Physical Activity: Home-based Exercise Interventions for Adults Aged 65 years and Older

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends home-based exercise interventions to improve physical fitness (i.e., muscle strength, muscle power, muscle endurance, balance) among adults aged 65 years and older. The Physical Activity Guidelines for Americans, 2nd edition recommends older adults achieve a multicomponent physical activity regimen that combines aerobic activities with physical fitness exercises such as those used in these interventions.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Home-based Exercise Interventions for Adults Aged 65 years and Older are available in The Community Guide Collection on CDC Stacks.

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The published review was selected and evaluated by a team of specialists in systematic review methods, and in physical activity research, practice, and policy.

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Study Characteristics
  • Included studies were randomized trials (17 studies).
  • Studies were conducted in the United States (4 studies), Japan (3 studies), and the United Kingdom (2 studies); one study each came from Canada, Denmark, Finland, Germany, Greece, Italy, Taiwan, and Iran.
  • Studies recruited participants in the community (10 studies), clinical settings (6 studies), and a residential care center (1 study).
  • The median age of study participants was 73 years (17 studies)
  • Studies recruited both males and females, however more participants were female (67%) than male (43%).
  • Interventions were delivered by physiotherapists and physical therapists (6 studies), trained intervention providers (6 studies), peer mentors (1 study), and nurses (1 study).
  • Training, supervision, and monitoring included home visits (8 studies), telephone calls (9 studies), training logs or diaries (15 studies), or other types of communication (e.g., lab or clinical visits; 3 studies).
  • Study interventions also reported engaging participants in walking (8 studies), flexibility exercises (4 studies), and other types of activities such as gardening (2 studies).
Summary of Results

The published systematic review and meta-analyses included 17 studies.

  • Older adults demonstrated small but statistically significant improvements in measures of physical fitness including balance (14 studies), muscle strength (10 studies), muscle power (4 studies), and muscular endurance (4 studies).
  • Studies examined effectiveness of multimodal (e.g., strength and balance exercises; 11 studies) or single mode exercise interventions (strength only, 5 studies; balance only, 1 study). Single mode strength training resulted in larger effects on both muscle strength and balance than multimodal interventions.

CPSTF examined additional data reported in the included studies.

  • Participants reported fewer falls and fall-related outcomes (5 studies) and more time spent engaged in physical activity overall (2 studies). Findings were mixed for self-reported improvements in quality of life (5 studies) and time spent in aerobic activities (2 studies).
  • Studies found no differences in measures of mental health (2 studies).

Summary Evidence Table

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Chaabene H, Prieske O, Herz M, et al. Home-based exercise programmes improve physical fitness of healthy older adults: a PRISMA-compliant systematic review and meta-analysis with relevance for COVID-19. Ageing Research Reviews 2021;67:101265.

Applicability

Based on the results from the review, findings should be applicable to the general population of older adults aged 65 years and older in the United States. Additional studies are needed, however, to evaluate effectiveness of home-based exercise interventions for participants from historically disadvantaged racial and ethnic populations and populations with lower incomes.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

CPSTF identified the following questions as priorities for research and evaluation:

  • How effective are home-based exercise interventions for participants from historically disadvantaged racial and ethnic populations?
  • How effective are home-based exercise interventions for participants with lower incomes?

Remaining questions for research and evaluation identified in this review include the following:

  • How does effectiveness vary by age for participants aged 65 years and older?
  • How do risks for exercise-associated injuries vary by age for participants aged 65 years and older?
  • How does effectiveness vary for participants with physical or cognitive disabilities?
  • What strategies are effective to increase recruitment of men in home-based exercise interventions?
  • What are the effects of home-based exercise interventions on the following outcomes?
    • Falls prevention
    • Mental health outcomes
    • Quality of life outcomes
    • Morbidity and mortality
Implementation Considerations and Resources

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

  • Physical Activity Guidelines for Americans (2nd edition) recommends multicomponent physical activities for older adults that include more than one type of activity (e.g., aerobic, muscle strengthening, balance training). Multicomponent physical activity can be done at home or in a community setting as part of a structured program that includes a combination of balance, muscle strengthening, and aerobic physical activity. Programs also may include gait, coordination, and physical function training (U.S. Department of Health and Human Services 2018).
  • Chaabene et al. focused on studies that measured muscle strengthening and balance. These interventions can complement support for aerobic activities, such as walking, to achieve the recommended multicomponent approach for older adults (U.S. Department of Health and Human Services 2018).
  • The following CPSTF recommendations may be used to support or complement the use of home-based exercise interventions:
  • Digital technologies may enhance home-based activities by providing social contact and support typically available in face-to-face and group-based activities (Parker et al. 2021; Lindsay Smith et al. 2017).
  • Several publicly available resources provide guidance on the implementation of exercise and physical activity interventions for older adults.
    • CDC’s Active People, Healthy NationSM provides community-level guidance on strategies to improve physical activity and tools for action.
    • The Otago program provides guidance for 17 strength and balance exercises and a walking program, designed to be performed three times a week in home settings.
    • Community Healthy Activities Model Program for Seniors (CHAMPS) outlines an individually tailored program appropriate for older adults with a range of health levels to increase physical activity.
    • Active Choices includes implementation guidance for a 6-month individualized physical activity program that helps individuals incorporate preferred physical activities in their daily lives.

"Healthy Healthy People 2030 Crosswalks

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.