Tomicki C.
        • Cecchin L.
        • Zanini S.C.C.
        • Benedetti T.R.B.
        • Leguisamo C.P.
        • Portella M.R.
        Association between number of falls and muscular strength of elderly residents in long stay institutions.
        Rev Kairós Gerontol. 2017; 20: 101
        • Urzi F.
        • Marusic U.
        • Ličen S.
        • Buzan E.
        Effects of elastic resistance training on functional performance and myokines in older women-a randomized controlled trial.
        J Am Med Dir Assoc. 2019; 20: 830-834.e2
        • Chen X.
        • Zhao L.
        • Liu Y.
        • Zhou Z.
        • et al.
        Otago exercise programme for physical function and mental health among older adults with cognitive frailty during COVID-19: A randomised controlled trial.
        J Clin Nurs. 2021; (Epub ahead of print)
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Veronese N.
        • Bolzetta F.
        • Toffanello E.D.
        • et al.
        Association between short physical performance battery and falls in older people: The Progetto Veneto Anziani Study.
        Rejuvenation Res. 2014; 17: 276-284
        • Cesari M.
        • Onder G.
        • Russo A.
        • et al.
        Comorbidity and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study).
        Gerontology. 2006; 52: 24-32
        • Kwon S.
        • Perera S.
        • Pahor M.
        • et al.
        What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study).
        J Nutr Health Aging. 2009; 13: 538-544
        • Zanini A.
        • Crisafulli E.
        • D'Andria M.
        • et al.
        Minimum clinically important difference in 30-s sit-to-stand test after pulmonary rehabilitation in subjects with COPD.
        Respir Care. 2019; 64: 1261-1269
        • Podsiadlo D.
        • Richardson S.
        The timed “Up & Go”: A test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Gautschi O.P.
        • Stienen M.N.
        • Corniola M.V.
        • et al.
        Assessment of the minimum clinically important difference in the Timed Up and Go test after surgery for lumbar degenerative disc disease.
        Neurosurgery. 2017; 80: 380-385
        • Pei-ye C.
        • Qing-hua Z.
        • Ming-zhao X.
        • Ling-Na K.
        • Ling X.
        The effectiveness of exercise for fall prevention in nursing home residents: A systematic review and meta-analysis.
        J Adv Nurs. 2018; 74: 2511-2522
        • Vlietstra L.
        • Hendrickx W.
        • Waters D.L.
        Exercise interventions in healthy older adults with sarcopenia: A systematic review and meta-analysis.
        J Ageing. 2018; 37: 169-183