Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

García-Hermoso, Antonio; Ramirez-Vélez, Robinson; Sáez de Asteasu, Mikel L.; Martínez-Velilla, Nicolás; Zambom-Ferraresi, Fabricio; Valenzuela, Pedro L.; Lucia, Alejandro; Izquierdo, Mikel

doi:10.1007/s40279-020-01259-y

Cited by 167Physical Activity and HealthBalance, Gait, and Falls PreventionFrailty in Older Adults

Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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García-Hermoso, Antonio, Ramirez-Vélez, Robinson, Sáez de Asteasu, Mikel L., Martínez-Velilla, Nicolás, Zambom-Ferraresi, Fabricio, Valenzuela, Pedro L., Lucia, Alejandro, Izquierdo, Mikel·2020·Sports Medicine

DOI 10.1007/s40279-020-01259-y

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Abstract

Background Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old).Objective To analyze the safety and effectiveness of long-term exercise interventions in older adults.Methods We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints).Results Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95-1.17) or mortality (RR = 0.93, 95% CI 0.83-1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48-0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants' baseline characteristics (age, physical function, and cognitive status) and exercise frequency.Conclusions Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.

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The type and frequency of exercise (PRT, aerobic MICT, or HIIT) and the individual's age, as well as cognitive and physical function levels, do not affect attrition rates owing to medical problems or mortality.
“The type and frequency of exercise (PRT, aerobic MICT, or HIIT) and the individual's age, as well as cognitive and physical function levels, do not affect attrition rates owing to medical problems or mortality [285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [285]
PRT is safe for older adults, including those who are frail or have multiple chronic conditions.
“Despite the proven safety of PRT for older adults [108,285,287], including those who are frail [288,289], or have multiple chronic conditions [108], clinicians often hesitate to prescribe this exercise modality [108,285,[287], [288], [289]].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [285]
Long-term physical exercise is safe and effective in older adults, and its benefits accrue regardless of age, physical function, or cognitive status at baseline.
“Therefore, long-term physical exercise is safe and effective in older adults, and its benefits accrue regardless of age, physical function, or cognitive status at baseline [285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [285]
Long-term (> one year) physical exercise interventions have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care.
“Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [285]
Long-term (> one year) physical exercise interventions have been shown to reduce risk of falls and improve muscle strength, balance, physical function, and cognition without increasing risk of health-related dropouts, mortality, or fractures compared to usual care.
“Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [285]

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“Ensuring safety among people at higher risk of falls, or people with major musculoskeletal problems would be paramount.[54].”
Background
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Moderate Exercise Improves Cognitive Function in Healthy Elderly People: Results of a Randomized Controlled Trial
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Physical Function and All-Cause Mortality in Older Adults Diagnosed With Cancer: A Systematic Review and Meta-Analysis
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Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults
de Asteasu, M. L. S., Martínez‐Velilla, N., Zambom-Ferraresi, F., Ramírez‐Vélez, R., García‐Hermoso, A., Cadore, E. L., Herrero, Á. C., Galbete, A., & Izquierdo, M. (2020) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12564 · Cited by 72 · see citing works
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Promoting resilience in The face of ageing and disease: The central role of exercise and physical activity
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Exercise in people over 85
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Musculoskeletal Changes Across the Lifespan: Nutrition and the Life-Course Approach to Prevention
Azzolino, D., Spolidoro, G. C. I., Saporiti, E., Luchetti, C., Agostoni, C. V., & Cesari, M. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.697954 · Cited by 69 · see citing works
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State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions
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Supervised Versus Unsupervised Exercise for the Improvement of Physical Function and Well-Being Outcomes in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials
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Alexa, let's train now! — A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging
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Supervised Exercise (Vivifrail) Protects Institutionalized Older Adults Against Severe Functional Decline After 14 Weeks of COVID Confinement
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Low relative mechanical power in older adults: An operational definition and algorithm for its application in the clinical setting
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Strength Training to Prevent Falls in Older Adults: A Systematic Review with Meta-Analysis of Randomized Controlled Trials
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Effectiveness of Protein Supplementation Combined with Resistance Training on Muscle Strength and Physical Performance in Elderly: A Systematic Review and Meta-Analysis
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Cognitive Function Improvements Mediate Exercise Intervention Effects on Physical Performance in Acutely Hospitalized Older Adults
Sáez de Asteasu, M. L., Martínez-Velilla, N., Zambom-Ferraresi, F., Ramírez-Vélez, R., García-Hermoso, A., & Izquierdo, M. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.08.024 · Cited by 35 · see citing works
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Resistance training alters body composition in middle-aged women depending on menopause - A 20-week control trial
Isenmann, E., Kaluza, D., Havers, T., Elbeshausen, A., Geisler, S., Hofmann, K., Flenker, U., Diel, P. R., & Gavanda, S. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02671-y · Cited by 33 · see citing works
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The Interconnection Between Muscle and Bone: A Common Clinical Management Pathway
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Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review
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Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age
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Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review
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Effects of Neuromuscular Training on Physical Performance in Older People: A Systematic Review
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Are the Recommended Physical Activity Guidelines Practical and Realistic for Older People With Complex Medical Issues?
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Athletes’ Psychological Adaptation to Confinement Due to COVID-19: A Longitudinal Study
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Cross-sectional associations of housework with cognitive, physical and sensorimotor functions in younger and older community-dwelling adults: the Yishun Study
Lee, S. Y., Pang, B. W. J., Lau, L. K., Jabbar, K. B. A., Seah, W. T., Chen, K. K., Ng, T. P., & Wee, S. L. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052557 · Cited by 25 · see citing works
A novel smart somatosensory wearable assistive device for older adults’ home rehabilitation during the COVID-19 pandemic
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Meta-analysis and systematic review of physical activity on neurodevelopment disorders, depression, and obesity among children and adolescents
Peng, S., Fang, Y., Othman, A. T., & Liang, J. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.940977 · Cited by 26 · see citing works
Handgrip Strength as a Complementary Test for Mobility Limitations Assessment in Acutely Hospitalized Oldest Old
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Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review
Meulenbroeks, I., Mercado, C., Gates, P., Nguyen, A., Seaman, K. L., Wabe, N., Silva, S. S. M., Zheng, W. Y., Debono, D. S., & Westbrook, J. I. (2024) · BMC Geriatrics · doi:10.1186/s12877-023-04624-4 · Cited by 23 · see citing works
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Effects and parameters of community-based exercise on motor symptoms in Parkinson’s disease: a meta-analysis
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Effects of Neuromuscular Training on Postural Balance and Physical Performance in Older Women: Randomized Controlled Trial
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Three-Month vs. One-Year Detraining Effects after Multicomponent Exercise Program in Hypertensive Older Women
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State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions
Lavin, K. M., Coen, P. M., Baptista, L. C. P., Bell, M. B., Drummer, D. J., Harper, S. A., Lixandrão, M. E., McAdam, J. S., O’Bryan, S. M., Ramos, S. V., et al. (2022) · Comprehensive physiology · doi:10.1002/j.2040-4603.2022.tb00211.x · Cited by 20 · see citing works
Association of regular aerobic exercises and neuromuscular junction variants with incidence of frailty: an analysis of the Chinese Longitudinal Health and Longevity Survey
Zhang, Y., Yao, Y., Zhang, P., Li, Z., Zhang, P., Li, F., Wang, Z., Liu, D., Lv, Y., Kang, L., et al. (2021) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12658 · Cited by 19 · see citing works
Relative Handgrip Strength Diminishes the Negative Effects of Excess Adiposity on Dependence in Older Adults: A Moderation Analysis
Ramírez‐Vélez, R., Pérez-Sousa, M. Á., García‐Hermoso, A., Zambom-Ferraresi, F., Martínez‐Velilla, N., de Asteasu, M. L. S., Cano, C. A., Rincón‐Pabón, D., & Izquierdo, M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9041152 · Cited by 19 · see citing works
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Reporting of Harm in Randomized Controlled Trials of Therapeutic Exercise for Knee Osteoarthritis: A Systematic Review
von Heideken, J., Chowdhry, S., Borg, J., James, K. A., & Iversen, M. D. (2021) · Physical Therapy · doi:10.1093/ptj/pzab161 · Cited by 19 · see citing works
Bridging the gap between strengthspan and lifespan
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Exercise in Octogenarians: How Much Is Too Little?
Carrick‐Ranson, G., Howden, E. J., & Levine, B. D. (2021) · Annual Review of Medicine · doi:10.1146/annurev-med-070119-115343 · Cited by 17 · see citing works
Effects of exercise programs on phase angle in older adults: A systematic review and meta-analysis
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Mental Well-Being or Ill-Being through Coaching in Adult Grassroots Sport: A Systematic Mapping Review
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Decreased daily exercise since the COVID-19 pandemic and the deterioration of health-related quality of life in the elderly population: a population-based cross-sectional study
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A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study
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Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults: An Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association – Geriatrics
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An Intervention of 12 Weeks of Nordic Walking and Recreational Walking to Improve Cardiorespiratory Capacity and Fitness in Older Adult Women
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The effect of a multicomponent exercise protocol (VIVIFRAIL©) on inflammatory profile and physical performance of older adults with different frailty status: study protocol for a randomized controlled trial
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Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial
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Effects of Exercise Type on Muscle Strength and Body Composition in Men and Women: A Systematic Review and Meta-Analysis
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Peer-led exercise program for ageing adults to improve physical functions - a randomized trial
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Anabolic-Androgenic Steroids and Exercise Training: Breaking the Myths and Dealing With Better Outcome in Sarcopenia
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Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial
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Chinese expert consensus on prevention and control interventions for older adults with physical functional impairment (2022)
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The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions
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Effects of Exercise Interventions on Inflammatory Parameters in Acutely Hospitalized Older Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Endothelial Progenitor Cell Response to Acute Multicomponent Exercise Sessions with Different Durations
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Home/community-based interventions to improve function in persons with mild cognitive impairment/early dementia
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Effect of physical exercise cessation on strength, functional, metabolic and structural outcomes in older adults: a protocol for systematic review and meta-analysis
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Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults
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Effects of resistance training and protein supplementation interventions on muscle volume and muscle function: sex differences in humans
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Reference Values for Handgrip Strength in the Basque Country Elderly Population
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Whole-Body Vibration to Improve Physical Function Parameters in Nursing Home Residents Older Than 80 Years: A Systematic Review With Meta-Analysis
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The benefits of Tai Chi practice on standing balance in older adults during COVID-19 pandemic
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The Science of Tai Chi and Qigong as Whole Person Health-Part II: Evidence Gaps and Opportunities for Future Research and Implementation
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Revolution or Empty Promise? A 6- and 12-Month Follow-Up to an RCT of the Online Exercise Program PERMANENTO in Older Adults
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Authors: García-Hermoso, A., Ramirez-Vélez, R., Sáez de Asteasu, M. L., Martínez-Velilla, N., Zambom-Ferraresi, F., Valenzuela, P. L., Lucia, A., & Izquierdo, M.
Affiliations: Universidad de Alcalá (ES)
ORCID: Valenzuela, Pedro L.
Izquierdo, Mikel
Venue: Sports Medicine
Publisher: Springer Science and Business Media LLC
Published: 2020-02-04
Volume: 50
Issue: 6
Pages: 1095-1106
ISSN: 0112-1642 (ISSN-L)
1179-2035
DOI: 10.1007/s40279-020-01259-y
OpenAlex: W3004722268
Cited by: 167
References: 123
Citations by year: 2026: 13 · 2025: 17 · 2024: 28 · 2023: 21 · 2022: 41 · 2021: 29 · 2020: 18
FWCI: 3.48
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Sports Medicine (publishedVersion)
PubMed (publishedVersion)
Academica-e (Universidad Pública de Navarra) (submittedVersion)
ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
Funders: Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable
European Commission
Ministerio de Economía y Competitividad (PI17/01814)
Instituto de Salud Carlos III (CP18/0150, PI17/01814)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords: long-term exercise intervention, older adults, exercise safety, exercise effectiveness, mortality, falls, fall-related injuries, fracture, physical function, cognitive function, quality of life, primary care intervention
MeSH terms: Accidental Falls, Aged, Exercise Therapy, Humans, Mortality, Quality of Life, Randomized Controlled Trials as Topic

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Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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