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Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Background

Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old).

Objective

To analyze the safety and effectiveness of long-term exercise interventions in older adults.

Methods

We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints).

Results

Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95–1.17) or mortality (RR = 0.93, 95% CI 0.83–1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48–0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants’ baseline characteristics (age, physical function, and cognitive status) and exercise frequency.

Conclusions

Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.

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Data Availability Statement

The data that support the findings of this review are available on request from the corresponding author (Mikel Izquierdo).

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Authors and Affiliations

  1. Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain

    Antonio García-Hermoso, Robinson Ramirez-Vélez, Mikel L. Sáez de Asteasu, Nicolás Martínez-Velilla, Fabricio Zambom-Ferraresi & Mikel Izquierdo

  2. Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, Santiago, Chile

    Antonio García-Hermoso

  3. CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain

    Antonio García-Hermoso, Robinson Ramirez-Vélez, Mikel L. Sáez de Asteasu, Nicolás Martínez-Velilla, Fabricio Zambom-Ferraresi, Alejandro Lucia & Mikel Izquierdo

  4. Department of Systems Biology, University of Alcalá, Madrid, Spain

    Pedro L. Valenzuela

  5. Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain

    Alejandro Lucia

  6. Research Institute of the Hospital 12 de Octubre (‘i + 12’), Madrid, Spain

    Alejandro Lucia

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  1. Antonio García-Hermoso
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  2. Robinson Ramirez-Vélez
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  8. Mikel Izquierdo
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Corresponding author

Correspondence to Mikel Izquierdo.

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Funding

This work was supported by the Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES) and FEDER funds from the European Union. It was further funded by a grant from the Spanish Ministry of Economy, “Ministerio de Economía y Competitividad,” Instituto de Salud Carlos III, FEDER, (PI17/01814). AGH is a Miguel Servet Fellow (Instituto de Salud Carlos III-CP18/0150). NM-V received funding from “la Caixa” Foundation (ID 100010434), under agreement LCF/PR/PR15/51100006.

Conflicts of Interest

Antonio García-Hermoso, Robinson Ramirez-Vélez, Mikel López Sáez de Asteasu, Nicolás Martínez-Velilla, Fabricio Zambom-Ferraresi, Pedro Valenzuela, Alejandro Lucia and Mikel Izquierdo declare that they have no conflicts of interest relevant to the content of this review.

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García-Hermoso, A., Ramirez-Vélez, R., Sáez de Asteasu, M.L. et al. Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sports Med 50, 1095–1106 (2020). https://doi.org/10.1007/s40279-020-01259-y

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