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Table 3 Summary of trial characteristics, interventions, and relevant outcomes

From: Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults

Author and publication year Origin Participants Intervention Relevant outcome measures
Design Mean age (years) Intervention site Results
Sample size (n) Sex (male/female) Duration  
Drop out (D n)   Frequency training program  
Adherence rate (AR%)    
Alexander et al., 2001 [9] USA RCT Total n = 161 FG n = 81 CG n = 80 D n = 37 AR = 81 % FG = 82 ± 6 CG = 82 ± 6 FG n = 13/68 CG n = 10/70 Congregate housing facilities. Twelve weeks, 60 min per session. Three times per week. FG: Bed- and chair-rise task-specific resistance training intervention. Three reps for each task at a comfortable rate. Adjusting weight or chair height to increase challenge. CG: Flexibility exercises. Isometric strength tests. Trunk lateral balance. Bed-rise and chair-rise task assessment. The training effects on trunk flexion/extension strength (Cohen’s d = 0.22 and 0.16) and lateral balance (Cohen’s d = 0.83) were significant. The effect on bed- and chair-rise task performance is evident in poor performers at baseline; the training significantly decreased bed- and chair-rise time for 0.5–1.5 s (effect sizes range from 0.11 to 0.20).
Clemson et al., 2012 [13] Australia RCT Total n = 317 FG n = 107 SBG n = 105 CG n = 105 D n = 81 FG D n = 24 SBG D n = 18 CG D n = 19 AR = 43 % FG AR = 47 % SBG AR = 35 % CG AR = 47 % FG = 83 ± 4 SBG = 84 ± 4 CG = 83 ± 4 FG = 48/59 SBG n = 48/57 CG n = 47/58 Home. Six months. Multiple times a day for FG; 3 times per week for SBG. FG: Movements specifically prescribed to improve balance or increase strength are embedded within everyday activities. SBG: Seven exercises for balance and six for lower limb strength using ankle cuff weights. FG and SBG were taught over five sessions with two booster sessions and two follow-up phone calls. Both programs were prescribed, tailored, and upgraded. CG: 12 gentle and flexibility seated exercise. The CG was taught over two sessions with one booster session, and six follow-up phone calls. The exercise was not upgraded. Isometric lower limb strength. Static and dynamic balance. Late-life Function and Disability Index. There were no group differences in knee and hip muscle strength outcomes. Both FG and SBG showed significant improvement in right/left ankle strength (effect size = 0.40/0.40 and 0.26/0.17, respectively). FG showed moderate effect sizes (0.42–0.63) in balance measures while SBG showed small to moderate effect sizes (0.29–0.49). Compared with CG, the FG had 31 % reduction in the rate of falls, and the SBG had 19 %. FG showed a large effect size in the Late Life Function Index (0.73) while SBG showed a moderate effect size (0.41). FG showed a moderate effect size in the Late Life Disability Frequency Index (0.49) while SBG showed a nonsignificant effect (0.17). Note that these outcomes included 12 month follow-ups.
Cress et al., 1996 [46] USA Two groups, pre-post tests. Total n = 13 FG n = 7 CG n = 6 D n = 0 AR = 86 % FG = 70 ± 4 CG = 73 ± 7 Sex n = 0/13 NS. 50 Weeks, 60 min per session. Three times per week. FG: Combined aerobic and resistance training. 10 min warm-up and stretch, 20 min stair climbing with weighted backpacks (10 % of body weight), and 30 min of endurance dance. CG: NS. Isokinetic strength. Stair performance. The training significantly increased muscle strength (effect size = 6.3). A significant positive relationship between muscle strength and maximal step height (eta2 = 0.65).
de Vreede et al., 2005 [35] The Netherlands RCT Total n = 98 SG n = 34 FG n = 33 CG n = 31 D n = 14 SG AR = 74 % FG AR = 83 % SG = 75 ± 4 FG = 75 ± 4 CG = 73 ± 3 Sex n = 0/98 Local leisure center. Twelve weeks, 60 min per session. Three times per week. Ten minutes warm-up, 40 min core exercise, and 10 min cool-down. Both FG and RG exercise at high intensity. SG: Progressive resistance strength training using dumbbells and elastic tubing. 10 reps/3 sets. FG: Exercise phase-moving with vertical and horizontal components, carrying an object, changing between lying, sitting, and standing position. 5–10 reps. Increasing speed and weight. Daily task phase—combining training components in the exercise phase to make training tasks similar to daily tasks. CG: No active or placebo intervention was prescribed. Isometric muscle strength, leg extension power, and grip strength. TUG. ADAP. FG improved in leg extensor power (mean change = 11.2 W) and the ADAP (mean change = 6.8). The effects were sustained 6 months after training. SG showed no improvement in the ADAP (mean change = 3.2), but increased knee extensor strength (mean change = 23.7 N) and leg extensor power (mean change = 10.8 W). No training effect on TUG.
Dobek et al., 2006 [17] USA One group with a control period. Total n = 14 D n = 0 AR = 85 % 82 ± 4 Sex n = 4/10 Retirement community. Ten weeks. Two times per week. Five to 10 min warm-up and cool-down. The training consisted of multistation exercises: sit-to-stand, stair climbing, laundry, grocery shopping, vacuuming, sweeping, dressing, traveling, and recovering from a fall. Two minutes on each station. Senior Fitness Test. Physical Performance test. Physical-Functional Performance-10. The training improved 3 items on the Senior Fitness Test (arm curl, chair stand, and 6-min walk) (improvements range from 11 to 33 %), and Physical Performance test and Physical Functional Performance-10 (improvements range from 7 to 31 %).
Gillies et al., 1999 [7] UK RCT Total n = 20 FG n = 10 CG n = 10 D n = 5 AR = 92 % FG = 88 ± 5 CG = 87 ± 4 FG n = 0/10 CG n = 1/9 Residential home. Twelve weeks. Two times per week. FG: 7 min warm-up, 8 circuits focused on walking, stair decent, stair ascent, chair rising, and trunk stretches. CG: The control group received reminiscing sessions, crossword puzzles, games, and gentle seated range-of-motion exercises, 2 times per week for 12 weeks. Four functional tests: stair ascent, stair descent, chair rising, and walking. FG significantly improved in walking distance (2 to 5 m more than CG). No group differences in chair rise, and stair ascent and decent.
Giné-Garriga et al., 2010 [51] Spain RCT Total n = 51 FG = 26 CG = 25 FG D = 4 CG D = 6 FG AR = 90 % CG AR = 76 % Participants FG = 84 ± 3 CG = 84 ± 3 FG n = 9/13 CG n = 7/12 Primary care facility Twelve weeks, 45 min per session. Two times per week. FG: 10 min warm-up, 30 min of exercises, 5 min cool-down. One day of balance-based exercises (static and dynamic balance training, varying gait patterns speed) with function focused activities (walking with obstacles, walking and carrying a package, walking and picking up objects from the floor). One day of lower body strength-based exercises with function focused activities (chair rise, stair climb, knee bends, floor transfer, lunges, leg squat, leg extension, leg flexion, calf raise, and abdominal curl). Load was added to increase intensity. CG: The CG met one time per week for social meetings. Lower body strength. Semitandem and tandem stands. Gait speed. Chair stand. Modified TUG. Barthel Index. Compared to the CG, the FG significantly improved in all outcomes after training (Cohen’s d ranges from −6.62 to 7.76). The effects on the Barthel Index, gait speed, and chair stand were sustained 6 months after training.
Helbostad et al., 2004 [8] Norway Two group, randomized trial Total n = 77 HT = 38 CT = 39 D n = 11 HT D n = 6 CT D n = 5 Group session HT AR = 83 % CT AR = 88 % Home program HT AR = 65 % CT AR = 68 % HT = 81 ± 4 CT = 81 ± 5 HT n = 7/31 CT n = 8/31 Home. NS for group sessions. Twelve weeks, 60 min per session HT: Home exercises twice per day. CT: Group session two times per week and home exercises twice per day. HT: 10 reps twice daily. Chair rise, standing rise to tiptoe, one leg standing with knee flexion on weight bearing leg, and one leg standing with hip flexion of non-weight bearing leg. CT: 10 min warm-up, 20 min progressive strength training, 20 min functional balance training, 10 min relaxation and stretching. Strength training exercises include 10 reps/3 sets of chair rise, stepping in different directions and heights, rising to tip-toe, and knee bending. Load was added to increase intensity. Balance training includes standing, walking on flat surface and over obstacles, walking upstairs, and carrying objects. Instructed to perform same home exercises as HT group. Isometric muscle strength of quadriceps. Walking speed. Sit-to-stand. TUG. Barthel Index. Both groups significantly improved from baseline to 3 months, except isometric muscle strength. There were no differences between groups at 3 months. The HT showed stronger leg strength than CT at 9 months (Cohen’s d = 0.59).
Krebs et al., 2007 [18] USA RCT Total n = 15 FG n = 9 SG n = 6 D n = 0 AR = 100 % FG = 78 ± 5 SG = 70 ± 7 FG n = 3/6 SG n = 2/4 Outpatient PT. Six weeks, 50 min per session. Three to five times per week. Ten minutes warm-up, 30 min exercise, and 10 min cool-down. FG: Exercises simulating locomotor ADL (e.g., chair rise, reach) performed at 3 different speeds with progressive levels of difficulty. SG: Progressive resistance training in hip, knee, and ankle muscles. 10 rep maximum. All exercised were conducted in seating positions. Lower-extremity isometric muscle strength. Quiet standing balance. Chair rise. Gait speed. SF 36. Both groups improved in lower-extremity strength, standing balance, chair rise, and SF 36. No group differences were found in these measures. The FG showed a greater improvement in gait velocity.
Littbrand et al., 2009 [1] Sweden RCT Total n = 191 FG n = 91 CG n = 100 D n = 25 AR = 72 % FG = 85 ± 6 CG = 84 ± 7 FG n = 24/67 CG n = 28/72 Residential care facilities. Thirteen weeks, 45 min per session. Five times every 2 weeks. FG: The exercises included lower-limb strength and balance exercises, in standing and walking, performed at a high intensity. The exercises also mimicked movements used in everyday tasks: standing up from a sitting position, step-ups, squats, turning trunk and head while standing, and walking over obstacles. CG: The CG received the control activity program which included activities while sitting, such as reading or watching a film. Barthel Index. The training improved indoor mobility in FG, but no group differences were found in the total Barthel Index score. The training effect on the Barthel Index was found in participants with dementia at 3 months (effect size = 0.47) but not 6 months.
Manini et al., 2007 [12] USA RCT with a control period Total n = 43 SG n = 14 FG n = 11 SFG n = 18 D n = 11 SG D n = 3 FG D n = 1 SFG D n = 7 AR = 100 % SG = 74 ± 11 FG = 79 ± 7 SFG = 74 ± 7 SG n = 1/10 FG n = 0/10 SFG n = 1/10 A training facility. Ten week, 30–45 min per session. Two times per week. SG: Progressive resistance strength training. 10 rep maximum. Using exercise machines. Three upper body and three lower boy exercises. FG: Five functional exercises: rising from a chair, rising from a kneeling position, stair climbing, vacuuming a carpet with a weighted vacuum cleaner, and lifting and carrying a weighted laundry basket. SFG: 1 day of strength exercises and 1 day of functional exercises. Isokinetic dynamometer. Single-leg balance. Gait speed. Short-form 12 (self-report physical function). Performance test on eight tasks. Greater improvement in arm muscle strength was observed in SG and SFG than FG. No group differences were found in self-reported physical function, gait speed, time to vacuum, and single-leg balance. Both FG and SFG but not SG reduced times to perform 8 functional tasks, such as lifting a laundry basket.
Skelton et al., 1996 [31] UK Multiple baseline design, two groups and randomized Total n = 20 FG n = 10 CG n = 10 D n = 2 AR = 74 % Median = 81 Sex n = 0/19 Clinic and home. Eight weeks, 50–60 min per session. Three times per week (one supervised by a PT in a clinic, two unsupervised at home). FG: 10 min warm-up and stretch, 30–40 min strength component, and 10 min cool-down. The exercise mimicked functional ability tasks and balance tests: floor exercises, and getting up off the chair and walking, following a progressive resistance protocol. 4–8 reps/1–3 sets. CG: No active or placebo intervention was prescribed. Isometric knee extensor strength. One-leg standing balance. Lifting a 2-kg bag on to a shelf. Chair rise. TUG. 6.1 m walk. Floor rise. Star climbing. Getting into and out of a bath. The training significantly increased knee extensor strength, improved balance, decreased time rise from a chair (single time), time to rise from the floor, and time to walk up and down a staircase, and improved TUG. No effects on lifting a bag, time to rise out of a low chair 10 times, time to get in and out of a bath or time to walk 6.1 m.
Whitehurst et al., 2005 [38] USA One group, pre-post tests Total n = 119 D n = NS AR = 83 % 73 ± 5 Sex n = NS NS. Twelve weeks. Three times per week. Ten functional exercises: wall exercise, single leg balance, cross-legged seated torso, modified push-up, crunch, superman, stretch and balance, weight transfer, v-sit, and star exercise. One min per exercise. Circuit format. 10–30 reps/3 sets. High intensity. Balance on standing reach. Sit-to-stand. TUG. SF 36. The training significantly improved TUG, standing reach, and self-reported physical functioning in SF36 (percentage change = 8.4, 12.9, and 8.5, respectively). The sit-to-stand outcome was not significant.
  1. ADAP Assessment of Daily Activity Performance, ADL (s) activities of daily living, CG control group, CT combined training, FG functional training group, HT home training, NS not specified, PT physical therapist, rep repetition, RCT randomized controlled trials, SBG strength plus balance training group, SF 36 Short Form 36, SFG strength plus functional training group, SG strength training group, TUG timed up and go test