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Purpose: Frailty in older adults is associated with multiple adverse health outcomes, while evidence on its successful preven-tion has been scarce. Therefore, we analyzed the effectiveness of different interventions for the prevention of frailty onset.
Methods: In this systematic review, eight databases were searched for randomized controlled trials of interventions innon-frail (i.e., robust or pre-frail) adults aged ≥ 60 years that assessed frailty incidence at follow-up. Additive componentnetwork meta-analysis (CNMA) was conducted to isolate the effect of different intervention types on the main outcome offrailty incidence, reporting relative risk (RR) with 95% confidence intervals (CI). The effect on gait speed was analyzed asan additional outcome using a classic network meta-analysis and the standardized mean difference (SMD) with 95% CI.
Results: We screened 24,263 records and identified 11 eligible trials. Nine trials (842 participants, all categorized accord-ing to the physical phenotype) in pre-frail (seven RCTs) and robust/pre-frail (two RCTs) older adults were included in theCNMA. Physical exercise significantly reduced frailty incidence at follow-up (RR 0.26, 95% CI 0.08; 0.83), while this wasnot found for nutritional interventions (RR 1.16, 95% CI 0.33; 4.10). Interventions based on physical exercise also improvedgait speed (SMD 1.55, 95% CI 1.16; 1.95). In addition, 22 eligible trial protocols without published results were identified.
Conclusion: Interventions based on physical exercise appear to be effective in preventing the onset of frailty in older adults.Although the available data are still limited, results from ongoing trials may add to the body of evidence in the foreseeable future