title: Frailty and exercise interventions : Evidence and barriers for exercise programs.
abstract: BACKGROUND
  Due to the worldwide demographic transition healthcare systems are facing new demands and are increasingly confronted with an older population with specific medical needs related to multiple chronic disorders. The majority of older persons have an increased risk of frailty. In addition to pharmaceutical interventions another beneficial approach for counteracting frailty might be exercise or physical activity intervention.
  
  
  OBJECTIVE
  The first goal was to narratively investigate the state of the art effective exercise interventions for frail older persons and briefly discuss the importance of exercise intervention for frailty. The second goal was to give recommendations to overcome barriers in the recruitment process and how to increase adherence of frail older persons in exercise programs.
  
  
  RESULTS
  Several systematic reviews came to the same conclusion that exercise has beneficial effects in frail older persons although uncertainty exists on the optimal exercise program with regard to frequency, type of exercise and duration. Furthermore, all reviews demonstrated the superior nature of multicomponent exercise programs as opposed to single component exercise programs. With regard to barriers different levels have to be taken into account and addressed: older persons themselves with self-efficacy and attitudes, the healthcare personnel involved and the provider of the intervention program.
  
  
  CONCLUSIONS
  Exercise seems a promising approach to counteract frailty but including frail older persons in research programs is challenging. Researchers have to be aware of the different levels of possible barriers ranging from older frail persons and medical personnel to researchers.
authors.affiliation: Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany. ellen.freiberger@fau.de.
authors.forename: E
authors.initials: E
authors.lastname: Freiberger
authors.affiliation: Osteoporosis Research Centrum, FAU Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Kemmler
authors.affiliation: Department for Prevention, Rehabilitation and Sports Medicine (PRS), Technische Universität München, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Siegrist
authors.affiliation: Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.|Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Sieber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology*; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D055948:Sarcopenia / Q000523:psychology* / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Aged; Health planning recommendations; Health service, geriatric; Patent compliance; Recruitment strategies