Breaking the frailty cycle with rehabilitation programs. A systematic review and meta-analysis of randomized controlled trials

To investigate how different sets of rehabilitation programs can contribute to breaking the frailty cycle. Systematic review with meta-analysis of randomized controlled trials that investigated the effects of rehabilitation programs for adults with FS. Search for references on Embase, PEDro, SciELO, Web Of Science, Pubmed, EBSCO and Scopus, published until September 2024. Methodological quality was assessed with the PEDro scale, risk of bias with ROB 2.0, and certainty of evidence with the GRADE approach. Thirty-four studies (34) were included, with high methodological quality and a low risk of bias. There is significant evidence that rehabilitation programs were able to improve performance in activities of daily living (SMD = 0.83; 95%CI: 0.26, 1.40; p = 0.004; low certainty), lower extremity function and mobility (SMD = 0.63; 95%CI: 0.40, 0.86; p < 0.001; moderate certainty) and gait speed (SMD = 1.07; 95%CI: 0.17, 1.97; p = 0.002; low certainty), reducing frailty score (SMD = -1.57; 95%CI: -2.97, -0.17; p ≤ 0.001; very low certainty) and prevalence of frailty (RR = 0.76; 95%CI: 0.65, 0.89; p = 0.006; very low certainty), with minimal to no reports of adverse effects. Rehabilitation programs consisting of multicomponent moderate-intensity physical exercise associated with nutritional monitoring, cognitive training, educational strategies, and medical and social support are effective to break the frailty cycle.Implications for rehabilitationRehabilitation programs for older people can prevent and reverse pre-frailty.Performance, mobility, gait speed and strength improve with rehabilitation programs.Rehabilitation professionals should considerer these key components when designing rehabilitation programs for the frail and pre-frail older people: multicomponent exercises, nutrition, and cognitive training.Rehabilitation professionals should be aware that adherence is the main barrier in older peoples frailty rehabilitation programs.