Effects of multimodal agility-like exercise training compared to inactive controls and alternative training on physical performance in older adults: a systematic review and meta-analysis

Background Multimodal exercise training (MT) as a time-efficient training modality promotes a wide range of physical dimensions. Incorporating agility-like training aspects (coordination, changes of direction and velocity) into MT may further enhance physical outcomes highly relevant for activities of daily living. This meta-analysis investigated the effects of multimodal agility-like exercise training (MAT) on physical and cognitive performance compared to inactive (IC) and active controls (AC) in older adults. Methods Literature search was conducted in four health-related databases (PubMed, SCOPUS, SPORTDiscus and Web of Science). Randomized controlled trials with pre-post testing applying MAT (including aspects of training with at least two different traditional domains: strength, balance, endurance) and an agility-like component in community-dwelling older adults were screened for eligibility. Standardized mean differences (SMD) adjusting for small sample sizes (hedges' g) were used to extract main outcomes (strength, gait, balance, mobility, endurance, cognition). Statistical analysis was conducted using a random effects inverse-variance model. Results Twenty trials with 1632 older adults were included. All effects were significantly in favour of MAT compared to IC: Strength, mobility and endurance revealed large overall effects (SMD: 0.88, 0.84, 1.82). Balance showed moderate effects (SMD: 0.6). Small overall effects were observed for gait (SMD: 0.41). Few data were available to compare MAT vs. AC with negligible or small effects in favour of MAT. Funnel plots did not reveal clear funnel shapes, indicating a potential risk of bias. Conclusions MAT may serve as a time-efficient training modality to induce positive effects in different physical domains. Compared to isolated training, MAT allows equal effect sizes at lower overall training volumes. More studies are needed to investigate the potential value of MAT with systematic training and load control, especially compared to other exercise-based interventions.