Eur J Clin Invest. 2025 Dec 22:e70158. doi: 10.1111/eci.70158. Online ahead of print.
ABSTRACT
BACKGROUND: Elderly frailty is a multifaceted clinical condition with diminished physiological reserves and increased stress susceptibility. It increases disability, hospitalization and mortality rates, requiring multidomain therapy. Structured physical-activity-based medical treatment can reduce frailty in physical, mental and emotional areas. This assessment distinguishes outcomes among validated frailty models (phenotype-based vs. deficit-accumulation) to highlight model-specific effects.
OBJECTIVES: The present systematic review assesses the efficacy of structured physical-activity-based physiotherapy in reducing frailty and enhancing physical, cognitive and emotional outcomes in persons aged ≥60. It highlights a critical data gap neglected by past studies by distinguishing intervention effects across proven frailty models (phenotype-based and deficit-accumulation frameworks).
METHODOLOGY: The review used PRISMA criteria and the PICOS framework to find relevant papers published between January 2002 and December 2025. PubMed, Scopus, Cochrane Library and Embase were searched. RCTs and longitudinal cohort studies on physiotherapy or structured physical-activity therapies (e.g. resistance training, aerobic conditioning, balance exercises, multimodal programs) for individuals aged ≥60 years were eligible. Frailty, physical performance and quality of life were evaluated. Cochrane Risk of Bias 2.0 was used for randomised studies and ROBINS-I for non-randomised designs.
RESULTS: 36 trials covered varied physiotherapy and structured physical-activity regimens. Participants, mostly aged ≥60, were mostly women (approximately two-thirds of the sample). The majority of investigations found that resistance training increased muscle strength and decreased frailty by 20%-35%. Exercises involving balance reduced fall risk by 25%-35%, while aerobic workouts improved gait and cardiovascular fitness. Multimodal interventions reversed frailty in 41%-50% of individuals and improved cognitive and emotional outcomes the highest. Physical performance, quality of life and functional independence improved across frailty models in weighted summaries.
CONCLUSION: Structured physical-activity-based physiotherapy therapies, especially multimodal programs, reduce frailty and enhance physical, cognitive and emotional resilience in older persons, highlighting their value in comprehensive geriatric care.
PMID:41427921 | DOI:10.1111/eci.70158