Impact of multicomponent exercise and nutritional supplement interventions for improving physical frailty in community-dwelling older adults: a systematic review and meta-analysis


  • Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92.

    PubMed 

    Google Scholar 

  • Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue QL, Walston JD, Kasper JD. Frailty in Older Adults: A Nationally Representative Profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427–34.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771–87.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Facal D, Burgo C, Spuch C, Gaspar P, Campos-Magdaleno M. Cognitive Frailty: An Update. Front Psychol. 2021;12:813398.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Bunt S, Steverink N, Olthof J, van der Schans CP, Hobbelen JSM. Social frailty in older adults: a scoping review. Eur J Ageing. 2017;14(3):323–34.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-156.

    PubMed 

    Google Scholar 

  • Proietti M, Cesari M. Frailty: What Is It? Adv Exp Med Biol. 2020;1216:1–7.

    PubMed 

    Google Scholar 

  • Hubbard RE, Peel NM, Samanta M, Gray LC, Mitnitski A, Rockwood K. Frailty status at admission to hospital predicts multiple adverse outcomes. Age Ageing. 2017;46(5):801–6.

    PubMed 

    Google Scholar 

  • Travers J, Romero-Ortuno R, Bailey J, Cooney MT. Delaying and reversing frailty: a systematic review of primary care interventions. The British journal of general practice : the journal of the Royal College of General Practitioners. 2019;69(678):e61–9.

    PubMed 

    Google Scholar 

  • Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, Ayala AP, Roy A, Rodríguez Monforte M, Bergman H, McGilton K. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing. 2017;46(3):383–92.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox Biol. 2020;35: 101513.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Sadjapong U, Yodkeeree S, Sungkarat S, Siviroj P. Multicomponent Exercise Program Reduces Frailty and Inflammatory Biomarkers and Improves Physical Performance in Community-Dwelling Older Adults: A Randomized Controlled Trial. Int J Environ Res Public Health. 2020;17(11):3760.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Goisser S, Guyonnet S, Volkert D. The Role of Nutrition in Frailty: An Overview. J Frailty Aging. 2016;5(2):74–7.

    PubMed 

    Google Scholar 

  • Khera S, Abbasi M, Dabravolskaj J, Sadowski CA, Yua H, Chevalier B. Appropriateness of Medications in Older Adults Living With Frailty: Impact of a Pharmacist-Led Structured Medication Review Process in Primary Care. J Prim Care Community Health. 2019;10:2150132719890227.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Cheng MH, Chang SF. Frailty as a Risk Factor for Falls Among Community Dwelling People: Evidence From a Meta-Analysis. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2017;49(5):529–36.

    PubMed 

    Google Scholar 

  • Negm AM, Kennedy CC, Thabane L, Veroniki AA, Adachi JD, Richardson J, Cameron ID, Giangregorio A, Petropoulou M, Alsaad SM, et al. Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. J Am Med Dir Assoc. 2019;20(10):1190–8.

    PubMed 

    Google Scholar 

  • Sun X, Liu W, Gao Y, Qin L, Feng H, Tan H, Chen Q, Peng L, Wu IXY. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age Ageing. 2023;52(2):afad004.

    Google Scholar 

  • Mudge AM, Hubbard RE. Frailty: mind the gap. Age Ageing. 2018;47(4):508–11.

    PubMed 

    Google Scholar 

  • Thomson KH, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O’Keefe H, Mohammed W, et al. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. The Lancet Healthy Longevity. 2022;3(10):e654–66.

    PubMed 

    Google Scholar 

  • Moraes MB, Avgerinou C, Fukushima FB, Vidal EIO. Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials. Nutr Rev. 2021;79(8):889–913.

    PubMed 

    Google Scholar 

  • Han CY, Miller M, Yaxley A, Baldwin C, Woodman R, Sharma Y. Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis. BMJ Open. 2020;10(12): e040146.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Huang CY, Mayer PK, Wu MY, Liu DH, Wu PC, Yen HR. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev. 2022;82: 101747.

    PubMed 

    Google Scholar 

  • Weng WH, Cheng YH, Yang TH, Lee SJ, Yang YR, Wang RY. Effects of strength exercises combined with other training on physical performance in frail older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2022;102: 104757.

    PubMed 

    Google Scholar 

  • Daryanti Saragih I, Yang YP, Saragih IS, Batubara SO, Lin CJ. Effects of resistance bands exercise for frail older adults: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs. 2022;31(1–2):43–61.

    PubMed 

    Google Scholar 

  • Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Tarazona-Santabalbina FJ, Gómez-Cabrera MC, Pérez-Ros P, Martínez-Arnau FM, Cabo H, Tsaparas K, Salvador-Pascual A, Rodriguez-Mañas L, Viña J. A Multicomponent Exercise Intervention that Reverses Frailty and Improves Cognition, Emotion, and Social Networking in the Community-Dwelling Frail Elderly: A Randomized Clinical Trial. J Am Med Dir Assoc. 2016;17(5):426–33.

    PubMed 

    Google Scholar 

  • Oliveira Gonçalves Id, Bandeira AN, Coelho-Júnior HJ, Silva Aguiar Sd, Minucci Camargo S, Yukio Asano R, Batista Júnior ML. Multicomponent Exercise on Physical Function, Cognition and Hemodynamic Parameters of Community-Dwelling Older Adults: A Quasi-Experimental Study. Int J Environ Res Public Health. 2019;16(12):2184. https://doi.org/10.3390/ijerph16122184.

  • Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS: American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009, 41(7):1510–1530.

  • Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.

    Google Scholar 

  • Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355: i4919.

    PubMed 
    PubMed Central 

    Google Scholar 

  • McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2020;12(1):55–61. https://doi.org/10.1002/jrsm.1411.

    Article 
    PubMed 

    Google Scholar 

  • Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane; 2024. Available from https://www.training.cochrane.org/handbook.

  • Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. Available from https://guidelinedevelopment.org/handbook.

  • Moreira NB, Rodacki ALF, Costa SN, Pitta A, Bento PCB. Perceptive-Cognitive and Physical Function in Prefrail Older Adults: Exergaming Versus Traditional Multicomponent Training. Rejuvenation Res. 2021;24(1):28–36.

    PubMed 

    Google Scholar 

  • Merchant RA, Tsoi CT, Tan WM, Lau W, Sandrasageran S, Arai H. Community-Based Peer-Led Intervention for Healthy Ageing and Evaluation of the “HAPPY” Program. J Nutr Health Aging. 2021;25(4):520–7.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Garcia R, Costa SN, Garcia E, Bento PCB. Does Home-Based Exercise Improve the Physical Function of Prefrail Older Women? Rejuvenation Res. 2021;24(1):6–13.

    PubMed 

    Google Scholar 

  • Costa SN, Vieira ER, Bento PCB. Effects of Home- and Center-Based Exercise Programs on the Strength, Function, and Gait of Prefrail Older Women: A Randomized Control Trial. J Aging Phys Act. 2020;28(1):122–30.

    PubMed 

    Google Scholar 

  • Yu R, Leung G, Woo J. Randomized Controlled Trial on the Effects of a Combined Intervention of Computerized Cognitive Training Preceded by Physical Exercise for Improving Frailty Status and Cognitive Function in Older Adults. Int J Environ Res Public Health. 2021;18(4):1396. https://doi.org/10.3390/ijerph18041396.

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial. J Am Med Dir Assoc. 2016;17(7):671.e679-671.e616.

    Google Scholar 

  • Gené Huguet L, Navarro González M, Kostov B, Ortega Carmona M, Colungo Francia C, Carpallo Nieto M, Hervás Docón A, Vilarrasa Sauquet R, García Prado R, Sisó-Almirall A. Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly. J Nutr Health Aging. 2018;22(10):1266–74.

    PubMed 

    Google Scholar 

  • Courel-Ibáñez J, Buendía-Romero Á, Pallarés JG, García-Conesa S, Martínez-Cava A, Izquierdo M. Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents’ Functional Capacity. J Am Med Dir Assoc. 2022;23(1):98-104.e103.

    PubMed 

    Google Scholar 

  • Carnavale BF, da Silva Santos VR, Farche ACS, Rossi PG, Fiogbé E, de Souza Buto MS, de Vassimon-Barroso V, de Medeiros Takahashi AC. Effects of a multicomponent training and detraining on frailty status, physical activity level, sedentary behavior patterns and physical performance of pre-frail older adults: a randomized controlled trial. Eur Geriatr Med. 2024. https://doi.org/10.1007/s41999-024-01052-4.

  • Cesari M, Vellas B, Hsu FC, Newman AB, Doss H, King AC, Manini TM, Church T, Gill TM, Miller ME, Pahor M. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. J Gerontol A Biol Sci Med Sci. 2015;70(2):216–22.

    PubMed 

    Google Scholar 

  • Ferreira CB, Teixeira PDS. Alves Dos Santos G, Dantas Maya AT, Americano do Brasil P, Souza VC, Córdova C, Ferreira AP, Lima RM, Nóbrega OT: Effects of a 12-Week Exercise Training Program on Physical Function in Institutionalized Frail Elderly. J Aging Res. 2018;2018:7218102.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Arrieta H, Rezola-Pardo C, Gil SM, Virgala J, Iturburu M, Antón I, González-Templado V, Irazusta J, Rodriguez-Larrad A. Effects of Multicomponent Exercise on Frailty in Long-Term Nursing Homes: A Randomized Controlled Trial. J Am Geriatr Soc. 2019;67(6):1145–51.

    PubMed 

    Google Scholar 

  • Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, Palomera E, Tarradelles M, Papiol M. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial. Age Ageing. 2017;46(3):401–7.

    PubMed 

    Google Scholar 

  • Seesen M, Semmarath W, Yodkeeree S, Sapbamrer R, Ayood P, Malasao R, Ongprasert K, Chittrakul J, Siviroj P, Limtrakul P. Combined Black Rice Germ, Bran Supplement and Exercise Intervention Modulate Aging Biomarkers and Improve Physical Performance and Lower-Body Muscle Strength Parameters in Aging Population. Int J Environ Res Public Health. 2020;17(8):2931. https://doi.org/10.3390/ijerph17082931.

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Chiu TY, Yu HW. Associations of multicomponent exercise and aspects of physical performance with frailty trajectory in older adults. BMC Geriatr. 2022;22(1):559.

    PubMed 
    PubMed Central 

    Google Scholar 

  • García-Vigara A, Fernandez-Garrido J, Carbonell-Asíns JA, Sánchez-Sánchez ML, Monllor-Tormos A, García-Pérez MA, Tarín JJ, Cano A. Physical activity to reduce the burden of frailty after menopause: effectiveness and adherence rate of a resource saving exercise plan. Menopause. 2024;31(7):634–40.

    PubMed 

    Google Scholar 

  • Biesek S, Vojciechowski AS, Filho JM, Menezes Ferreira ACRd, Borba VZC, Rabito EI, Gomes ARS. Effects of Exergames and Protein Supplementation on Body Composition and Musculoskeletal Function of Prefrail Community-Dwelling Older Women: A Randomized, Controlled Clinical Trial. Int J Environ Res Public Health. 2021;18(17):9324. https://doi.org/10.3390/ijerph18179324.

  • Guerville F, de Souto BP, Giudici KV, Rolland Y, Vellas B. Association of 3-Year Multidomain Intervention and Omega-3 Supplementation with Frailty Incidence. J Am Geriatr Soc. 2019;67(8):1700–6.

    PubMed 

    Google Scholar 

  • Na W, Kim J, Kim H, Lee Y, Jeong B, Lee SP, Sohn C. Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly. Clin Nutr Res. 2021;10(1):24–35.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Barrachina-Igual J, Martínez-Arnau FM, Pérez-Ros P, Flor-Rufino C, Sanz-Requena R, Pablos A. Effectiveness of the PROMUFRA program in pre-frail, community-dwelling older people: A randomized controlled trial. Geriatr Nurs. 2021;42(2):582–91.

    PubMed 

    Google Scholar 

  • Casas-Herrero Á, Sáez de Asteasu ML, Antón-Rodrigo I, Sánchez-Sánchez JL, Montero-Odasso M, Marín-Epelde I, Ramón-Espinoza F, Zambom-Ferraresi F, Petidier-Torregrosa R, Elexpuru-Estomba J et al: Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial. J Cachexia Sarcopenia Muscle 2022, 13(2):884–893.

  • Chan DD, Tsou HH, Chang CB, Yang RS, Tsauo JY, Chen CY, Hsiao CF, Hsu YT, Chen CH, Chang SF, et al. Integrated care for geriatric frailty and sarcopenia: a randomized control trial. J Cachexia Sarcopenia Muscle. 2017;8(1):78–88.

    PubMed 

    Google Scholar 

  • Liao YY, Chen IH, Wang RY. Effects of Kinect-based exergaming on frailty status and physical performance in prefrail and frail elderly: A randomized controlled trial. Sci Rep. 2019;9(1):9353.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Liu Z, Hsu FC, Trombetti A, King AC, Liu CK, Manini TM, Fielding RA, Pahor M, Newman AB, Kritchevsky S, Gill TM. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC Med. 2018;16(1):185.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Cameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N, Aggar C, Sherrington C, Lord SR, Kurrle SE. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med. 2013;11:65.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Seino S, Nishi M, Murayama H, Narita M, Yokoyama Y, Nofuji Y, Taniguchi Y, Amano H, Kitamura A, Shinkai S. Effects of a multifactorial intervention comprising resistance exercise, nutritional and psychosocial programs on frailty and functional health in community-dwelling older adults: A randomized, controlled, cross-over trial. Geriatr Gerontol Int. 2017;17(11):2034–45.

    PubMed 

    Google Scholar 

  • Ng TP, Feng L, Nyunt MS, Feng L, Niti M, Tan BY, Chan G, Khoo SA, Chan SM, Yap P, Yap KB. Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial. Am J Med. 2015;128(11):1225-1236.e1221.

    PubMed 

    Google Scholar 

  • Badrasawi M, Shahar S, Zahara AM, Nor Fadilah R, Singh DK. Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial. Clin Interv Aging. 2016;11:1675–86.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Kim H, Suzuki T, Kim M, Kojima N, Ota N, Shimotoyodome A, Hase T, Hosoi E, Yoshida H. 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. PLoS ONE. 2015;10(2): e0116256.

    PubMed 
    PubMed Central 

    Google Scholar 

  • Kara M, Kaymak B, Ata AM, Özkal Ö, Kara Ö, Baki A, Şengül Ayçiçek G, Topuz S, Karahan S, Soylu AR, et al. STAR-Sonographic Thigh Adjustment Ratio: A Golden Formula for the Diagnosis of Sarcopenia. Am J Phys Med Rehabil. 2020;99(10):902–8.

    PubMed 

    Google Scholar 

  • Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–9.

    PubMed 

    Google Scholar 

  • Khant N, Dani VB, Patel P, Rathod R. Establishing the reference value for “timed up-and-go” test in healthy adults of Gujarat. India J Educ Health Promot. 2018;7:62.

    PubMed 

    Google Scholar 

  • Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017;18(7):564–75.

    PubMed 

    Google Scholar 

  • World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017. https://iris.who.int/handle/10665/258981.

  • Liao C-D, Chen H-C, Huang S-W, Liou T-H. The Role of Muscle Mass Gain Following ProteinSupplementation Plus Exercise Therapy in Older Adults with Sarcopenia and Frailty Risks: A Systematic Review and Meta-Regression Analysis of Randomized Trials. Nutrients. 2019;11(8):1713. https://doi.org/10.3390/nu11081713.

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Khor PY, Vearing RM, Charlton KE. The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults: A systematic review. J Hum Nutr Diet. 2022;35(3):566–82.

    PubMed 

    Google Scholar 

  • Golder S, Loke YK, Wright K, Norman G: Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review. PLoS medicine 2016, 13(9):e1002127.

  • Page MJ, McKenzie JE, Kirkham J, Dwan K, Kramer S, Green S, Forbes A: Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions. The Cochrane database of systematic reviews 2014, 2014(10):Mr000035.

  • Cruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019;393(10191):2636–46.

    Google Scholar 

  • Negm AM, Kennedy CC, Thabane L, Veroniki A-A, Adachi JD, Richardson J, Cameron ID, Giangregorio A, Papaioannou A. Management of frailty: a protocol of a network meta-analysis of randomized controlled trials. Syst Rev. 2017;6(1):130.

    PubMed 
    PubMed Central 

    Google Scholar 


  • Leave a Reply

    Your email address will not be published. Required fields are marked *