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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
Open accessAbstract
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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In the citing paper
“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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
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International exercise recommendations in older adults (ICFSR): Expert consensus guidelines
Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., et al. (2021) · The Journal of nutrition, health and aging · doi:10.1007/s12603-021-1665-8 · Cited by 1,247
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El Assar, M., Álvarez-Bustos, A., Sosa, P., Angulo, J., & Rodríguez-Mañas, L. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23158713 · Cited by 371
Exercise interventions for older adults: A systematic review of meta-analyses
Lorito, C. D., Long, A., Byrne, A., Harwood, R., Gladman, J. R. F., Schneider, S., Logan, P., Bosco, A., & van der Wardt, V. (2020) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2020.06.003 · Cited by 285
Izquierdo, M., de Souto Barreto, P., Arai, H., Bischoff-Ferrari, H. A., Cadore, E. L., Cesari, M., Chen, L.-K., Coen, P. M., Courneya, K. S., Duque, G., et al. (2025) · The Journal of nutrition, health and aging · doi:10.1016/j.jnha.2024.100401 · Cited by 273
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Metadata
- 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)
- Venue
- Sports Medicine
- Published
- 2020-02-04
- Volume
- 50
- Issue
- 6
- Pages
- 1095-1106
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- 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
- 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 › Public Health, Environmental and Occupational Health › 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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