Evidence on non-pharmacological interventions for preventing or reversing physical frailty in community-dwelling older adults aged over 50 years: overview of systematic reviews.

Abstract

Background: A large proportion of older adults are pre-frail. Interventions aimed at this group provide opportunity to reduce progression of physical frailty. The aim of this overview of reviews is to evaluate evidence for non-pharmacological interventions for the prevention/reversal of physical frailty in community-dwelling adults aged ≥ 50 years.

Methods: Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, Google Scholar and Social Science Citation Index were searched for non-pharmacological interventions that used a validated frailty measurement tool. Review quality was assessed using AMSTAR-2 and a Synthesis Without Meta-analysis (SWiM) approach was adopted.

Results: Twenty-three reviews were included, six of which were of high quality. This included 18,768 unique participants from 98 unique primary studies. Physical activity containing an aspect of resistance training, for a minimum of twice per week, was evidenced as being beneficial for reversing frailty (28 primary studies and 3,246 unique participants). However, one randomised controlled trial (RCT) showed resistance training by pre-frail adults (n = 66) for eight weeks was not effective at reversing frailty status. Nutrition interventions combined with physical activity that include resistance training (9 studies, 1,812 participants) were effective at reversing/preventing frailty.

Conclusion: The evidence synthesised in this overview of reviews suggests physical activity containing an aspect of resistance training is beneficial at reversing frailty status and preventing frailty progression. Nutrition interventions alone were inconclusive. It is recommended that future studies include a validated tool to assess frailty status, report samples by frailty status and make recommendations based on dose (frequency/duration of minutes per session) and adherence to dose.