Mobility training for increasing mobility and functioning in older people with frailty

Frailty is a condition characterized by a progressive deterioration of multiple body systems, which diminishes physiological reserve and increases vulnerability. Epidemiological studies indicate that 21% of people over age 65 living in the community can be characterized as frail, and an additional 48% can be characterized as pre-frail.

Individuals with frailty are more prone to experience falls, a decrease in mobility, a decline in functioning, impaired activities of daily living, and death. This puts an increasing economic burden on individuals, families, and society. In this scenario, rehabilitation aims to contain the decrease in mobility and functioning, reduce morbidity and mortality, and prevent hospital admissions.

Modern guidelines state that physical activity should be recommended to all older people who have been identified as frail, but not enough evidence supports any specific exercise as more effective in this population. Furthermore, the safety of these exercises is unclear.

This review investigated whether mobility training improves mobility and function and whether it is safe, in older individuals with frailty living in the community.

This review is important for

Older people with frailty and their families, as this intervention, has the potential to reduce hospitalization or admission to residential care facilities. Furthermore, this review may provide a compendium for health professionals, general practitioners, researchers, and policymakers.

Outcomes of this review

This is a new Cochrane Systematic Review (CSR), published in 2022. The outcomes analyzed were mobility, functioning, adverse events, admission to a nursing care facility, falls, deaths, and costs.

The CSR included 12 randomized controlled trials (RCTs) published and/or registered up to June 2021, with a total of 1,317 adult participants over 60 years old. Results showed that, compared to usual care or to a non-active intervention, mobility training led to a clinically significant improvement in mobility at the end of the intervention period and at six months. Moreover, mobility training probably slightly improves function at the end of the intervention but not at six months. The review authors are uncertain whether mobility training produced an effect on adverse events as the certainty of the evidence was very low. Mobility training may result in little to no difference in nursing care admissions, falls, or death rates at the end of the intervention.

These results must be interpreted with caution because (i) only three studies reported on falls, making it difficult to draw conclusions about this outcome; (ii) the method used to monitor adverse events was inconsistent between studies; (iii) interventions were not accurately described, thus limiting their replicability; and (iv) the level of frailty for each patient was not accurately reported, making it difficult to determine if that level would affect the results.

Author’s conclusion of the review

In comparison to control, older individuals with frailty who undergo mobility training will improve their mobility and may improve their functioning, since the evidence for the respective outcomes was high and moderate. Furthermore, the improvement in mobility will persist at six months. On the other hand, mobility training may make little to no difference in preventing falls, admissions to nursing care, or death. The authors were uncertain whether mobility training produced an effect on adverse events as the certainty of the evidence was very low.

Future recommendations

The authors recommended that large-scale, multi-center studies are needed, particularly (a) to find out the effectiveness of mobility training on older individuals with frailty who also show cognitive impairment, and (b) to assess how different types of exercise interventions may be effective on mobility and functional outcomes. (c) Further studies also should provide long-term follow-up to assess whether the effects of the intervention can be maintained over time. (d) Moreover, adverse events, admissions to care facilities, and falls should be systematically inquired.

Robin Kuruvila Sentinella