Exercise-Based Strategies to Address Frailty in Nursing Home Residents: Evidence from Randomized Trials

Background:
Frailty is a prevalent geriatric syndrome among institutionalized older adults and is associated with increased risk of disability, falls, hospitalization, and reduced quality of life. Physical exercise has emerged as a potentially effective and cost-efficient strategy to address frailty; however, uncertainty remains regarding the most appropriate intervention characteristics in long-term care settings.

Objective:
To synthesize current evidence on the effects of structured physical exercise interventions on frailty and related functional outcomes in institutionalized older adults.

Methods:
A systematic synthesis of randomized controlled trials was conducted following PRISMA recommendations. Searches were performed in PubMed/MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials. Studies including adults aged ≥60 years living in nursing homes or long-term care facilities and evaluating exercise-based interventions were eligible. Methodological quality was assessed using the PEDro scale. Due to heterogeneity in interventions and outcomes, a narrative synthesis was performed.

Results:
Twelve randomized controlled trials were included. Exercise interventions—particularly multicomponent programs combining resistance, balance, and aerobic training—were associated with improvements in frailty status, physical performance, balance, and functional capacity. Some studies also reported positive effects on cognitive function and quality of life. Despite overall favorable findings, variability in intervention duration, intensity, and outcome measures limited direct comparisons across studies.

Conclusions:
Exercise-based interventions appear to be effective strategies to mitigate frailty and improve functional outcomes in institutionalized older adults. Multicomponent, supervised programs tailored to individual capacities may offer the greatest benefits. Further high-quality trials are needed to define optimal exercise prescriptions in long-term care settings.