Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial

Objectives: To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. Design: A randomized controlled trial with a 1:1 allocation. Setting: Home-based. Participants: Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2 +/- 6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met >= 3 criteria. Interventions: A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149). Main Outcome Measures: FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months. Results: FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity. Conclusions: One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength. (C) 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.