By Lisa Jerry, SPT


Frailty is a syndrome that can accompany increased age, especially in individuals over the age of 65, that decreases the body’s functional capacity to handle stresses. Frailty increases an individual’s risk of disability, falls, and hospitalization. Several issues associated with frailty include weight loss, decreased muscle strength, decreased endurance activity, and slower walking speed. This systematic review aims to look at the benefits of several different types of training and their impact on frailty, as prescribed by a Physical Therapist (PT).


20 randomized controlled trial studies had their data combined which focused on strength training, endurance training, balance training, and multi-component exercises (a combination of all three of these trainings). These studies described their participants as frail, pre-frail, elderly individuals with a history of falls, and recent illness-induced functional decline.

Types of Exercise Interventions

Strength training: Strength training is a common intervention utilized to counteract the changes that occur due to aging. Strengthening the hips and knees is a good foundation for these exercise programs looked at in the studies. Overall consensus between these studies was that strengthening these groups 3 times per week, 3 sets of 8-12 reps, and increasing resistance over time showed overall positive improvements in gait, stairs, and muscular strength.

Endurance training: Aging decreases the cardiovascular system’s capacity, making everydays tasks harder to perform. Different types of endurance activities that have proven to be effective include walking at different speeds, treadmill walking, stair climbing, and stationary cycling. The principle “start low and go slow” is an important principle during endurance training, so it is beneficial to start at just 5-10 minutes of endurance training at first and slowly progress up to 30-60 minutes.  It is important to consult with your physician before beginning a new exercise program.

Balance training: The best way to improve balance is to work on balance! There are countless balance interventions used during these studies including: walking in a straight line, stepping practice, throwing and tossing a ball, changing the surface a person stands on, and Tai-Chi. One study showed that 15 weeks of Tai-Chi reduced the risk of falls by 58%. Similar to the other two training types, balance training should start easier and safely progress into the more challenging activities as tolerated.

Multi-component exercises: This type of training encompasses all three of the interventions mentioned above. Targeting several different training types will allow the body to better adapt to stresses placed on it. One study found that 12 weeks of multi-component exercises resulted in an increase in strength by 75% as well as 25% fewer falls in the frail population. Another study showed that 1 year of this type of program resulted in 40% fewer falls.

Conclusion and PTF Implications

This review shows that a combination of strength, endurance, and balance training increases strength and decreases the fall risk, thus improving quality of life. Here at Physical Therapy First, we listen to each individual and what they want to improve upon. We use our knowledge and experience to create a unique progressive training program that is right for each individual to help them get back to doing what they love.

Original Article

Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Research. Vol 16, Number 2, pages 105-114.