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Meta-Analysis
. 2005 Jan 25;2005(1):CD004017.
doi: 10.1002/14651858.CD004017.pub2.

Home versus center based physical activity programs in older adults

N L Ashworth  1 , K E Chad, E L Harrison, B A Reeder, S C Marshall
Affiliations
Meta-Analysis

Home versus center based physical activity programs in older adults

N L Ashworth et al. Cochrane Database Syst Rev. .

Abstract

Background: Physical inactivity is a leading cause of preventable death and morbidity in developed countries. In addition physical activity can potentially be an effective treatment for various medical conditions (e.g. cardiovascular disease, osteoarthritis). Many types of physical activity programs exist ranging from simple home exercise programs to intense highly supervised hospital (center) based programs.

Objectives: To assess the effectiveness of 'home based' versus 'center based' physical activity programs on the health of older adults.

Search strategy: The reviewers searched the Cochrane Central Register of Controlled Trials (CENTRAL) (1991-present), MEDLINE (1966-Sept 2002), EMBASE (1988 to Sept 2002), CINAHL (1982-Sept 2002), Health Star (1975-Sept 2002), Dissertation Abstracts (1980 to Sept 2002), Sport Discus (1975-Sept 2002) and Science Citation Index (1975-Sept 2002), reference lists of relevant articles and contacted principal authors where possible.

Selection criteria: Randomised or quasi-randomised controlled trials of different physical activity interventions in older adults (50 years or older) comparing a 'home based' to a 'center based' exercise program. Study participants had to have either a recognised cardiovascular risk factor, or existing cardiovascular disease, or chronic obstructive airways disease (COPD) or osteoarthritis. Cardiac and post-operative programs within one year of the event were excluded.

Data collection and analysis: Three reviewers selected and appraised the identified studies independently. Data from studies that then met the inclusion/exclusion criteria were extracted by two additional reviewers.

Main results: Six trials including 224 participants who received a 'home based' exercise program and 148 who received a 'center based' exercise program were included in this review. Five studies were of medium quality and one poor. A meta-analysis was not undertaken given the heterogeneity of these studies. CARDIOVASCULAR. The largest trial (accounting for approximately 60% of the participants) looked at sedentary older adults. Three trials looked at patients with peripheral vascular disease (intermittent claudication). In patients with peripheral vascular disease center based programs were superior to home at improving distance walked and time to claudication pain at up to 6 months. However the risk of a training effect may be high. There are no longer term studies in this population. Notably home based programs appeared to have a significantly higher adherence rate than center based programs. However this was based primarily on the one study (with the highest quality rating of the studies found) of sedentary older adults. This showed an adherence rate of 68% in the home based program at two year follow-up compared with a 36% adherence in the center based group. There was essentially no difference in terms of treadmill performance or cardiovascular risk factors between groups. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). Two trials looked at older adults with COPD. In patients with COPD the evidence is conflicting. One study showed similar changes in various physiological measures at 3 months that persisted in the home based group up to 18 months but not in the center based group. The other study showed significantly better improvements in physiological measures in the center based group after 8 weeks but again the possibility of a training effect is high. OSTEOARTHRITIS. No studies were found. None of the studies dealt with measures of cost, or health service utilization.

Authors' conclusions: In the short-term, center based programs are superior to home based programs in patients with PVD. There is a high possibility of a training effect however as the center based groups were trained primarily on treadmills (and the home based were not) and the outcome measures were treadmill based. There is conflicting evidence which is better in patients with COPD. Home based programs appear to be superior to center based programs in terms of the adherence to exercise (especially in the long-term).

PubMed Disclaimer

Conflict of interest statement

We are currently conducting a CIHR funded randomized controlled trial of home versus center based exercise programs in older adults.

Figures

1.1
1.1. Analysis
Comparison 1 Cardiovascular, Outcome 1 Exercise participation (% of max available time).
1.2
1.2. Analysis
Comparison 1 Cardiovascular, Outcome 2 HDL Cholesterol.
1.3
1.3. Analysis
Comparison 1 Cardiovascular, Outcome 3 LDL Cholesterol.
1.4
1.4. Analysis
Comparison 1 Cardiovascular, Outcome 4 Total Cholesterol.
1.5
1.5. Analysis
Comparison 1 Cardiovascular, Outcome 5 Triglycerides.
1.6
1.6. Analysis
Comparison 1 Cardiovascular, Outcome 6 VO2 max.
1.7
1.7. Analysis
Comparison 1 Cardiovascular, Outcome 7 Treadmill duration (min).
2.1
2.1. Analysis
Comparison 2 COPD, Outcome 1 Quality of Life (General well‐being).
2.2
2.2. Analysis
Comparison 2 COPD, Outcome 2 Chronic respiratory questionaire.
2.3
2.3. Analysis
Comparison 2 COPD, Outcome 3 VO2 max.
2.4
2.4. Analysis
Comparison 2 COPD, Outcome 4 Treadmill duration (min).
2.5
2.5. Analysis
Comparison 2 COPD, Outcome 5 Heart rate maximum.
2.6
2.6. Analysis
Comparison 2 COPD, Outcome 6 PaO2 (end).
2.7
2.7. Analysis
Comparison 2 COPD, Outcome 7 PaCO2 (end).
2.8
2.8. Analysis
Comparison 2 COPD, Outcome 8 Leg Fatigue (Borg).
2.9
2.9. Analysis
Comparison 2 COPD, Outcome 9 FEV1.
2.10
2.10. Analysis
Comparison 2 COPD, Outcome 10 FVC.
2.11
2.11. Analysis
Comparison 2 COPD, Outcome 11 Total lung capacity.
2.12
2.12. Analysis
Comparison 2 COPD, Outcome 12 Functional residual capacity.
2.13
2.13. Analysis
Comparison 2 COPD, Outcome 13 Pulmonary transfer factor for CO.
2.14
2.14. Analysis
Comparison 2 COPD, Outcome 14 Max Inspiratory Pressure at residual volume.
2.15
2.15. Analysis
Comparison 2 COPD, Outcome 15 Max Expiratory Pressure at TLC.
2.16
2.16. Analysis
Comparison 2 COPD, Outcome 16 Pa O2.
2.17
2.17. Analysis
Comparison 2 COPD, Outcome 17 Pa CO2.
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Thomas 2002 {published data only}
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Urbscheit 2002 {published data only}
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Venkat 1998 {published data only}
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Wadden 1997 {published data only}
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Wadden 1998 {published data only}
    1. Wadden TA VRFGAD. Exercise and the maintenance of weight loss: 1‐year follow‐up of a controlled clinical trial. Journal of Consulting & Clinical Psychology 1998;66(2):429‐33. [MEDLINE: ] - PubMed
Walker 2000 {published data only}
    1. Walker RD NSWCSJPAWR. Influence of upper‐ and lower‐limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication. Journal of Vascular Surgery 2000;31(4):662‐9. [MEDLINE: ] - PubMed
Weinstock 1998 {published data only}
    1. Weinstock RS DH. Diet and exercise in the treatment of obesity: effects of 3 interventions on insulin resistance. Archives of Internal Medicine 1998;158(22):2477‐83. [MEDLINE: ] - PubMed
Wijkstra 1994 {published data only}
    1. Wijkstra PJ VA. Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. European Respiratory Journal 1994;7(2):269‐73. [MEDLINE: ] - PubMed
Wijkstra 1995 {published data only}
    1. Wijkstra PJ, Vergert EM, Altena R, Otten V, Kraan J, Postma DS, Koeter GH. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax 1995;50(8):824‐8. [MEDLINE: ] - PMC - PubMed
Wijkstra 1996 {published data only}
    1. Wijkstra PJ, Mark TW, Kraan J, Altena R, Koeter GH, Postma DS. Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD). 1996. [MEDLINE: ] - PubMed
Woods 1999 {published data only}
    1. Woods JA CMWBEJL. Effects of 6 months of moderate aerobic exercise training on immune function in the elderly. Mechanisms of Ageing & Development 1999;109(1):1‐19. [MEDLINE: ] - PubMed

References to studies awaiting assessment

Neilsen 1977 {published data only}
    1. Neilson SL, Larsen B, Prahl M, et al. [Hospitalstraening contra hjemmetraening af patienter med claudicatio intermittens]. Ugeskrift for Laeger 1977;139:2733‐6. - PubMed

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