Effect of Physical Exercise on Frailty in Older Nursing Home Residents: A Systematic Review and Meta-Analysis

Background: Physical exercise is a key strategy for mitigating frailty and attenuating the decline in physical, cognitive, and psychological functions associated with frailty. This meta-analysis evaluated the effects of physical exercise programs on frailty and frailty-related outcomes in institutional settings. Methods: A systematic search was conducted across CINAHL, Cochrane Library, PubMed, EMBASE, OVID Medline, and two trial registration websites (ClinicalTrials.gov and WHO ICTRP). Randomized controlled trials investigating the influence of physical exercise on frail older adults residing in nursing homes were included in the analysis. Results: A total of 20 out of 183 articles met the inclusion criteria for the final review. The final sample comprised 1701 participants. This meta-analysis demonstrated significant improvements in measures of frailty (p < 0.001), physical function (p < 0.001), and cognitive function (p = 0.04). This study's results reported improvements exceeding the minimal clinical important difference (MCID) for several key outcomes, including the Fried frailty phenotype, physical functions (the Sit-to-Stands Test, the Time Up and Go Test, the Short Physical Performance Battery, and the Gait speed), and cognitive function as measured by the Mini-Mental State Examination. In contrast, improvements in handgrip strength, functional reach, and the Montreal Cognitive Assessment did not reach the MCID threshold. Subgroup analyses revealed that interventions involving ≥ 3 sessions/week for ≥ 15 weeks, totaling > 2000 min were associated with notable enhancements in overall functions. Conclusions: In summary, our results indicate that a sustained and intensive physical exercise intervention may improve measures of frailty, physical and cognitive function in frail older nursing home residents.