The effectiveness of unsupervised home-based exercise for improving lower extremity physical function in older adults in Western and Eastern cultures: a systematic review and meta-analysis

Abstract

Background: Ageing leads to decreased physical function, which can impact independent living and raise health risks, increasing demand on healthcare resources. Finding affordable and accessible exercise to improve physical function is necessary for a population seemingly resistant to strength and balance training in leisure settings. This review aimed to evaluate whether unsupervised home-based exercises improve lower extremity function in older adults.

Methods: We systematically searched for randomised controlled trials (RCTs) and cluster RCTs investigating unsupervised home-based exercises' effects on physical function in older adults through English and Mandarin databases. Studies' methodological quality was assessed using the Cochrane's Risk of Bias Tool. Meta-analyses were conducted on lower extremity functions outcomes.

Results: Of the 6791 identified articles, 10 English studies (907 participants) were included, 8 studies (839 participants) were used for final meta-analysis, with no Mandarin studies. Studies were largely based in Europe with mostly moderate risk of bias. Most interventions were multicomponent lasting 10-40 min/session, 3 times/week. Meta-analysis showed no statistically significant differences in 5 sit-to-stand (p = 0.05; I² = 0%), maximal knee extension strength (p = 0.61; I² = 71%), 10 m maximal walking speed (p = 0.22; I² = 30%), timed-up-to-go (p = 0.54; I² = 0%), and short physical performance battery (p = 0.32; I² = 98%) between exercise and control groups.

Conclusions: This meta-analysis suggests that unsupervised home-based exercise programmes have little impact on lower extremity functions in older adults. This review is limited by the small number of included studies, sample sizes, and high heterogeneity. There is a need to understand why this format lacks efficacy, and design more beneficial home-based exercise programmes.

Keywords: Ageing population; Home-based activities; Independent living; Lower extremity physical performance; Unsupervised exercise intervention.

Fig. 1

Literature screening flowchart

Fig. 2

Forest plots depicting the pooled standardised mean difference in 5 x sit-to-stand time. Outcomes favouring intervention are depicted to the right, favouring shorter time performing 5-time sit-to-stand test

Fig. 3

Forest plots depicting the pooled standardised mean difference in maximal knee extension strength. Outcomes favouring intervention are depicted to the left

Fig. 4

Forest plots depicting the pooled standardised mean difference in 10-metre maximal walking speed. Outcomes favouring intervention are depicted to the left

Fig. 5

Forest plots depicting the pooled standardised mean difference in TUG performance. Outcomes favouring intervention are depicted to the right

Fig. 6

Forest plots depicting the pooled standardised mean difference in SPPB score. Outcomes favouring intervention are depicted to the left

Fig. 7

Risk of bias assessment for included studies where green = low risk of bias, yellow = moderate risk of bias, and red = high risk of bias