Multi-modal exercise programs for older adults

Background: various modalities of exercise have been demonstrated to improve physical function and quality of fife in older adults. Current guidelines stress the importance of multi-modal exercise for this cohort, including strengthening exercises, cardiovascular, flexibility and balance training. There is a lack of evidence, however, that simultaneously prescribed doses and intensities of strength, aerobic, and balance training in older adults are both feasible and capable of eliciting changes in physical function and quality of life. Methods: a comprehensive, systematic database search for manuscripts was performed. Two reviewers independently assessed studies for potential inclusion. Physical and functional performance outcomes were extracted. The relative effect sizes (ES) were calculated with 95% confidence intervals. Results: fifteen studies were included totalling 2,149 subjects; the mean cohort age ranging from 67 +/- 8 to 84 +/- 3 years. A low mean relative ES for strength was seen across the reviewed studies. Only six of the eleven studies that included balance measurements found a significant improvement in balance compared to controls. Aerobic fitness was seldom measured or reported. Five out of the six studies investigating fall rates showed a significant reduction. Functional and quality of life measures generally did not improve with exercise. Conclusion: multi-modal exercise has a positive effect on falls prevention. The limited data available suggests that multi-modal exercise has a small effect on physical, functional and quality of life outcomes. Future research should include robustly designed trials that involve multi-modal exercise at individually prescribed intensities based on doses found to be effective in single-modality studies.