Progressive resistance strength training for physical disability in older people

 

Characteristics of included studies [ordered by study ID]

Ades 1996

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Methods	Randomised Controlled Trial - Method of Randomisation unclear -Assessor Blinding no - Participant Blinding no -Loss to Follow-up Not reported - Intention to Treat Analysis No
Participants	- Location USA - N = 24 - Sample healthy, sedentary - Age mean 70.4 (SD 4) - Inclusion Criteria healthy, sedentary older people - Exclusion Criteria angina or electrocardiographic ischaemia during exercise test, resting BP>160/90, non-cardiopulmonary limitation of exercise capacity (i.e. claudication, arthritis, cerebrovascular disease)
Interventions	Rx Group - Type of Ex 4UL, 3LL - Equipment machines (Universal Gym) - Intensity high (50-80% of 1RM) - Frequency 3 times per week - Reps/Sets 8 repetitions, 3 sets of each exercise - Duration 12 weeks - Setting gym - Supervision not reported - Adherence not reported Control Group instructed not to alter their home activity habits
Outcomes	- strength (1RM) - peak Aerobic capacity - body weight - BMI Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Baker 2001

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Methods	Randomised Controlled Trial - Method of Randomisation generated by statistician, concealed from investigators -Assessor Blinding blinded for primary measures, not for secondary (including strength) - Participant Blinding yes -Loss to Follow-up 2/46 - Intention to Treat Analysis yes for primary, no for secondary measures
Participants	- Location USA - N = 46 - Sample older people with osteoarthritis, recruited through commmunity advertising - Age mean 68 (SD 6) treatment group - Inclusion Criteria age 55 or older, body mass index less than 40 kg/m2, pain on more than half the days of the past month and during activities and radiographic evidence of OA - Exclusion Criteria medical condition that precluded safe participation in an exercise program or was more limiting than OA, inflammatory OA, or had participated in any regular exercise program in the last 6 months
Interventions	Rx Group - Type of Ex 2 functional exercises (squats and step-ups), 5 LL isotonic exercises - Equipment adjustable velcro ankle weights (isotonic ex only) - Intensity initially low (3-5 on Borg scale), progressed to 8 ("hard" on Borg scale) - Frequency 3 times per week - Reps/Sets 12 repetitions, 2 sets - Program Duration 16 weeks - Setting home- based - Supervision low (12 visits over 16 weeks) - Adherence 84(SD 27)% of sessions Control Group nutrition info, 7 home visits over 16 weeks, kept food logs 3/14 days
Outcomes	Primary -WOMAC pain and physical function subscales Secondary - clinical knee exam - strength (1RM) - physical performance (stair climb, chair stand time) - SF-36 - nutrition - adherence Post Program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Balagopal 2001

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Methods	Randomised Controlled Trial with young, middle-aged and older groups - only older group in this review - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	-Location USA - N = 20 older people - Sample healthy older people - Age mean 71 (SD 1) - Inclusion Criteria older people aged 65-79, healthy (based on physical exam and blood tests) - Exclusion Criteria subjects who exercised regularly for > or = 2 days per week, women taking hormone replacement
Interventions	Rx Group - Type of Ex 4UL, 3LL - Equipment resistance training machines - Intensity 50-80% 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 3 months - Setting gym - Supervision full Adherence NR Control Group NR
Outcomes	- transcript levels of myosin heavy chain isoforms in muscle - muscle strength (1RM) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Ballor 1996

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Methods	Randomised Trial of aerobic training vs PRT - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No -Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location USA - N = 18 - Sample obese, recently completed dietary program - Age mean 61 (SE 1) - Inclusion Criteria aged 55-70 years, a BMI before weight loss of > 32 kg/m squared, no signs, symptoms or history of heart disease, non-diabetic, non-smoker, resting blood pressure <160/90 mm Hg, no symptoms that would preclude safe participation in an exercise program - Exclusion Criteria NR
Interventions	PRT Group - Type of Ex 4UL, 3LL - Equipment machines (Universal Gym) - Intensity 50-80% of 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 12 weeks - Setting gym - Supervision full Adherence NR Aerobic Training Group exercised 3 times per week on a motorised treadmill at approximately 50% of maximum aerobic uptake for 20-60 minutes per session
Outcomes	- strength (1RM) - aerobic capacity - body weight - body composition - body metabolism Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Bermon 1999

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 1 - Intention to Treat Analysis No
Participants	- Location France - N = 32 - Sample healthy older people - Age mean 70 - Inclusion Criteria elderly adults, free of cardiorespiratory and neurological diseases, sedentary to moderately active, passed screening procedure including medical history and physical examination - Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 1UL, 2LL - Equipment weight machine (Marcy Vertex II) - Intensity 80% of 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 8 weeks - Setting gym - Supervision full Adherence NR Control Group asked to maintain customary activities and dietary patterns
Outcomes	- strength (1RM) - anthropometry - hormones Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Brandon 2000

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Methods	Randomised Controlled Trial BUT some changing of groups allowed before intervention began (husband/wives or people sharing rides changed groups) - Method of Randomisation not stated -Assessor Blinding No - Participant Blinding No -Loss to Follow-up not reported - Intention to Treat Analysis No
Participants	- Location USA - N = 85 - Sample healthy older adults, participants in community activities - Age mean 72 - Inclusion Criteria "community-dwelling older adults", no symptoms of cardiovascular disease, consent from physician, - Exclusion Criteria depression (according to Beck Inventory), MMSE > 19, contraindications on submaximal aerobic test
Interventions	Rx Group - Type of Ex 3LL - Equipment Nautilaus machines - Intensity moderate-high (50-70%) - Frequency 3 times per week - Reps/Sets 8-12 repetitions, 3 sets - Duration 4 months - Setting gym-based - Supervision full - Adherence 95% Control Group no intervention
Outcomes	- strength (1RM) - Physical Performance Test (PPT) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Buchner 1997

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Methods	Randomised Controlled Trial with four groups: strength training alone, endurance training alone, strength and endurance training and control group - Method of Randomisation variation of randomly permuted blocks - Assessor Blinding Yes - Participant Blinding No -Loss to Follow-up 4 (from PRT/control) - Intention to Treat Analysis Yes
Participants	- Location USA - N = 105 total (55 in PRT vs control) - Sample older people with muscle weakness, recruited from primary care physicians in a HMO - Age mean 75 - Inclusion Criteria between 68 and 85 years of age; unable to do an eight-step tandem gait without errors; below the 50th percentile in knee extensor strength for the subject's height and weight - Exclusion Criteria active cardiovascular, pulmonary, vestibular and bone diseases; positive cardiac stress test; body weight >180% of ideal; major psychiatric illness; active metabolic diseases; chronic anemia; amputation; chronic neurological or muscle disease; inability to walk; dependency in eating, dressing transfer or bathing; inability to speak English or fill out written forms
Interventions	Rx Group - Type of Ex 2UL, 9LL, 1Tr - Equipment machines (Cybex) - Intensity high (set 1:50-60% 1RM , set 2: 75%) - Frequency 3 times per week - Reps/Sets 10 reps, 2 sets - Program Duration 24-26 weeks - Setting gym - Supervision NR Adherence 95% excluding drop-outs; 81% including drop-outs Control Group maintained usual activity levels, allowed to join exercise program after 6 months
Outcomes	- aerobic capacity - strength (isokinetic) - balance Post program f/u exercisers assessed at 9 months, all participants monitored for falls for median 1.42 years (max 2.35 years) - gait - SF-36 - Sickness Impact Profile - Lawton IADL scale - stair climbing - falls - health care use - cost
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Castaneda 2001

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Methods	Randomised Controlled Trial, both groups were also on a low-protein diet (run-in period for 6 weeks to evaluate this); comparison was between low-protein diet alone or low-protein diet plus resistance training - Method of Randomisation NR - Assessor Blinding blind for all assessments except strength - Participant Blinding yes, sham-exercises - Loss to Follow-up 0 - Intention to Treat Analysis not stated
Participants	- Location USA - N = 26 - Sample patients with moderate chronic renal insufficiency, recruited from nephrology clinics - Age mean 65 (SD 9) - Inclusion Criteria older than 50 years of age; serum creatinine concentrations between 133-422 umol/L (1.5 and 5.0 mg/dL); physician approval to follow a low protein diet; nephrologist confirmed diagnosis of chronic renal insufficiency - Exclusion Criteria myocardial infarction within the last 6 months; any unstable chronic condition; dementia; alcoholism; dialysis or previous renal; current resistance training; recent involunrary weight change (+/- 2kg); albumin level less than 30g/L; proteinuria greater than 10g/d; abnormal stress test on screening
Interventions	Rx Group (PRT plus low-protein diet) - Type of Ex 2UL, 3LL - Equipment resistance training machines (Keiser) - Intensity 80% of 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 12 weeks - Setting gym at research centre - Supervision full Adherence 91% Control Group on low-protein diet; performed 5-8 sham exercises (gentle movements while standing sitting and bending) for upper and lower body
Outcomes	Primary outcome measures - total body potassium Post program f/u no - regional body composition of mid-thigh - type I and II muscle fiber cross-sectional areas Secondary outcomes - strength (1RM) - anthropometry - biochemical measures - glomerular filtration rate - resting energy expenditure - peak oxygen consumption - whole-body leucine kinetics
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Chandler 1998

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Methods	Randomised Controlled Trial - Method of Randomisation block randomised and stratified by 2 levels of functioning - Assessor Blinding some measures - Participant Blinding No -Loss to Follow-up 13 - Intention to Treat Analysis No
Participants	- Location USA - N = 100 - Sample community-dwelling older people with functional limitations - Age mean 77.6 - Inclusion Criteria community-dwelling; aged 64 or above; unable to descend stairs step over step without holding onto the railing - Exclusion Criteria > or = 3 on Reuben's Advanced Activities of Daily Living; terminal illness (i.e. not expected to survive 6 months); severe unstable cardiac disease including MI in the past 6 months; severe fixed or progressive neurologic disease; complete blindness; lower extremity amputation; score below 18 on MM SE and unable to follow a 3-step command
Interventions	Rx Group - Type of Ex 8LL - Equipment theraband - Intensity progressively increased (8 RM to 2 sets of 10RM) - Frequency 3 times per week - Reps/Sets 10 reps, 2 sets - Program Duration 10 weeks - Setting home-based - Supervision not reported Adherence NR Control Group could begin exercise after 10 weeks, one friendly phone call at 5 weeks
Outcomes	- HRQoL (SF-36) - Lower limb strength (cybex) - 6-minute walk test - chair rise - functional reach - Falls Self-Efficacy (/100) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Charette 1991

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Methods	Randomised Controlled Trial - Method of Randomisation NR -Assessor Blinding No -Participant Blinding No -Loss to Follow-up 8 - Intention to Treat Analysis No
Participants	- Location USA - N = 27 - Sample healthy, sedentary women - Age mean 69 - Inclusion Criteria aged 64-86; healthy; female, Palo Alto community - Exclusion Criteria pre-existing disability or illness that would preclude participation in a weight training program of moderate intensity
Interventions	Rx Group - Type of Ex 7LL - Equipment weight training machines - Intensity 65-75% of 1RM - Frequency 3 times per week - Reps/Sets 6 reps, 3 sets (increased to 6 sets for leg extension and press after 2 weeks) - Program Duration 12 weeks - Setting gym - Supervision full - Adherence 90% completed all sessions Control Group maintain normal activities, asked not to start an exercise program. Could undertake training at the end of the program. Contacted to make appointments/ maintain interest.
Outcomes	- strength (1RM) - muscle histology Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Collier 1997

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Methods	Randomised Controlled Trial - Method of Randomisation NR -Assessor Blinding No - Participant Blinding No -Loss to Follow-up 1 - Intention to Treat Analysis No
Participants	- Location USA - N = 39 - Sample healthy, community-dwelling - Age range 65-85 - Inclusion Criteria aged 65-85, approval of physician, community residents - Exclusion Criteria NR
Interventions	Rx Group Type of Ex 5UL, 2LL - Equipment Universal Hercules Gym Machine - Intensity not specified, but progressed throughout - Frequency 3 times per week - Reps/Sets 10 reps 2 sets - Program Duration 10 weeks - Setting gym - Supervision full Adherence NR Control Group no active intervention
Outcomes	Strength (number of reps at % of body weight) Functional Fitness Assessment for adults >60 Body composition Agility Assessment (walking between cones) Hand-eye co-ordination ("soda pop" test) Grip strength Physical Self-Efficacy Scale (PSE) Geriatric Depression Scale Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Damush 1999

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding attention control group used - Loss to Follow-up 9 - Intention to Treat Analysis No
Participants	- Location USA - N = 71 - Sample community-dwelling women, recruited through media-based promotion - Age mean 68 (SD 5.6) - Inclusion Criteria age 55+, living in retirement residential community, clearance from GP - Exclusion Criteria GP-identified contraindications to exercise
Interventions	Rx Group Type of Ex - 4UL, 3LL - Equipment theraband - Intensity low to moderate (4/10 on Borg scale) - Frequency 3 times per week - Reps/Sets 1 set, as many reps to reach 4/10 on Borg - Program Duration 8 weeks - Setting gym, group-based - Supervision full - Adherence 88% Control Group attended all of the exercise sessions to allow social contact, on
Outcomes	- HRQoL (SF-36) - strength (3RM) - grip strength Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Donald 2000

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Methods	Randomised Controlled Trial, factorial design (comparison of floor surface types not included here) - Method of Randomisation randomised envelopes - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 22 - Intention to Treat Analysis No
Participants	- Location UK - N = 58 - Sample hospitalised older people - Age mean 81 - Inclusion Criteria admitted to elderly care rehabilitation ward from Feb. to Sept. 1996, consent from patient and carers - Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 2 LL - Equipment NR - Intensity high (maximum weight the patient could manage) - Frequency twice daily - Reps/Sets 10 reps, 3 sets - Program Duration NR (length of hospital stay) - Setting hospital - Supervision full Adherence NR Control Group regular in-hospital daily physiotherapy
Outcomes	- falls (during hospital stay) - Barthel Index (ADL measure) - strength (hand-held dynamometer, hand-grip strength) - timed "up-and-go" (mobility) - functional reach test (balance) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Earles 2001

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Methods	Randomised Controlled Trial, PRT vs moderate aerobic exercise - Method of Randomisation randomised, with subjects blocked for gender and residence - Assessor Blinding No - Participant Blinding No - Loss to follow-up 3 - Intention to Treat Analyses No
Participants	- Location USA - N = 43 - Sample independent community volunteers - Age mean 77 (SD 5) in PRT group - Inclusion Criteria age greater than 70 years; score of 8 or higher on the Short Physical Performance Battery; ability to travel (by using public or private transportation) to the retirement community where exercise sessions were held; willingness to attend exercise sessions for 12 weeks - Exclusion Criteria myocardial infarction in the past 6 months; heart failure (New York Heart Association classification <1); angina with moderate activity; chronic obstructive pulmonary disease or shortness of breath while walking at a normal pace; stroke with residual motor deficits; poorly controlled hypertension (>174mmHg systolic, >100mmHg diastolic); cancer with chemotherapy or radiation in the past year; physical performance limited by arthritis; on any of the following medications: neuroleptics, oral steroids, testosterone or growth hormones
Interventions	PRT Group - Type of Ex 2 LL; also did step-ups, chair rises and plantar flexion exercises in standing - Equipment pneumatic resistance machines - Intensity high for leg press- started at 50% of 1RM, increased by 10% during each week of training; moderate for other exercises - Frequency 3 times per week - Reps/Sets 10 reps, 2-3 sets - Duration 12 weeks - Setting gym at retirement center - Supervision full Adherence 90% Aerobic training group moderate intensity exercise 30 minutes daily, 6 days weekly
Outcomes	- short physical performance battery (SPPB) - balance (semi-tandem stance, single leg stance) - chair rise (5) - 8-foot walk - aerobic capacity (6-minute walk) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Ettinger 1997

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Methods	Randomised Controlled Trial with 3 groups: PRT, aerobic training and health education (attention control) - Method of Randomisation stratified, variable block randomisation, computer generated - Assessor Blinding Yes - Participant Blinding attention control group used - Loss to Follow-up 75 total (48 from PRT and control group) at 18 months - Intention to Treat Analysis yes
Participants	- Location USA - N = 439 total (295 in PRT versus control) - Sample community-dwelling people with osteoarthritis resulting in functional limitation - Age mean 68 (SD 6) in PRT group - Inclusion Criteria age 60 years or more, pain on most days in 1 or more knees, difficulty with at least 1 of the following due to knee pain: walking a quarter mile, climbing stairs, getting in and out of a car, lifting and carrying groceries, getting out of bed, getting out of the bathtub or performing shopping, cleaning or self-care activities; radiographic evidence of knee osteoarthritis in the tibial-femoral compartment. - Exclusion Criteria person has a medical condition that preculded safe participation in the exercise program or prevented completion of the study (myocardial infarction or stroke in the past 3 months, evidence of ischemia during the exercise treadmill test, congestive heart failure, severe chronic obstructive pulmonary disease, active treatment for cancer, insulin dependent diabetes mellitus, hemoglobin less than 110g/L, creatinine greater than 176.8 umol/L, severe systemic disease or major psychiatric disease), inflammatory arthritis (ie rheumatoid or psoriatic), exercised regularly (defined as aerobic activity or resistance training more than 1 time per week for 20 minutes or longer), planned to move from the area or be admitted to a long-term care facility in the next 2 years; unable to walk at least 420 feet in 6 minutes without a cane or assistive device; unable to to walk on a treadmill without an assistive device; participating in another research study; resided in a long - term care facility
Interventions	PRT Group - Type of Ex 4UL, 4LL, 1Tr - Equipment cuff-weights, dumb bells - Intensity moderate to high (2 sets of 12 reps max) - Frequency 3 times per week - Reps/Sets 12 reps, 2 sets - Program Duration 78 weeks - Setting facility-based group for 3 months, then home- based for 15 months - Supervision high for gym-based, telephone contact and visits during home based phase (diminishing contact over time) Adherence: 70% at 18 months Attention Control Group health education program (meetings and telephone contact) Aerobic Training Group - walking program for 40 minutes 3 times per week at 50-70% of HR reserve - group facility based for 3 months then home-based for 15 months (same contact as PRT)
Outcomes	Primary self-report physical disability (23 item scale developed for use in this trial) Secondary - 6 minute walk test - stair climbing - lifting object - timed task in and out of car - graded submaximal aerobic treadmill test - strength (isokinetic dynamometer) - knee x-rays - knee pain Post program f/u participants followed after initial supervised sessions (3months) to home-based sessions (3-18 months)
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Fiatarone 1994

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Methods	Randomised Controlled Trial, factorial design (comparison of nutritional supplements versus placebo not considered here) - Method of Randomisation NR - Assessor Blinding for some assessments, not for all - Participant Blinding no, but recreational activities offered to control group (? quantity) No - Loss to Follow-up 6 total (4 in PRT and control groups) - Intention to Treat Analysis Yes
Participants	- Location USA - N = 51 in PRT vs control - Sample residents of a long term care facility for older people - Age mean 87.1 (SE 0.6) - Inclusion Criteria residential status, age over 70 years, ability to walk 6m - Exclusion Criteria severe cognitive impairment; rapidly progressive or terminal illness, acute illness or unstable chronic illness; myocardial infarction; fracture of a lower extremity within the six months before the study; insulin dependent diabetes mellitus; on a weight-loss diet or undergoing resistance training at the time of enrolment; tests of muscle strength revealed a musculoskeletal or cardiovascular abnormality
Interventions	Rx Group Type of Ex 2LL - Equipment weight training machines - Intensity high (80% of 1RM) - Frequency 3 times per week - Reps/Sets 8 reps/3 sets - Program Duration 10 weeks - Setting nursing home - Supervision full - Adherence 97% Control Group engaged in 3 activities of their choice offered by recreational therapy
Outcomes	- strength (1RM) - gait speed - stair climbing power - anthropometric measurements - physical activity (leg monitors) Post program f/u falls monitored median 1.53 years, max 4.11 years
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Fiatarone 1997

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Methods	Randomised Controlled Trial Method of Randomisation NR - Assessor Blinding No - Participant Blinding No, but control group received weekly phone calls -Loss to Follow-up 4 - Intention to Treat Analysis No
Participants	- Location USA - N = 34 - Sample frail older people - Age mean 82 - Inclusion Criteria community dwelling older people, moderate to severe functional impairment - Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 11 total to UL and LL - Equipment arm and leg weights - Intensity high - Frequency 3 days per week - Reps/Sets NR - Program Duration 16 weeks - Setting home-based - Supervision low - 2 weeks of home instruction, then phone calls Adherence 90% Control Group weekly phone calls
Outcomes	- strength - gait velocity - self-reported activity level - Attitude towards Ageing on the PGC Morale Scale - bed days - falls - health care visits Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Flynn 1999

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location USA - N = 29 - Sample healthy older women - Age 73 - Inclusion Criteria older community-dwelling women - Exclusion Criteria dementia, exclusion criteria of the American College of Sports Medicine, arthritis, bedridden within 3 months of the study, central or peripheral nervous system disorders, stroke, use of anti-depressant medications, acute or chronic infection, major affective disorder, human immunodeficiency virus infection or autoimmune disorders, metabolic disorders (type I diabetes mellitus), oral steroid use, cigarette or smokeless tobacco use, regular aerobic or resistance training within previous 3 mo, surgery within the previous 3 mo, caffeine consumption in excess of four cups of coffee per day, adequate flexibility and mobility (screened with performance tests)
Interventions	Rx Group Type of Ex - 8 LL - Equipment NR - Intensity high (70-80% of 1RM) - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 10 weeks - Setting gym - Supervision NR - Adherence: NR Control Group asked to maintain their normal activity level
Outcomes	- indicators of immune function - strength (1RM - ? data collected for controls) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hagerman 2000

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No -Loss to Follow-up 4 - Intention to Treat Analysis No
Participants	- Location USA - N = 22 - Sample untrained but physically active older men - Age mean 63.7 - Inclusion Criteria male, aged 60-75, physically active but not engaged in resistance training - Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 3 LL - Equipment machines - Intensity high (85-90% of 1RM) - Frequency two times per week - Reps/Sets 6-8 reps, 3 sets - Program Duration 16 weeks - Setting gym - Supervision full - Adherence 100% Control Group NR
Outcomes	- strength (1RM) - peak aerobic capacity - muscle biopsy - echocardio- graphy - hematology Post-program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Haykowsky 2000

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Methods	Randomised Controlled Trial - Method of Randomisation matched according to combined leg press and bench press strength scores, then randomly assigned - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 4 - Intention to Treat Analysis No
Participants	- Location Canada - N = 22 - Sample healthy older men - Age mean 68 (SD 3) - Inclusion Criteria aged 61-76; no clinical evidence of cardiovascular disease or hypertension; normal resting electrocardiogram; normal electrocardiographic response to graded treadmill exercise; not requiring or using cardiovascular medications; no regular participation in endurance or RT; absence of cerebrovascular or orthopaedic disability that would limit RT - Exclusion Criteria
Interventions	Rx Group - Type of Ex 5UL, 3LL - Equipment machines - Intensity 60-80% of 1RM - Frequency 3 times per week - Reps/Sets 3-10 reps - Program Duration 16 weeks - Setting gym - Supervision NR Adherence 97% attended Control Group continued normal activities
Outcomes	- strength (1RM) - echocardio- graphic measurements Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hennessey 2001

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Methods	Randomised controlled trial with 4 groups: PRT alone, growth hormone treatment alone, PRT and growth hormone treatment and control. Only PRT alone and control are included in this review - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location USA - N = 16 in PRT and control - Sample frail older people - Age mean 71.3 (SD 4.5) - Inclusion Criteria frail which was defined as scoring between 12 and 28 on Reuben's Physical Performance Test; - Exclusion Criteria medical conditions (cancer, heart disease, diabetes, recent fracture, carpal tunnel syndrome) that would interfere with administration of growth hormone or the performance of regular exercise 3 times per week; did not expect to spend a year in Rhode Island; their doctor convinced them not to participate for medical reasons or otherwise; unwilling to inject the drug and be randomised to exercise or no exercise
Interventions	PRT Group - Type of Ex 11 exs, UL and LL - Equipment ankle and wrist weights and larger exercise equipment - Intensity increased throughout the program, from 20% to 95% 1RM - most training was at a high-intensity - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 25 weeks - Setting gym in study facility or in local community centres - Supervision Full Adherence NR Control Group NR
Outcomes	- muscle biopsy - strength (isokinetic dynamometry) - body composition Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hepple 1997

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Methods	Randomised Controlled Trial of PRT versus Aerobic Training - Method of Randomisation NR -Assessor Blinding No -Participant Blinding No -Loss to Follow-up 1 - Intention to Treat Analysis No
Participants	- Location Canada - N = 20 - Sample healthy older men, recruited through newspaper advertisement - Age mean 68.3 (se 1.1) - Inclusion Criteria male, aged 65-74 - Exclusion Criteria positive Physical Activity Readiness Questionnaire, abnormal ECG or blood pressure response, musculoskeletal impairment
Interventions	PRT Group - Type of Ex 4LL - Equipment machines (Universal Weight) - Intensity high, 6-12 RM - Frequency 3 times per week - Reps/Sets 6-12 reps, 3 sets - Program Duration 9 weeks - Setting gym - Supervision NR - Adherence NR Aerobic Training Group (no inactive control in this trial) cycle ergometry for 30 minutes, 3 times per week
Outcomes	- peak VO2 - muscle biopsy - histochemical analyses - morphometry Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hiatt 1994

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Methods	Randomised Controlled Trial with 3 groups: PRT, walking (aerobic training) and control Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 2 - Intention to Treat Analysis No
Participants	- Location USA - N = 29 (19 in PRT versus control) - Sample people who have peripheral arterial disease and intermittent claudication - Age 67 - Inclusion Criteria intermittent claudication (disabling but stable for 3 months prior to enrolment); peripheral arterial disease - Exclusion Criteria leg pain at rest, ischemic ulceration, gangrene, unable to walk on the treadmill at a speed of at least 2mph; exercise capacity limited by symptoms of angina, congestive heart failure, chronic obstructive pulmonary disease, arthritis; diabetes; vascular surgery or angioplasty in the past year
Interventions	PRT Group - Type of Ex 5LL - Equipment cuff weights - Intensity high (6RM) - Frequency 3 times per week - Reps/Sets 6 reps, 3 sets - Program Duration 12 weeks - Setting gym - Supervision full Adherence NR Aerobic Training Group intermittent walking on treadmill until pain subsided, 3 times per week Control Group usual level of activity
Outcomes	- strength (cybex dynamometer) - peak Vo2 - hemodynamic measurements Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hortobagyi 2001

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Methods	Randomised Controlled Trial with 3 groups: High-intensity PRT, Low-intensity PRT and Control - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 3 - Intention to Treat Analysis No
Participants	- Location USA - N = 30 total (20 in High-intensity PRT versus control) - Sample healthy older people - Age mean (SD) 72 (4.7) - Inclusion Criteria older men and women, healthy, had not exercised more than once a week in the previous 3 years, approval of GP - Exclusion Criteria more than two risk factors for coronary artery disease; a history of falls, osteoporosis, osteoarthritis, or orthopaedic or neurological conditions (i.e. stroke); took medications that cause dizziness or slow movement; smoked; had a BMI greater than 28 kg/m squared; blood pressure greater than 140/90 mmHg or a heart condition
Interventions	Rx Group (PRT low and high) - Type of Ex 1 LL - Equipment machine - Intensity High - 80% 1RM Low - 40% 1RM - Frequency 3 times per week - Reps/Sets Hi-4-6 reps, 5 sets Low - 8-12 reps, 5 sets - Program Duration 10 weeks - Setting gym - Supervision NR - Adherence 98% Control Group NR
Outcomes	- force accuracy and steadiness - maximal strength (Cybex) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Hunter 2001

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Methods	Randomised Controlled Trial with people randomised to variable intensity resistance training and high-intensity resistance training NOTE: control group participants were not randomly assigned, and are not included in this review - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 2 - Intention to Treat Analysis No
Participants	- Location USA - N = 28 - Sample healthy male and female volunteers over 60 - Age mean 67.4 in high intensity group - Inclusion Criteria normal body mass index, free of metabolic disorders or medications that might affect energy expenditure, non-smokers, stable weight - Exclusion Criteria NR
Interventions	Rx Groups (high vs variable resistance) - Type of Ex 5 UL, 2LL, 2 Tr - Equipment resistance training machines - Intensity High intensity group: 80% 1RM Variable resistance group: 50%, 65%, 80% across the 3 training days each week - Frequency 3 times per week - Reps/Sets 10 reps, 2 sets - Program Duration 25 weeks - Setting gym - Supervision full Adherence NR Control Group not randomly assigned, not included in this review
Outcomes	- strength (1RM and isometric) - EMG analysis - bone density - perceived exertion and HR during daily tasks - submaximal aerobic capacity Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Jette 1996

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Methods	Randomised Controlled Trial - Method of Randomisation NR -Assessor Blinding Yes - Participant Blinding No - Loss to Follow-up 9 - Intention to Treat Analysis No
Participants	- Location USA - N = 102 - Sample non-disabled community-dwelling older people - Age 72 - Inclusion Criteria non-disabled, community dwelling, aged 65 and over; clearance from GP - Exclusion Criteria significant coronary artery disease, angina, congestive heart failure, myocardial infarction, cardiac surgery, or significant or new onset rhythm disturbance; neurological disorders with residual deficit; renal failure requiring dialysis; recent cancer with active chemotherapy or radiation treatment; uncontrolled hypertension, diabetes or seizure disorders; recent fracture; legal blindness; major mobility limitations; failed exercise safety evaluation (i.e. resting heart rate greater than 120 bpm, resting systolic/ diastolic great than 165/100 or less than 80/50, or failed treadmill test; English speaking; have access to a VCR or willing and able to use one provided by the study
Interventions	Rx Group - Type of Ex 10 exercises to the UL, LL and Trunk - Equipment theraband - Intensity low to moderate - Frequency 3 times per week - Reps/Sets 10 reps - Program Duration 12-15 weeks - Setting home-based - Supervision low Adherence mean 58%, median 71% Control Group continued with normal activities , on waiting list for exercises
Outcomes	- strength (Cybex isokinetic dynamometer) - psychological well-being (Profile of Mood States battery) - SF-36 Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Jette 1999

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Methods	Randomised Controlled Trial - Method of Randomisation randomly permuted blocks by size 4, assigned by a staff member not involved in data collection - Assessor Blinding Yes - Participant Blinding No - Loss to Follow-up 15 at 6 months - Intention to Treat Analysis No
Participants	- Location USA - N = 215 - Sample older adults with disabilities - Age PRT group Mean 75.4 (SD 7.4) - Inclusion Criteria aged 60 years or over; limitations in at least one of 9 functional areas - Exclusion Criteria medical history that contained current treatment for cancer, kidney disease requiring dialysis, recent fracture, uncontrolled diabetes or seizures, regular use of a wheelchair, current rehabilitation care, current fainting or dizzy spells, sudden loss of coordination or legal blindness or physician identified contraindications to exercise
Interventions	Rx Group - Type of Ex 11 exercises to UL, LL and trunk - Equipment theraband - Intensity low-moderate - Frequency 3 times per week - Reps/Sets 10 reps - Program Duration 6 months - Setting home-based - Supervision low - Adherence 89% Control Group on waiting list
Outcomes	- strength (hand-held dynamometer) - balance (functional reach, unilateral stance, tandem stance) - timed "up-and-go" - Profile of Mood States - Sickness Impact Profile 68 Post program f/u no (but 6 months of exercise)
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Jones 1994

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Methods	Randomised Controlled Trial (note: data reported by dominant and non-dominant leg. Data for dominant leg used in analyses) - Method of Randomisation not stated - Assessor Blinding Yes - Participant Blinding No - Loss to Follow-up 4 - Intention to Treat Analysis No
Participants	- Location USA - N = 46 - Sample women from a community senior center - Age mean 67.4 - Inclusion Criteria female, from a community senior centre, age>60, independently ambulatory - Exclusion Criteria unstable cardiovascular disease, orthopaedic or neurological dysfunction, any other uncontrolled chronic conditions that would interfere with the safety and conduct of the training protocol
Interventions	Rx Group - Type of Ex 7 LL exercises - Equipment velcro leg weights - Intensity started low, progressed to moderate - Frequency 3 times per week - Reps/Sets 3 sets of 14 by end of program - Program Duration 16 weeks - Setting group at local community centre (2 days/wk) and home (1 day/week) - Supervision full in group, none at home Adherence 86-93% Control Group no intervention - contacted to monitor health and activity level
Outcomes	- strength and muscular endurance (isokinetic dynamometer) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Jubrias 2001

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Methods	Randomised Controlled Trial with 3 groups: PRT, aerobic training and control - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location USA - N = 40 total (n = 26 in PRT and control) - Sample healthy, active older people - Age 69.2 +/-0.6 - Inclusion Criteria healthy (screened with physical exam, exercise testing), physically active, not engaged in PRT or aerobic training before this study - Exclusion Criteria
Interventions	PRT Group - Type of Ex 1LL, 2 UL - Equipment resistance training machines - Intensity phase 1: 60-70% 1RM phase 2: 70-85% 1RM - Frequency 3 times per week - Reps/Sets phase 1: 10-15 reps, 3 sets phase 2: 4-8 reps, 3-5 sets - Program Duration 24 weeks - Setting gym - Supervision NR Adherence 94.2% attendence Control Group continued normal activities, asked not to begin PRT or aerobic training during the trial Aerobic Training Group training began at 60% heart rate reserve for 10-20 minutes, progressed to 80-85% HR reserve for a total of 40 minutes, three times per week
Outcomes	- muscle size, energy and fibre properties Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Judge 1994

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Methods	Randomised Controlled Trial with factorial design: PRT alone, balance training alone, PRT and balance, control - Method of Randomisation balance block design (blocks of 4 subjects) - Assessor Blinding yes - Patient Blinding no, but control group received educational sessions - Loss to Follow-up 3 from PRT and control group - Intention to Treat Analysis yes
Participants	- Location USA - N = 110 total (55 in PRT vs control) - Sample ambulatory older people from voter registration list - Age mean 80 - Inclusion Criteria age 75 years or greater, the ability to walk without an assistive device for 8 metres, MMSE >24 - Exclusion Criteria symptomatic cardiovascular disease, poorly controlled hypertension (>160/96), history or physical findings of focal neurological deficit, Parkinson disease, peripheral neuropathy of the legs, hip or knee joint replacement, hip fracture, cancer (metastatic or under active treatment), taking neuroleptic, prednisolone > 5mg/day, benzodiazepines, significant hip or knee arthritis that requires a cane for ambulation
Interventions	PRT Group - Type of Ex 6 LL - Equipment cuff-weights and exercise machines - Intensity 60-75% for exercises with machines; low to moderate for other - Frequency 3 times per week - Reps/Sets machines: 3 sets to failure sandbags: 13 reps, 2 sets body weight: 10 reps, 2 sets - Program Duration 3 months - Setting group exercises - Adherence 82% - Supervision full Control Group 5 education sessions Balance Group 3 times per week, 45 minute sessions, one-on-one with exercise leader including balance platform and floor-based exercises (eyes open and closed on different surfaces, with pertubations and base of support changes)
Outcomes	- strength (isokinetic dynamometer) - side effects of training (musculoskeletal or neurologic complaints) - gait velocity - chair rise - balance (one leg stance reported here) Post program f/u yes, monitored for 6 months after intensive program while participants undertook tai chi Falls monitored for median 0.88 years, max 1.86 years
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Kerr 2001

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Methods	Randomised Controlled Trial to 3 groups: strength, aerobic fitness group or control - Method of Randomisation block randomisation - Participant Blinding - Assessor Blinding - Loss to Follow-up 18 - Intention to Treat Analysis No
Participants	- Location Australia - N = 126 total (84 in PRT and control group) - Sample women - Age mean 60 (SD 5) - Inclusion Criteria female, more than 4 years post-menopause, capable of entering exercise programs, not already exercising at a moderate intensity more than 2 times per week - Exclusion Criteria women who performed weight training in the previous 5 years, on hormone replacement or other medications known to affect bone mineral density, those who had cardiovascular, physical or orthopaedic disabilities that would limit their ability to perform exercises
Interventions	Note: participants in all groups were given 600mg calcium per day PRT Group - Type of Ex 4UL, 4LL - Equipment resistance training machines - Intensity high - completed 8RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 2 years - Setting gym - Supervision full Adherence 74% Control Group nonexercise group Aerobic Fitness Group 3 sessions per week, performed same exercises as PRT group but with no resistance, plus added stationary cycling for 40 second stations
Outcomes	- bone mineral density Post program f/u no (but duration of program 2 years)
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Latham 2001

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Methods	Randomised Controlled Trial - Method of Randomisation concealed envelopes -Assessor Blinding No - Participant Blinding No - Loss to Follow-up 3 - Intention to Treat Analysis No
Participants	- Location New Zealand - N = 20 - Sample hospitalised older people - Age mean 81 (SD 8.6) - Inclusion Criteria 65 years or older, patient on hospital ward, expected length of stay of > 1 week - Exclusion Criteria unable to perform knee extension against gravity with both legs, recent lower limb fracture, cognitive impairment which limited participation, leg ulcers on lower calf region
Interventions	Rx Group - Type of Ex 1 LL - Equipment velcro ankle weights - Intensity 50-80% 1RM - Frequency 5 times per week - Reps/Sets 8 reps, 3 sets - Program Duration duration of hospital stay (app 2 weeks) - Setting gym in rehabilitation wards of a hospital - Supervision full Adherence 90% Control Group regular physiotherapy
Outcomes	- strength (1RM) - gait speed - timed "up-and-go" - balance (Berg) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Latham 2002

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Methods	Randomised Controlled Trial with a factorial design (only information about PRT vs control reported, 3- month outcomes reported) - Method of Randomisation central computerised randomisation, blocks of 6 by centre - Assessor Blinding yes - Participant Blinding no, but attention control - Loss to Follow-up 21 - Intention to Treat Analysis yes
Participants	- Location New Zealand and Australia - N = 243 - Sample frail older adults recruited from hospital geriatric services - Age mean 79.1 (SD 6.9) - Inclusion Criteria age 65 years or more, receiving hospital care from geriatric services, considered to be frail, not clear indication or contraindication to study treatments - Exclusion Criteria responsible physician considered the interventions definitely hazardous or required, patients unlikely to survive 6 months, severe cognitive impairment which could compromise adherence to the exercise programme, not fluent in the English language
Interventions	Rx Group - Type of Ex 1 LL - Equipment velcro ankle weights - Intensity aimed for 50-80% for most of the programme - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 10 weeks - Setting home-based - Supervision limited - fortnightly home visits alternating with phone calls Adherence 82% (including drop-outs) Control Group frequency-matched phone calls and home visits
Outcomes	Primary - falls over 6 months - HRQoL (SF-36) Secondary - balance (Berg) - strength (hand-held dynamometer) - gait speed - timed "up-and-go" - Barthel Index - Adelaide Activities Profile - Falls Self-Efficacy Index - adverse events ( limitation in ADL for 2+ days and/or attention sought from health care professional) Post program f/u yes - assessed at 6 months
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Maiorana 1997

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 5 - Intention to Treat Analysis No
Participants	- Location Australia - N = 31 - Sample men at least 3 months after coronary bypass - Age mean 61.2(SD8.4) in training group - Inclusion Criteria male, at least 3 months after coronary artery bypass surgery, low risk for recurrent cardiac events (normal left ventricular function, no residual ischemia, and an exercise capacity exceeding 4 metabolic equivalents during graded exercise testing) - Exclusion Criteria not in an exercise rehabilitation programme at time of recruitment, moderate/severe left ventricular function, valve replacement/repair, history of CHF, on beta-blocking medication, significant resting hypertension (systolic BP >160mmHg or diastolic 100 mmHg) angina or significant ST depression during graded exercise testing
Interventions	Rx Group - Type of Ex 7UL, 4LL, 1Tr - Equipment machines, dumb-bells - Intensity 40% of MVCat beginning or program, 60% by end - Frequency 3 times per week - Reps/Sets 10-15 reps, 3 sets - Program Duration 10 weeks - Setting gym - Supervision full - Adherence all subjects completed at least 80% of sessions (excluding drop-outs) Control Group maintain current physical activity habits
Outcomes	- strength (1RM) - body composition - aerobic capacity (Peak VO2 on treadmill test) - self-efficacy Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Maurer 1999

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Methods	Randomised Controlled Trial - Method of Randomisation random number generator, stratified by disease severity - Assessor Blinding Yes - Participant Blinding no, but attention control group -Loss to Follow-up 15 - Intention to Treat Analysis no
Participants	- Location USA - N = 113 - Sample people with diagnosed OA of the knee - Age mean 66.3 (SD 8.8) in treatment group - Inclusion Criteria met current American College of Rheumatology criteria for OA, between 50-80 years, receiving no drugs for their arthritis other than stable doses of analgesics or NSAIDs, had mild to moderate knee pain for at least the previous 3 months, scored 1-3 on the Kellgren radiographic scale - Exclusion Criteria concurrently receiving physical therapy, actively involved in any other pharmaceutical or exercise study or had undergone isokinetic strength training within the previous 3 years, had significant cardiovascular disease, more than mild knee swelling, large popliteal cysts, knee instability, major hip or knee surgery on the side to be treated, systemic disease other than OA that might affect muscle function, severe osteopenia, history of fracture in the area of the joint to be treated, paresis of the lower extremity
Interventions	Rx Group - Type of Ex 1 LL - Equipment isokinetic dynamometer - Intensity appears high - Frequency 3 times per week - Reps/Sets 3 reps at 3 speeds (total 9 reps) in 3 sets - Program Duration 8 weeks - Setting gym - Supervision NR Adherence NR Control Group four classes on OA education and self-management
Outcomes	Primary - WOMAC - SF-36 Secondary - strength (isokinetic dynamometer) - AIMS index Post program f/u yes - at 12 weeks (after 8 weeks of training)
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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McCartney 1995

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Methods	Randomised Controlled Trial, all results broken down into four groups by sex and age (60-70 or 70-80, only results for women aged 70-80 -the largest group- used for pooled comparisons in review) - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No, but attention/exercise control group - Loss to Follow-up 23 - Intention to Treat Analysis No
Participants	- Location Canada - N = 142 - Sample healthy volunteers - Age mean 64 (SD 2.4) for exercise group - Inclusion Criteria approval of family physician, successful completion of cycle ergometer test, aged 60-80 years, no prior resistance training experience - Exclusion Criteria evidence of coronary artery disease, chronic obstructive or restrictive lung disease, osteoporosis, major orthopaedic disability, smoking, body weight greater than 130% of ideal
Interventions	Rx Group - Type of Ex 3UL, 3LL, 1Tr - Equipment weight-lifting machines - Intensity 50-80% 1RM - Frequency 2 times per week - Reps/Sets 10-12 reps, 3 sets - Program Duration 42 weeks - Setting gym - Supervision NR Adherence 88% (at 1 year) Control Group 2 times per week low-intensity walking
Outcomes	- strength (1RM) - maximum cycle ergometry - treadmill testing - stair climbing ergometry - muscle cross-sectional area - bone density Post program f/u no, but exercise program had 2 year duration
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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McGuigan 2001

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding no - Participant Blinding no - Loss to Follow-up 4 - Intention to Treat Analysis no
Participants	- Location Australia - N = 20 - Sample people with peripheral arterial disease - Age mean 66 (SD 6) exercise group - Inclusion Criteria PAD diagnosed by a vascular surgeon - Exclusion Criteria leg pain at rest, ischemic ulceration or gangrene, inability to walk at lest 2km/h on a treadmill, limited exercise capacity by factors other than claudication, vascular surgery or angioplasty in previous year, smoking of cigarettes
Interventions	Rx Group - Type of Ex 8 exercise that included URL, LL, Tr, combination varied in each session (1-3) per week - Equipment machines - Intensity used linear periodization, intensity varied with reps - Frequency 3 times per week - Reps/Sets 8-15 reps, 2 sets - Program Duration 24 weeks - Setting gym - Supervision full Adherence NR Control Group no intervention
Outcomes	- strength (10 RM) - 6 minute walk test - treadmill walk time - hemodynamic measures - muscle biopsy evaluations Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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McMurdo 1995

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Methods	Randomised Controlled Trial with three groups, PRT, mobility exercise programme and attention control - Method of Randomisation sealed envelopes in sequence, computer generated random number tables generated the sequence - Assessor Blinding yes - Participant Blinding no, but attention control used - Loss to Follow-up 7 from PRT and control group - Intention to Treat Analysis no
Participants	- Location UK - N = 86 total (55 in PRT vs control) - Sample residents of sheltered housing complexes - Age mean 82 - Inclusion Criteria age 75 years and over, limited mobility requiring the use of a walking aid, dependence in functional activities of daily living requiring the assistance of home help at least once per week - Exclusion Criteria major neurological disease, unstable cardiovascular disease, severe cognitive impairment
Interventions	PRT Rx Group - Type of Ex 24 (UL, LL., Tr) - Equipment theraband, progressive thickness - Intensity low-moderate - Frequency daily - Reps/Sets 5-10 reps Program Duration 26 weeks - Setting home - Supervision low - visited at home every 3-4 weeks Adherence NR Control Group health education visits every 3-4 weeks Mobility Group ? same 24 exercises, but with no resistance
Outcomes	- timed "up-and-go" - sit to stand test (time to complete 10 full stands) - grip strength - functional reach - ADL (Barthel Index) Post program f/u no, but program 6 months long
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Mihalko 1996

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Methods	Randomised Controlled Trial - cluster randomised by residence - Method of Randomisation not reported - Assessor Blinding No - Participant Blinding No, but attention control group - Loss to Follow-up Not reported - Intention to Treat Analysis No
Participants	- Location USA - N = 58 - Sample sedentary residents of senior citizen or residential nursing homes - Age mean 82.7 (SD 7.7) - Inclusion Criteria residents of senior citizen and residential nursing home facilities, sedentary, clearance form personal physician - Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 5 UL - Equipment dumb bells - Intensity high - worked until failure - Frequency 3 times per week - Reps/Sets 10-12 reps - Program Duration 8 weeks - Setting gym - Supervision NR Adherence NR Control Group fluid movement program
Outcomes	- ADL performance (modified version of Lawton and Brody's IADL scale) - strength (1RM) - Satisfaction with Life Scale - positive and negative affect Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Moreland 2001

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Methods	Randomised Controlled Trial - Method of Randomisation Concealled, phoned central office - Assessor blinding Yes - Participant blinding no, but attention control - Loss to Follow-up 10 - Intention to Treat Analysis yes
Participants	- Location Canada - N = 133 - Sample people post-stroke - Age mean 69 - Inclusion Criteria - Exclusion Criteria
Interventions	Rx Group - Type of Ex NR - UL, LL NR - Equipment NR - Intensity NR - Frequency NR - Reps/Sets NR - Program Duration until hospital discharge - Setting hospital - Supervision full Adherence NR Control Group regular therapy
Outcomes	Primary Chedoke-McMaster Stroke Assessment Secondary - 2 minute walk test - adverse events Post program f/u yes, at 6 months
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

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Nelson 1994

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 1 - Intention to Treat Analysis Yes
Participants	- Location USA - N = 40 - Sample healthy females post-menopause - Age mean 61.1 (SD 3.7) - Inclusion Criteria at least 5 years post-menopausal but not older than 70, do not engage in any regular physical training, weigh less than 130% of ideal body weight, currently non-smoking, do not have more than one crush fracture of the spine, no history of other osteoporotic fractures, have not taken estrogen or other medications known to affect bone for 12 months, passed physical screening (including ECG during strength training session)
Interventions	Rx Group - Type of Ex 2 LL, 1 UL, 2Tr - Equipment pneumatic resistance machines (Keiser) - Intensity 80% 1RM - Frequency two days per week - Reps/Sets 8 reps/ 3 sets - Program Duration 52 weeks - Adherence 87.5% - Setting gym - Supervision full Control Group asked to maintain normal level of activity, could receive the exercise program at the end of the trial
Outcomes	- strength (1RM) - balance (backward walking) - physical activity (Harvard Alumini Questionnaire, kJ/week) - bone densiometry - nutritional intake - body mass - hormones Post progrm f/u no, but program had 1-year duration
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Newnham 1995

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding Yes - Participant Blinding no, but attention control - Loss to Follow-up 6 - Intention to Treat Analysis No
Participants	- Location Canada - N = 30 - Sample residents of long-term care facility - Age mean 81.7 (SD 5.6) - Inclusion Criteria age 70+, independent in ambulation (with or without walking aid) over 40m at <0.9m/s, 20+ on TUAG; at least 90 degrees of available ROM at knee, can follow a 3-step command - Exclusion Criteria have Parkinsons Disease or CVA; participation in strength training in the past year; unstable medical conditions
Interventions	Rx Group - Type of Ex UL, LL - Equipment pullies - Intensity 80% of 1RM - Frequency 3 times per week - Reps/Sets 10 reps, 3 sets - Program Duration 12 weeks - Setting gym in nursing home - Supervision full Adherence 86% Control Group attention control
Outcomes	- strength (1RM) - gait velocity - TUAG - Balance (Berg) Post program f/u yes, followed up at 24 weeks
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Nichols 1993

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Methods	Randomised Controlled Trial - Method of Randomisation stratified into rank-ordered pairs and randomised - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 6 - Intention to Treat Analysis No
Participants	- Location USA - N = 36 - Sample active healthy women - Age mean 67.8 (SE 1.6) - Inclusion Criteria greater than 60 years, active for at least 6 months prior to the trial with exercise at least 3 times per week, physician's consent - Exclusion Criteria previous weight training, history of cardiovascular disease, taking thyroid or cardiac medications, nonestrogen repleted
Interventions	Rx Group - Type of Ex 4UL, 2LL, 1Tr - Equipment variable resistance machines (Polaris) - Intensity 80% 1RM - Frequency 3 times per week - Reps/Sets 8-10 reps, 3 sets - Program Duration 24 weeks - Setting gym - adherence 87% of sessions - Supervision full Control Group maintain current routine
Outcomes	- strength (1RM) - body composition - activity performance, Blair Seven Day Recall Post program f/u no, but 6 month duration of program
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Parkhouse 2000

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location Canada - N = 22 - Sample sedentary older women with low bone mineral density - Age mean 68.1 - Inclusion Criteria community-dwelling, sedentary, post-menopausal women, aged 60-80 years, low bone mineral density - Exclusion Criteria medical or orthopaedic problems that would interfere with their ability to participate in physical activity, on hormone replacement
Interventions	Rx Group - Type of Ex 9 LL - Equipment NR - Intensity 75-80% 1RM - Frequency 3 times per week - Reps/Sets 8-10 reps, 3 sets - Program Duration 8 months - Setting gym - Supervision NR Adherence NR Control Group NR
Outcomes	- strength (1RM) - serum insulin growth factor-1 Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Perrig-Chiello 1998

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 0 - Intention to Treat Analysis No drop-outs - ITT not stated
Participants	- Location Switzerland - N = 46 - Sample older men and women who are part of a cohort involved in a longitudinal study - Age 73.2 - Inclusion Criteria already enrolled in the Interdisciplinary Ageing Study, expressed an interest in resistance training, aged 65-95 Exclusion criteria NR
Interventions	Rx Group - Type of Ex 3LL, 3UL, 2Tr - Equipment machines - Intensity NR - Frequency one time per week - Reps/Sets NR - Program Duration 8 weeks - Setting gym - Supervision NR Adherence NR Control Group NR
Outcomes	- memory - well-being - control beliefs Post program f/u yes, evaluated at 1 year
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Pollock 1991

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Methods	Randomised Controlled Trial with 3 groups: PRT, aerobic training and control group - Method of Randomisation rank ordered then randomly stratified into 3 groups, with the restriction that more would be assigned to training groups - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 8 total (4 in PRT and control) - Intention to Treat Analysis No
Participants	- Location USA - N = 57 in total (36 in PRT and control) - Sample sedentary men and women - Age 72 - Inclusion Criteria free from overt evidence of coronary heart disease or any other conditions that would limit their participation in vigorous exercise; aged 70-79, sedentary for one year - Exclusion Criteria blood pressure >160/100; ECG changes or cardiac symptoms during exercise testing
Interventions	Rx Group - Type of Ex 5UL, 2LL, 3Tr - Equipment variable resistance machines (Nautilus) - Intensity initially light to moderate, by week 14 encouraged to train to fatigue - Frequency 3 times per week - Reps/Sets 8-12 reps, 1 set - Program Duration 26 weeks - Setting gym - Supervision NR Adherence 97.8% sessions attended (excluding drop-outs), 87% stayed with program Aerobic Training Group 3 sessions per week of walk/jog program for 26 weeks, aimed for duration of 35-45min minutes at 75-85% VO2 max by week 26 Control Group NR
Outcomes	- strength - VO2 max - adverse events - body composition - reaction time Post program f/u no, but 6 month exercise program
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Pu 2001

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding for some (not all) measures - Participant Blinding Yes ("sham- exercise" program) - Loss to Follow-up 0 - Intention to Treat Analysis Yes
Participants	- Location USA - N = 16 - Sample older women with CHF - Age mean 77 (SE 6) - Inclusion Criteria community-dwelling women; 65 years or older; mild to moderate systolic heart failure New York Heart Association (NYHA) class I to III; resting ejection fraction less than or equal to 45%, - Exclusion Criteria NYHA class IV heart failure; myocardial infarction within 6 months of randomization, hospitalization for CHF within 2 months, change of CHF therapy within 1 MO; unstable angina pectoris, fixed ventricular rate pacemaker, abdominal aortic aneurysm >4cm, major limb amputation, symptomatic abdominal or inguinal hernias, MMSE <23, signification abnormalities on treadmill or strength testing, any unstable medical conditions
Interventions	Rx Group - Type of Ex 2UL, 2LL - Equipment pneumatic resistance equipment (Keiser) - Intensity 80% 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 10 weeks - Setting gym - Adherence 98% - Supervision full Control Group - sham exercise group 2 time per week of supervised, low-intensity stretches for 10 weeks
Outcomes	Primary - exercise capacity (6-minute walk) - muscle function Secondary - maximal oxygen consumption - body composition - muscle metabolism/histology - cardiac function Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Rall 1996

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Methods	Randomised Controlled Trial (groups of healthy young people and middle-aged people with RA not included in this review) - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 0 - Intention to Treat Analysis no drop-outs, not stated
Participants	- Location USA - N = 14 - Sample healthy elderly - Age mean 70.3 (SD 5) - Inclusion Criteria healthy older people (ages 65-80) Exclusion Criteria obese (BMI>30), diabetes, cancer, renal disease, liver disease, cardiac artery disease, endocrine disorder, autoimmune disease
Interventions	Rx Group - Type of Ex 1UL, 2LL, 2Tr - Equipment pneumatic resistance machines (Keiser) - Intensity 80% - Frequency 2 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 12 weeks - Setting gym - Supervision full Adherence 92% Control Group 15 minutes of water exercises
Outcomes	- strength (1RM) - aerobic capacity - VO2 max - body composition - resting energy expenditure (kcal/day) measured by indirect calorimetry Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

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Rhodes 2000

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Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 6 - Intention to Treat Analysis No
Participants	- Location Canada - N = 44 - Sample healthy, community-dwelling sedentary women - Age mean 68.8 - Inclusion Criteria aged 65-75, not actively engaged in an organised activity program, had independent community dwelling status, passed medical screening by doctor - Exclusion Criteria recent hospital stay, blind, severe hearing impairment, uncontrolled hypertension and diabetes, symptomatic cardiorespiratory disease, severe renal or hepatic disease, uncontrolled epilepsy, progressive neurological disease, chronic disabling arthritis, MMSE<25/30, anaemia, marked obesity with the inability to exercise, regular exercise at the time of screening more than 3 times 30 minutes per week, current use of Beta-blockers, oral anti-coagulants or central nervous system stimulants
Interventions	Rx Group - Type of Ex 3UL, 3LL - Equipment weight-lifting equipment (Universal Gym) - Intensity 75% 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 1 year - Setting first 3 months in supervised gym, last 9 months at a recreation facility close to participants' home - Supervision supervised for first 3 months, last 9 months had occasional visits from study staff Adherence 86% (attendence) Control Group asked to maintain normal lifestyle, could participate in exercises at the end of the trial
Outcomes	- muscle strength (1RM, hand grip) - flexibility (trunk flexion test) - body composition - bone density Post program f/u no, but exercise program 1 year duration
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Sartorio 2001

---

Methods	Randomised Controlled Trial - Method of Randomisation computer generated list - Assessor Blinding No - Participant Blinding No - Loss to Follow-up NR - Intention to Treat Analysis No
Participants	- Location Italy - N = 30 - Sample healthy men recruited from fitness classes - Age mean 73.1 - Inclusion Criteria healthy men, recruited from fitness classes, not affected by cardiovascular, metabolic or neuromuscular diseases, not taking drugs known to interfere with bone metabolism Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 4UL, 2LL - Equipment isotonic strength training machines - Intensity 50-80% 1RM for lower limb; 40-65% 1RM for upper limbs - Frequency 3 times per week - Reps/Sets 10 repetitions - Program Duration 16 weeks - Setting gym - Supervision full Adherence NR Control Group maintain habitual level of activity for 16 weeks
Outcomes	- biochemical markers of bone formation Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Schilke 1996

---

Methods	Randomised Controlled Trial - Method of Randomisation table of random numbers used - Assessor Blinding No - Participant Blinding No - Loss to Follow-up No - Intention to Treat Analysis No dropouts, not stated ITT
Participants	- Location USA - N = 20 - Sample man and women with knee OA - Age mean 64.5 in PRT group - Inclusion Criteria from rheumatology clinic, no condition to preclude increased activity/strength training, not currently involved in a scheduled program of regular of exercise and had not participated in a strength-training program in the last 6 months
Interventions	Rx Group - Type of Ex 1LL - Equipment isokinetic dynamometer (Cybex II) - Intensity high - maximal contractions - Frequency 3 times per week - Reps/Sets 5 reps, 6 sets by session 6 (end of week 2) - Program Duration 8 weeks - Setting gym - Supervision full Adherence NR Control Group usual activities
Outcomes	- strength (isokinetic dynamometer) - timed walk - range of motion - health status (Arthritis Impact Measurement Scales; higher score = poor health status) - Osteoarthritis Screening Index (OASI; modified from Rheumatoid Arthritis Disease Activity Index; higher score = worse health) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Schlicht 1999

---

Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 2 - Intention to Treat Analysis No
Participants	- Location USA - N = 24 - Sample moderately active, community-dwelling men and women - Age mean 72 (SD 6.3) - Inclusion Criteria 60 years and older, community-dwelling, physician consent to participate - Exclusion Criteria dependent living status, current involvement in a strength training program, physiological disorders that precluded strenuous exercise or affected vestibular function
Interventions	Rx Group - Type of Ex 6LL - Equipment resistance training machines (Universal, Cybex and Paramount equipment) - Intensity 75% 1RM - Frequency 3 times per week - Reps/Sets 10 reps, 2 sets - Program Duration 8 weeks - Setting gym - Supervision NR Adherence 99% (excluding drop outs) Control Group NR
Outcomes	- muscle strength (1 RM) - maximum walking speed - 5-rep sit-to-stand - balance (1-leg stance with eyes shut) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Simpson 1992

---

Methods	Randomised Controlled Trial - Method of Randomisation stratified (don't know how) and randomly assigned - Participant Blinding No - Assessor Blinding No - Loss to Follow-up 6 - Intention to Treat Analysis No
Participants	- Location Canada - N = 34 - Sample people with chronic airflow obstruction - Age mean 73 (SD 4.8) in PRT group - Inclusion Criteria aged 58-80, attending a respiratory outpatient clinic, in a clinically stable state, no recent infective exacerbation, drug management was considered to be optimal, FE to VC ratio of less than 0.7, body weight within 30% of ideal weight, absence of disorders likely to affect exercise, capacity to take part in the training program, Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 1UL, 2LL - Equipment weight-lifting machines - Intensity 50-85% 1RM - Frequency 3 times per week - Reps/Sets 10 reps, 3 sets - Program Duration 8 weeks - Setting gym - Supervision NR Adherence 90% Control Group only attended testing sessions
Outcomes	- strength (1RM) - spirometry - aerobic capacity (VO2 max) - 6-minute walk test - Likert scale rating of discomfort during four daily activities (1 = extreme disability, 7 = none) assessed for fatigue, dyspnoea, emotion and mastery Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Singh 1997

---

Methods	Randomised Controlled Trial - Method of Randomisation computer-generated list in blocks of five - Assessor Blinding All outcomes except strength - Participant Blinding No, but attention control group - Loss to Follow-up 0 - Intention to Treat Analysis no drop-outs but not stated
Participants	- Location USA - N = 32 - Sample community-dwelling depressed older people - Age mean 70 (SD 1.5) in PRT group - Inclusion Criteria age 60 and over, fulfill DSM-IV diagnostic criteria for either unipolar major or minor depression or dysthymia. - Exclusion Criteria dementia, MM SE<23, unstable diseases, bipolar disorder, active psychosis, suicidal plans, currently seeing a psychiatrist, on antidepressant drugs within the last 3 months, participating in any progressive resistance training or in aerobic exercise more than twice a week in the previous month
Interventions	Rx Group - Type of Ex 2UL, 3LL - Equipment exercise machines (Keiser) - Intensity 80% of 1RM - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 10 weeks - Setting gym - Supervision full Adherence median 93% Control Group health education program, 2 times per week for 1 hour
Outcomes	Primary - depression (Beck Depression Inventory, Hamilton Rating Scale of Depression, Geriatric Depression Scale) Secondary Self-efficacy and Morale (Philadelphia Geriatric Morale Scale, Ewart's Scale of Self-Efficacy) - Sickness Impact Profile - Katz ADL scale - Lawton Brody IADL scale - SF-36 - strength (1RM) - adverse events (chest pain, musculoskeletal pain, medication change, intercurrent illness, hospitalisation, visits to a health professional, worsening of suicidality Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Sipila 1996

---

Methods	Randomised Controlled Trial with 3 groups: PRT, aerobic training and control - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 4 in PRT/controls (8 total) - Intention to Treat Analysis No
Participants	- Location Finland - N = 42 total (27 in PRT and control) - Sample healthy older women - Age 76-78 years - Inclusion Criteria born between 1915-17 (aged 76-78), no severe diseases or functional impairments, no indications against intensive physical exercise (medical exam and exercise test screening)
Interventions	Rx Group - Type of Ex 4LL - Equipment variable resistance machines (HUR equipment) - Intensity 60-75% - Frequency 3 times per week - Reps/Sets 8-10 reps in 3-4 sets - Program Duration 18 weeks - Setting gym - Supervision full Adherence 71-86% (varied depending upon muscle group/exercise type) Control Group instructed to continue daily routines and not change their physical activity levels Endurance exercise group 18 weeks of track walking (2 times per week) and step aerobics (once per week) at 50%-80% of initial maximum heart rate reserve
Outcomes	- strength - walking speed - body composition Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Skelton 1995

---

Methods	Randomised Controlled Trials - Method of Randomisation a random numbers table - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 7 - Intention to Treat Analysis No
Participants	- Location UK - N = 47 - Sample healthy, independent women - Age median 79.5 (range 76-93) in PRT group - Inclusion Criteria healthy; medically stable; no recent history of cardiovascular, cerebrovascular, respiratory, systemic or muscular disease; any impairment that interferred with mobility, live independently, require not help with ADL's
Interventions	Rx Group - Type of Ex 3UL, 6LL - Equipment rice bags and elastic tubing - Intensity resistance increased as soon as participant could complete 3 sets of 8 reps - Frequency 3 times per week - Reps/Sets 4-8 reps, 3 sets - Program Duration 12 weeks - Setting group exercise class 1 day per week, home 2 days - Supervision NR Adherence no one attended fewer than 6 classes or 11 home sessions Control Group asked not to change their activities
Outcomes	- Human Activity Profile - Anthropometry - Strength (isometric strength and handgrip) - leg extensor power - functional reach - chair rise - timed walk - stair walking Post-program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Skelton 1996

---

Methods	Randomised Controlled Trial - Method of Randomisation matched by age then randomised - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 2 - Intention to Treat Analysis No
Participants	- Location UK - N = 20 - Sample women with functional limitations - Age median 81 - Inclusion Criteria aged 75+, From GP practice, have minor or major functional/mobility laminations - Exclusion Criteria any disease / condition adversely affected by exercise
Interventions	Rx Group - Type of Ex 2UL, 6LL - Equipment theraband, cuff-weights - Intensity resistance increased as soon as participant could complete 3 sets of 8 reps - Frequency 3 times per week - Reps/Sets 4-8 reps, 3 sets - Program Duration 8 weeks - Setting 1 class per week, 2 home sessions per week - Supervision class supervised, home exercises unsupervised Adherence no subject performed fewer than 30 complete sessions Control Group asked not to change activities
Outcomes	- Human Activity Profile - Strength (isometric strength and handgrip) - 1-legged balance - chair rise - timed walk - timed up-and-go Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Taaffe 1996

---

Methods	Randomised Controlled Trial with 3 groups: high intensity training, low intensity and control (high-intensity only used for main comparisons) - Method of Randomisation NR - Participant Blinding No - Assessor Blinding No - Loss to Follow-up 11 total (5 from HI PRT and control) - Intention to Treat Analysis No
Participants	- Location USA - N = 36 total (23 in control and main PRT group) - Sample healthy older women - Age mean 67 (SE 0.2) in HI-PRT group - Inclusion Criteria female, did not participate in a strength-training program; not taking HRT or on HRT for more than one year - Exclusion Criteria evidence of acute or uncontrolled chronic illness or condition that would prevent participation in a resistance training program; presence of vertebral compression fracture; evidence of any disorder that would affect bone metabolism
Interventions	Rx Group - Type of Ex 3LL - Equipment weight machines (Universal Gym, and Marcy equipment) - Intensity HI = 80% 1RM LI = 40% 1RM - Frequency 3 times per week - Reps/Sets HI = first set at 40% 1RM for 14 reps, last 2 sets had 7 reps LI = 14 reps, 3 sets - Program Duration 52 weeks - Setting gym - Supervision full Adherence 79% Control Group maintain customary dietary and activity patterns
Outcomes	- strength (1RM) - muscle composition/fibre assessment Post program f/u no, but 1 year duration of program - bone mineral density - habitual activity ( 4 day activity records)
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Taaffe 1999

---

Methods	Randomised Controlled Trial with 4 groups, PRT once per week, twice per week, 3 times per week and control (main analyses with 3 times per week and control) - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 7 total (2 in control and Ex3) - Intention to Treat Analysis No
Participants	- Location USA - N = 46 total (25 in Ex3 and control) - Sample community-dwelling, healthy men and women - Age mean 71.0 (SD 4.1) in Ex3 group - Inclusion Criteria aged 65-79 years, apparently healthy, BMI<30, no musculoskeletal disorder that could inhibit them from exercising, no weight training in previous 12 months, passed medical screening (including maximum exercise stress test)
Interventions	Rx Group - Type of Ex 6UL, 6LL - Equipment Universal Gym, Marcy and Nautilus equipment - Intensity 80% 1RM - Frequency EX1 = once per week Ex2 = twice per week Ex3 = three times per week - Reps/Sets 8 reps, 3 sets - Program Duration 24 weeks - Setting gym - Supervision full Adherence 97-99% Control Group maintain customary dietary and activity patterns
Outcomes	- strength (1RM) - bone mineral density - timed backward tandem walk - chair rise Post program f/u no, but 24 weeks duration
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Topp 1993

---

Methods	Randomised Controlled Trial (note: results extrapolated from graph) - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No, but attention control group - Loss to Follow-up 7 - Intention to Treat Analysis No
Participants	- Location USA - N = 63 - Sample community-dwelling men and women - Age mean 69.2 (SE0.8) for PRT group - Inclusion Criteria community-dwelling, 65+, - Exclusion Criteria cardiopulmonary/ cardiovascular disease, intolerance to exercise, functional disabilities that would contraindicate strength training, unable to commit to a 12-week program, currently involved in strength training more than 1 hour per week
Interventions	Rx Group - Type of Ex 6UL, 6LL - Equipment surgical tubing - Intensity low-moderate - increased tubing thickness when they could perform 12 reps of an exercise - Frequency 3 times per week - Reps/Sets upper body 10 reps, 2 sets; lower body 10 reps, 3 sets - Program Duration 12 weeks - Setting exercise class for at least one session per week, home for other session(s) - Supervision full in exercise class, low at home Adherence 90% Control Group attended two 3-hour driver education classes, continue usual activities, could have 4 weeks of exercise at the end of the trial
Outcomes	- gait speed - balance (modified Romberg protocol) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Topp 1996

---

Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding no, but attention control group - Loss to Follow-up 19 - Intention to Treat Analysis No - excluded people who completed <70% of prescribed sessions
Participants	- Location USA - N = 61 - Sample community-dwelling, sedentary - Age mean 70.8 (SE 1.03) in exercise group - Inclusion Criteria community dwelling older adults - Exclusion Criteria any contraindications to participating in regular exercise including a history of coronary artery disease, more than one major coronary risk factor or major symptoms or signs of cardiopulmonary or metabolic disease evident during a medically supervised history and physical; already participating in a program of regular resistance training, unable to make a 14-week commitment to the project
Interventions	Rx Group - Type of Ex 11 exercises (UL, LL, Tr) - Equipment theraband - Intensity low-moderate - used theraband of a thickness sufficient to produce moderate fatigue during the final 2 reps of an exercise - Frequency 3 times per week - Reps/Sets by end of study, 2 sets of 10 for UL, 3 sets of 10 for LL - Program Duration 14 weeks - Setting exercise class at least once per week, home for other session(s) - Supervision full for exercise class, none for home Adherence 93% (excluding drop-outs) Control Group two 3-hour supervised driver-education classes
Outcomes	- strength - postural control (measured using a force plate) - gait speed Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Tsutsumi 1997

---

Methods	Randomised Controlled Trial, with 3 groups: High-intensity PRT, low-intensity PRT, and control - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 1 - Intention to Treat Analysis No
Participants	- Location USA - N = 42 total (28 in HI and control) - Sample sedentary, healthy - Age mean 68.9 (SD 5.7 years) - Inclusion Criteria aged 60+, medically healthy, sedentary (no involvement in regular exercise for the previous 6 months) Exclusion Criteria NR
Interventions	Rx Group - Type of Ex 7UL, 2LL, 2Tr - Equipment dynamic variable resistance weight machines - Intensity HI = 75-85% 1RM LI = 55-65% 1RM - Frequency 3 times per week - Reps/Sets HI = 8-12 reps, 2 sets LI = 12-16 reps, 2 sets - Program Duration 12 weeks - Setting gym - Supervision full Adherence NR Control Group NR
Outcomes	- strength (1RM) - aerobic capacity (VO2 max; bicycle ergometer testing) - SF-36 - Profile of Mood states - body composition - physical self-efficacy - neurocognitive function Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Tyni-Lenne 2001

---

Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 0 - Intention to Treat Analysis No
Participants	- Location Sweden - N = 24 - Sample people with moderate to severe CHF - Age mean 63 (SD 9) in PRT group - Inclusion Criteria diagnosed with CHF; medically stable CHF in New York Heart Association Class II or III - Exclusion Criteria angina pectoris, valvular heart disease determined by Doppler, co-morbidity such as intermittent claudication, diabetes mellitus, chronic obstructive pulmonary disease or any other disorder limiting physical performance other than heart failure
Interventions	Rx Group - Type of Ex many UL and LL exercises - Equipment theraband - Intensity low-moderate, used Borg rating scale and increased resistance when people rated peripheral resistance <13 - Frequency 3 times per week - Reps/Sets 25 reps, 2 sets - Program Duration 8 weeks - Setting group activity - Supervision full Adherence 95% Control Group NR
Outcomes	- aerobic capacity ( Peak VO2 and 6 minute walk test) - quality of life (Minnesota Living with Heart Failure Index) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Vincent 2002

---

Methods	Randomised Controlled Trial with 3 groups: High-intensity PRT, low-intensity PRT and control - Method of Randomisation stratified by strength, randomised using a random numbers table - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 22 - Intention to Treat Analysis No
Participants	- Location USA - N = 62 total (38 in HI PRT vs control) - Sample healthy men and women - Age mean 68.4 (SD 6) - Inclusion Criteria free from cardiovascular or orthopedic problems that would limit exercise (assessment included physical exam), had not participated in resistance exercise for at least one year
Interventions	Rx Group - Type of Ex 6UL, 5LL, 2Tr - Equipment resistance machines (MedX) - Intensity High intensity: 80% 1RM Low Intensity: 50% 1RM - Frequency 3 times per week - Reps/Sets High Intensity: 8 reps, 1 set Low Intensity: 13 reps, 1 set - Program Duration 6 months - Setting gym - Supervision full Adherence excluded those who completed less than 85% of sessions Control Group instructed not to make any changes in their lifestyle during the study
Outcomes	- strength (1RM) - bone mineral density - biochemical measures Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	A - Adequate

---

Westhoff 2000

---

Methods	Randomised Controlled Trial - Method of Randomisation NR - Assessor Blinding Yes - Participant Blinding No - Loss to Follow-up 5 - Intention to Treat Analysis No
Participants	- Location The Netherlands - N = 26 - Sample low knee-extensor muscle strength - Age mean 75.9 (SD 6.8) in exercise group - Inclusion Criteria local residents 65 years and over - Exclusion Criteria maximum knee extensor torque for both legs >87.5 Nm, self-reported disease or condition such as uncontrolled heart failure or a neurological disease that would be adversely affected by the exercises in the program
Interventions	Rx Group - Type of Ex 9LL - Equipment theraband - Intensity low - increased theraband resistance when participant could do 3 sets of 8 reps - Frequency 3 times per week - Reps/Sets 8 reps, 3 sets - Program Duration 10 weeks - Setting at a community centre two times per week and home once per week - Supervision supervised 2 times per week; at home without supervision 1 time per week Adherence 87-88% Control Group no active intervention, asked to continue with normal exercises
Outcomes	- strength (maximum torque measured by the Quadriso-tester) - Gronigen Activity Restriction Scale, an ADL/IADL Index with scores from 18 (no limitations) to 72 (fully dependent) - timed walking test - timed up-and-go - balance (FICSIT balance test, graded from 1-6) Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

Wood 2001

---

Methods	Randomised Controlled Trial with 4 groups: PRT alone, aerobic training alone, combined PRT and aerobic training and control - Method of Randomisation NR - Assessor Blinding No - Participant Blinding No - Loss to Follow-up 9 in four groups - drop outs not reported by group - Intention to Treat Analysis No
Participants	- Location USA - N = 45 total (16 in PRT and control) - Sample healthy older people - Age mean 69.8 (SD 6) in PRT - Inclusion Criteria aged 60-84, no diseases or conditions that would put them at high risk for adverse responses to exercise - Exclusion Criteria history of surviving sudden cardiac death, recent myocardial infarction, unstable angina, poorly controlled hypertension, poorly controlled diabetes mellitus, frequent or complex ventricular ectopy, significant cognitive dysfunction that might interfere with one's ability to adhere to exercise protocols, in the inflammatory stage of arthritis, receiving medical treatment for osteoporosis
Interventions	PRT Group - Type of Ex 5UL, 3LL - Equipment resistance training machines - Intensity 75% of 5RM at first, progressed to 8-12RM - Frequency 3 times per week - Reps/Sets 8-12 reps, 1 set, progressed to 2 sets - Program Duration 12 weeks - Setting gym - Supervision NR Adherence excluded those who did not have 80% or more attendence Control Group asked not to make significant changes in their physical activity and nutrition habits over a 12-week period Aerobic Training trained on treadmills and cycle ergometers 3 times per week at 60-70% extimated HR reserve, for 21- 45 minutes per session
Outcomes	- strength (5RM) - submaximal aerobic capacity - co-ordination Post program f/u no
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	B - Unclear

---

 Age: overall age of all groups. If this is not available age for progressive resistance training group alone is reported.
BMI: body mass index
CHF: congestive heart failure
Ex: exercise
Ex1: exercise once per week
Ex2: exercise twice per week
Ex3: exercise three times per week
f/u: follow up
HI: high intensity
LI: low intensity
LL: lower limb
MMSE: the Mini-Mental State Examination
N: number of participants randomised to intervention groups that are compared in this review, excludes other intervention groups that did not meet critieria for this review.
NR: not reported
OA: osteoarthritis
PAD: peripheral arterial disease
RM: repetition maximum
Rx: treatment group
SF-36: Medical Outcome Studies 36 Item Short Form questionnaire
Tr: trunk
TUAG: timed "up-and-go" test
UL: upper limb
WOMAC: Western Ontario/McMaster Universities Arthritis Index

 

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Adami 1999	not an RCT
Adams 2001	participants too young (mean age <60)
Agre 1988	not an RCT
Allen 1999	combined program - not PRT alone
Aniansson 1984	not an RCT
Aniansson 1980	not an RCT
Aniansson 1981	not an RCT
Ardman 1998	not an RCT
Beniamini 1997	participants too young (mean age <60)
Beniamini 1999	participants too young (mean age <60)
Berg 1998	not an RCT
Bernard 1999	combined program - not PRT alone
Bilodeau 2000	participants too young (mean age <60)
Brill 1998	not an RCT
Brown 1990	not an RCT
Brown 1991	combined program - not PRT alone
Brown 2000	combined program - not PRT alone
Bunout 2001	combined program - not PRT alone
Campbell 1997	combined program - not PRT alone
Chaloupka 2000	participants too young (mean age <60)
Chapman 1972	not an RCT
Connelly 1995	not an RCT
Connelly 2000	not an RCT
Cress 1991	not an RCT
Cress 1999	combined program - not PRT alone
Crilly 1989	combined program - not PRT alone
De Vito 1999	combined program - not PRT alone
Dupler 1993	not an RCT
Fernandez Ramirez 99	combined program - not PRT alone
Fiatarone 1990	not an RCT
Fisher 1991	not an RCT
Fisher 1993	not an RCT
Fisher 1993a	not an RCT
Fisher 1994	not an RCT
Fisher 1997	not an RCT
Frontera 1988	not an RCT
Frontera 1990	not an RCT
Grimby 1992	not an RCT
Hakkinen 1995	not an RCT
Hakkinen 1996	not an RCT
Hakkinen 1999	participants too young (mean age <60)
Hartard 1996	not an RCT
Humphries 2000	participants too young (mean age <60)
Hunter 1995	not an RCT
Hurley 1998	not an RCT
Ivey 2000	not an RCT
Jones 1987	participants too young (mean age <60)
Judge 1993	combined program - not PRT alone
Judge 1993B	combined program - not PRT alone
Kauffman 1985	not an RCT
Kauranen 1998	not an RCT
Kerr 1996	participants too young (mean age <60)
King 1991	combined program - not PRT alone
King 2000	combined program - not PRT alone
Komatireddy 1997	participants too young (mean age <60)
Larsson 1982	not an RCT
Lazowski 1999	combined program - not PRT alone
Lexell 1992	not an RCT
Lexell 1995	not an RCT (not clearly stated that patients were randomised)
Lichenstein 1989	combined program - not PRT alone
Liemohn 1975	combined program - not PRT alone
Lohman 1995	participants too young (mean age <60)
Lord 1994	combined program - not PRT alone
Lord 1995	combined program - not PRT alone
Lord 1996	combined program - not PRT alone
MacRae 1994	combined program - not PRT alone
Maddalozzo 2000	participants too young (mean age <60)
Magnusson 1996	participants too young (mean age <60)
Martel 1999	not an RCT
McAuley 2000	combined program - not PRT alone
McCool 1991	not an RCT
McMurdo 1993	training did not meet criteria for PRT
McMurdo 1994	training did not meet criteria for PRT
Meredith 1992	not an RCT
Messier 2000	combined program - not PRT alone
Meuleman 2000	combined program - not PRT alone
Morey 1989	combined program - not PRT alone
Morey 1991	combined program - not PRT alone
Moritani 1980	not an RCT
Morris 1999	combined program - not PRT alone
Mulrow 1994	combined program - not PRT alone
Narici 1989	participants too young (mean age <60)
Nelson 1997	combined program - not PRT alone
Nowalk 2001	combined program - not PRT alone
O'Reilly 1999	training did not meet criteria for PRT
Oka 2000	combined program - not PRT alone
Okumiya 1996	combined program - not PRT alone
Oster 1997	combined program - not PRT alone
Parsons 1992	not an RCT
Perhonen 1992	training did not meet criteria for PRT
Perkins 1961	training did not meet criteria for PRT
Petrella 2000	training did not meet criteria for PRT
Pyka 1994	serious threats to internal validity - participants allowed to move from exercise to control group
Richards 1996	not an RCT
Rikli 1991	combined program - not PRT alone
Roman 1993	not an RCT
Rooks 1997	training did not meet criteria for PRT
Rubenstein 2000	combined program - not PRT alone
Ryan 1998	not an RCT
Sagiv 1989	training did not meet criteria for PRT
Sanders 1998	not an RCT
Sashika 1996	not an RCT
Sauvage 1992	combined program - not PRT alone
Sforzo 1995	serious threats to internal validity - 1/3 of randomised participants dropped out; reasons and numbers by treatment group not provided
Sharp 1997	not an RCT
Shaw 1998	not an RCT
Sherrington 1997	training did not meet criteria for PRT
Shumway-Cook 1997	combined program - not PRT alone
Sinaki 1996	participants too young (mean age <60)
Sipila 1994	not an RCT
Sullivan 2001	not an RCT
Taaffe 1997	not an RCT
Thompson 1988	combined program - not PRT alone
Tinetti 1994	combined program - not PRT alone
Treuth 1994	not an RCT
Tsuji 2000	combined program - not PRT alone
van den Ende 2000	combined program - not PRT alone
Verfaillie 1997	combined program - not PRT alone
Welsh 1996	not an RCT
Williams 1997	combined program - not PRT alone

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 RCT=randomized controlled trial; PRT=progressive resistance training

 

Comparison 1. Strength

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Main Lower Limb Strength (LL) Measure - PRT versus control	41	1948	Std. Mean Difference (IV, Random, 95% CI)	0.68 [0.52, 0.84]
2 Main LL strength measure - high versus low intensity	4	85	Std. Mean Difference (IV, Fixed, 95% CI)	0.51 [0.07, 0.94]
3 Main LL strength measure - high intensity versus variable intensity	1	24	Std. Mean Difference (IV, Random, 95% CI)	0.61 [-0.21, 1.44]
4 Main LL strength measure - once per week versus 3x per week	1	22	Std. Mean Difference (IV, Random, 95% CI)	0.40 [-0.44, 1.25]
5 Main LL strength measure - PRT versus aerobic	7	420	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [-0.08, 0.30]

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Comparison 2. Aerobic capacity

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Main measure of aerobic function - PRT versus control	16	777	Std. Mean Difference (IV, Fixed, 95% CI)	0.13 [-0.02, 0.27]
2 VO2 max (ml/kg.min) - PRT versus control	11	496	Mean Difference (IV, Fixed, 95% CI)	0.47 [-0.03, 0.97]
3 Six-Minute Walk Test (metres) - PRT versus Control	6	202	Mean Difference (IV, Fixed, 95% CI)	53.69 [27.03, 80.36]
4 High versus low intensity PRT - VO2 Max (ml/kg/min)	1	27	Mean Difference (IV, Fixed, 95% CI)	5.20 [1.30, 9.10]
5 High intensity PRT versus variable intensity PRT - VO2 Max	1	28	Mean Difference (IV, Fixed, 95% CI)	1.30 [-0.12, 2.72]
6 Aerobic Training versus PRT - Six minute walk test	1	40	Mean Difference (IV, Fixed, 95% CI)	8.0 [-42.58, 58.58]
7 Aerobic Training versus PRT - VO2 max (ml/kg.min)	6	374	Mean Difference (IV, Fixed, 95% CI)	-0.47 [1.00, 0.05]

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Comparison 3. Balance

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Balance measures (higher = better balance) - PRT versus control	12	789	Std. Mean Difference (IV, Fixed, 95% CI)	0.11 [-0.03, 0.25]
2 Balance measures - PRT versus balance training	1	39	Std. Mean Difference (IV, Fixed, 95% CI)	-0.60 [-1.24, 0.04]

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Comparison 4. Gait speed

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Gait speed (m/s) - PRT versus control	14	798	Mean Difference (IV, Fixed, 95% CI)	0.07 [0.04, 0.09]
2 Timed walk (seconds) - PRT versus control	4	81	Mean Difference (IV, Fixed, 95% CI)	0.77 [-0.65, 2.20]
3 Timed "Up-and-Go" (seconds) - PRT versus control	6	494	Mean Difference (IV, Fixed, 95% CI)	-1.23 [-2.80, 0.35]

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Comparison 5. Chair Stand

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Time to stand from a chair - PRT versus control	4	185	Std. Mean Difference (IV, Random, 95% CI)	-0.67 [-1.31, -0.02]

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Comparison 6. Disability

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Main Disability Measure (higher score =better function) - PRT versus control	10	722	Std. Mean Difference (IV, Fixed, 95% CI)	0.01 [-0.14, 0.16]
2 Main Disability Measure (lower score=better function) - PRT versus Control	6	559	Std. Mean Difference (IV, Random, 95% CI)	-0.17 [-0.53, 0.19]
3 PF of SF-36 (Higher score=better function) - PRT versus Control	7	493	Mean Difference (IV, Fixed, 95% CI)	0.96 [-3.35, 5.26]
4 ADL Measure (higher score = better function) - PRT vs control	2	258	Std. Mean Difference (IV, Fixed, 95% CI)	0.09 [-0.15, 0.34]
5 Activity level measure, kJ/week - PRT versus control	2	58	Std. Mean Difference (IV, Fixed, 95% CI)	1.36 [0.68, 2.04]
6 High versus Low Intensity Training - main disability measure (higher score=better function)	1	27	Std. Mean Difference (IV, Fixed, 95% CI)	-0.29 [-1.05, 0.46]
7 Aerobic Training versus PRT - main disability measure (higher score = better function)	3	102	Std. Mean Difference (IV, Fixed, 95% CI)	-0.26 [-0.65, 0.14]
8 Aerobic training versus PRT - main disability measure (lower score =better function)	1	237	Std. Mean Difference (IV, Fixed, 95% CI)	0.05 [-0.21, 0.30]

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Comparison 7. Pain

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain (higher =less pain, BP on SF-36) - PRT versus Control	6	440	Mean Difference (IV, Fixed, 95% CI)	-0.14 [-4.45, 4.18]
2 Pain (lower score=less pain) - PRT versus control	3	311	Std. Mean Difference (IV, Fixed, 95% CI)	-0.33 [-0.55, -0.11]
3 PRT versus Aerobic training - Pain (lower score=less pain)	1	237	Std. Mean Difference (IV, Fixed, 95% CI)	0.12 [-0.14, 0.37]
4 High versus low intensity PRT- Pain (higher score=less pain)	1	27	Std. Mean Difference (IV, Fixed, 95% CI)	-0.21 [-0.97, 0.55]

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Comparison 8. Vitality

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vitality (SF-36, higher = more vitality) - PRT versus Control	5	389	Mean Difference (IV, Fixed, 95% CI)	1.42 [-2.22, 5.07]
2 High versus low intensity PRT - Vitality (SF-36, higher score=more vitality)	1	27	Mean Difference (IV, Fixed, 95% CI)	5.40 [-0.85, 11.65]

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Comparison 9. Death

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Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death - PRT versus control	6	806	Risk Ratio (M-H, Fixed, 95% CI)	0.60 [0.29, 1.23]

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Table 1. Quality rating of trials

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Study	Concealed Random	ITT	Assessor Blind	Patients Blind	Comp at Entry	Identical Care	Inclusion/Exclusion	Interventions Define	Outcomes Defined
Ades 1996	1	0	0	0	2	2	0	2	1
Baker 2001	2	2/0	2/0	2	2	2	2	2	2
Brandon 2000	0	0	0	0	2	2	1	2	2
Buchner 1997	2	2	2	0	2	2	2	2	2
Chandler 1998	2	0	1	0	2	2	2	2	2
Charette 1991	1	0	0	0	1	2	0	2	2
Collier 1997	1	0	0	0	1	2	1	1	2
Damush 1999	1	0	0	1	2	2	1	1	2
Donald 2000	1	0	0	0	2	2	0	0	2
Ettinger 1997	2	2	2	1	2	2	2	2	2
Fiatarone 1994	1	2	2/0	1	2	2	2	2	2
Fiatarone 1997	1	0	0	1	NA	2	NA	2	2
Flynn 1999	1	0	0	0	2	2	1	2	2
Hagerman 2000	1	0	0	0	2	2	0	2	2
Hepple 1997	1	0	0	0	2	2	1	2	2
Hiatt 1994	1	0	0	0	1	2	2	2	2
Hortobagyi 2001	1	0	0	0	2	2	2	2	2
Jette 1996	1	0	2	0	2	2	2	2	2
Jette 1999	2	0	2	0	2	2	2	2	2
Jones 1994	1	0	2	0	2	2	1	2	2
Judge 1994	2	2	2	1	2	2	2	2	2
Latham 2001	2	0	0	0	2	2	2	2	2
Latham 2002	2	2	2	1	2	2	2	2	2
Maiorana 1997	1	0	0	0	2	2	2	2	1
Maurer 1999	2	0	2	1	1	2	2	1	2
McCartney 1995	1	0	0	1	2	2	2	2	1
McGuigan 2001	1	0	0	0	2	2	1	2	1
McMurdo 1995	2	0	2	1	2	2	2	1	2
Mihalko 1996	1	0	0	1	1	2	0	1	1
Moreland 2002	2	2	2	1	2	2	NA	NA	NA
Nelson 1994	1	2	0	0	2	2	2	2	2
Newnham 1995	1	0	2	1	2	2	2	2	2
Nichols 1993	1	0	0	0	2	2	2	2	1
Parkhouse 2000	1	0	0	0	1	2	2	1	1
Perrig-Chiello 1998	1	0	0	0	0	2	0	0	0
Pollock 1991	1	0	0	0	2	2	2	2	2
Pu 2001	1	2	2/0	2	2	2	2	2	2
Rall 1996	1	0	0	0	2	2	1	2	2
Rhodes 2000	1	0	0	0	2	2	1	2	1
Schilke 1996	1	0	0	0	2	2	0	1	2
Schlicht 2001	1	0	0	0	2	2	2	2	1
Simpson 1992	1	0	0	0	2	2	2	1	1
SIngh 1997	2	0	2/0	1	2	2	2	2	2
Siplia 1996	1	0	0	0	1	2	1	2	2
Skelton 1995	1	0	0	0	2	2	1	2	2
Skelton 1996	1	0	0	0	2	2	1	2	1
Taaffe 1996	1	0	0	0	2	2	1	2	2
Taaffe 1999	1	0	0	0	2	2	2	2	2
Topp 1993	1	0	0	1	2	2	1	2	2
Topp 1996	1	0	0	1	2	2	1	2	2
Tsutsumi 1997	1	0	0	0	2	2	1	2	2
Westhoff 2000	1	0	2	0	2	2	1	2	2
Balagopal 2001	1	0	0	0	2	2	1	1	2
Ballor 1996	1	0	0	0	2	2	1	2	2
Bermon 1999	1	0	0	0	2	1	0	2	2
Castaneda 2001	1	1	2/0	2	2	2	2	2	2
Earles 2001	1	0	0	0	2	2	2	2	2
Haykowsky 2000	1	0	0	0	2	2	1	1	2
Hennessey 2001	1	0	0	0	2	2	2	2	2
Hunter 2001	1	0	0	0	2	2	0	2	1
Jubrias 2001	1	0	0	0	2	2	1	2	2
Kerr 2001	1	0	0	0	2	2	2	2	2
Sartorio 2001	1	0	0	0	2	2	0	2	2
Tyni-Lenne 2001	1	0	0	0	2	1	2	1	2
Vincent 2001	1	0	0	0	2	2	2	2	2
Wood 2001	1	0	0	0	2	2	2	2	2
Note: 2/0 indicates that different standards used to assess different outcomes in the same study
NA = not available, no full report published

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Table 2. Functional or quality of life measures that could not be pooled

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Study	Outcome Measure	Treatment Group	Control Group
Buchner 1997	mean change in number of independent IADL's	mean 0.1 (SD 0.7)	mean 0.2 (SD 0.7)
Donald 2000	Barthel Index (actual data not in paper)	no significant difference
Fiatarone 1994	ankle activity monitors (counts/day)	mean change 3412 (SD 1700)	mean change -1230 (SD 1670)
Fiatarone 1997	overall self-reported activity level (measure not specified)	significant improvement (p<0.05) in exercise group	NR
Jette 1996	SF-36 - PF (actual data not reported)	no significant difference between groups (data not reported)
Mariorana 1997	Physical Activity Questionnaire(no reference) Self report	mean 209.8 (SD 142.9) kJ/kg	mean 250.1 (SD 225) kJ/kg
Maurer 1999	SF-36 PF (no SD/SE reported)	mean 50.3	mean 49.2
Maurer 1999	WOMAC section C (no SD/SE reported)	464.4	606.6
Maurer 1999	Aims Mobility (no SD/SE reported)	1.28	1.21
McMurdo 1995	Barthel Index (medians reported)	median change 0 (range -1 to 2)	median change control 0 (range -1 to 1)
Mihalko 1996	adapted version of Lawton and Brody's IADL scale (higher = better, not pooled because study was cluster randomised)	mean 105 (SD 12)	mean 68 (SD 25)
Nichols 1993	Blair Seven-day recall Caloric Expenditure (KCalories)	not signficantly altered	not significantly altered
Schilke 1996	AIMS mobility score (actual data not reported)	"no significant differences between or within groups"
Singh 1997	IADL (Lawton Brody Scale)	mean 23.4 (SD 0.4)	mean 23.9 (SD 0.1)
Skelton 1996	Human Activity Profile - (only reported training groups % change and the p-value of the change)	3.9% change3.9% change	NR
Skelton 1996	Human Activity Profile - Max Activity Score	0% change	NR
Skelton 1995	Human Activity Profile	no difference from baseline	no difference from baseline
Tyni-Lenne 2001	Minnesota Living with Heart Failure Questionnaire (lower score = better QOL, medians reported)Minnesota Living with Heart Failure Questionnaire (lower score = better QOL, medians reported)	median 19 (range 0-61)	median 44 (range 3-103)

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Table 3. Falls

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Study	Fall Statistic	PRT	Control
Buchner 1997	1)Cox regression analysis, time to first fall, 0.53, 95% CI 0.3-0.91 for exercise group (including endurance exercise groups)
	2) proportion of people who fell in one year	all exercise groups:42%	60%
	3) fall rate (falls/year)	all exercise: 0.81 falls/year	0.49 falls/year
Donald 2000	1) number of falls	7 (n = 32)	4 (n = 27)
	2) number of people who fell	6 (n = 32)	2 (n = 27)
*Fiatarone 1994 (*as reported in Province 1995)	1) average falls/subject	2.32	2.77
	2) covariance adjusted treatment incidence ratio (PRT vs control)	0.95 (95% CI 0.64, 1.41)
Fiatarone 1997	falls	no difference between groups (no data provided)
*Judge 1994	1) Average falls/subject	0.82	1.22
	2) Co-variate adjusted treatment incidence ratio (PRT vs control)	0.61 (95%CI 0.34,1.09)
*Buchner 1997	1) Average falls/subject	0.68	1.6
	2) Co-variate adjusted treatment incidence ratio (PRT vs control)	0.91 (95%CI 0.48,1.74)
Latham 2002	total falls	164	149
Latham 2002	1) number of people who fell	60	64
	2) fall-rate, person years	1.02	1.07
	Note Data marked with * were obtained from Province 1995

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Table 4. Adverse events

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Study	Any Comment re: AE	AE Occurred (y/n/na)	Description	Dropout Pathologies	Pain	Medical Care	Deaths
Ades 1996	No			None reported
Baker 2001	Yes	No	NR	Yes, 2 in treatment group (neck arthritis, prior back injury), 2 in control (illness, psoriatic arthritis)	treatment group decreased in WOMAC, SF-36 BP no change	NR
Brandon 2000	No				NR	NR
Buchner 1997	Yes	Yes	6 Injuries in strength training or in strength/endurance training group (not reported seperately, n = 50)	Not described	no significant change in BP of SF-36	for all exercise groups (ie including endurance exercise groups): stable outpatient visits in exercise group/ control increased, no difference in hospitalisation rates
Chandler 1998	No			9 drop-outs due to illness, 1 due to increased hip pain, 1 refused further strength testing (not given by group)	NR	NR
Charette 1991	No			1 discomfort after initial strength testing, 3 intercurrent illness not related to training	NR	NR
Collier 1997	No			No
Damush 1999	No			6 exercise drop-outs due to illness
Donald 2000	No			not clear
Ettinger 1997	Yes	Yes	PRT: 2 falls, one weight dropped on foot; Aerobic: 2 falls; Control: 1 sudden death (defined AE as death or injury requiring medical care)	NR	less for PRT group vs control	NR	NR
Fiatatrone 1994	Yes	Yes	PRT: 2 reports of joint pain, program was altered No control info No cardiovasc events	2 exercise drop outs, 1 due to musculoskeletal pain, 1 due to pneuomonia	not measured	NR	1 control, 0 PRT
Fiatarone 1997	No			1 exercise drop-out due to increased musculoskeletal pain	NR	no difference in health care visits between groups	NR
Flynn 1999	No			NR	NR	NR	NR
Hagerman 2000	No			3 PRT and 1 control withdrew because of minor injuries or previous medical problems exacerbated by testing/training	"no complaints of excess or intolerable muscle soreness or fatigue"	NR	NR
Hepple 1997	No			No
Hiatt 1994	No			No
Hortobagyi 2001	No (not identified as such)	Yes	Pain and bruising of shoulder from machine - dropped out	Yes	Yes	NR	NR
Jette 1996	No (not identified as such)			Yes - 2 drop-outs because of the exercises, 1 due to back pain, 1 due to shortness of breath during exercise,
Jette 1999	Yes	No		Reasons not described	NR, but fatigue significantly worse in exercise group	NR	NR
Jones 1994	Yes	No		NR
Judge 1994	Yes (a priori outcome of study)	Yes	10/55 people in RT or combined balance and RT develeoped musculoskeletal complaints, (specific details given), only 1 complaint in balance group, no control report, no serious injuries in any group	NR	NR
Latham 2001	Yes	No		No
Latham 2002	Yes (a priori outcome)	Yes	18 musculoskeletal adverse events in PRT group vs 5 in control group	No			6 in PRT versus 8 in control
Maiorana 1997	Yes (safety an aim of study)	Yes	In ex group: MI (before exercises began),1 vasovagal epidsode, 1 musculoskeletal pain. Control: 2 people stoptted testing because of aggravation of psoriatic arthritis(1) and atrial fibrilation (1)	Yes, as reported	NR	NR - ischaemic symptoms/ECG changes during training
Maurer 1999	Yes	No		Yes, 4 drop-outs due to increased pain "but neither subjects nor investigators attributed pain to the treatment"	WOMAC pain, 143.8 in PRT vs 167.1 control	NR	NR
McCartney 1995	Yes	No		9 exercise drop-outs due to "illness", 3 controls due to medical problems. Stated "no injuries as a result of training"
McGuigan 2001	No			NR
McMurdo 1995	Yes	No		see hosp admissions		3 hospital admissions in PRT, 2 in control, 3 in home mobility - reported not related to exercise	2 in home mobilitly group, no others - not related to exercise
Mihalko 1996	No			NR
Moreland 2002	Yes (a priori outcome)	Yes	yes to pain or stiffness = 14 in PRT vs 8 in control; other adverse: 8 in PRT vs 3 in control	5 withdrew due to medical complications in PRT vs 3 in control
Nelson 1994	Yes	Yes	7/20 in PRT group experienced transient musculoskeletal pain; 3 musculoskeletal injuries (2 factures and 1 sprain) in the control group	No - MI in PRT group occurred while patient was on vacation
Newnham 1995	No			No			3 in each group
Nichols 1993	Yes (safety a priori objective)	Yes	control subject contused sternum during baseline testing, mild to moderate delayed onset muscle soreness	PRT - 1 injury unrelated to program
Parkhouse 2000	No			NR
Perrig-Chiello 1998	No			NR
Pollock 1991	Yes (a-priori outcome, well-defined)	Yes	11/57 subjects sustained an injury during 1RM testing; 2/23 sustained an injury during training. In aerobic group, no injuries during testing but 9/21 had an injury during training	NR by group
Pu 2001	Yes	Yes	1 control patient developed trochanteric bursitis from 1RM testing, 4 people had had mild musculoskeletal soreness, no cardiac complications, deaths or hospitalisations occurred	No
Rall 1996	Yes	No
Rhodes 2000	No			NR
Schilke 1996	No			No	decreased in OASI, no difference between groups on AIMS
Schlicht 2001	Yes	No		No
Simpson 1992	No			No
Singh 1997	Yes (a priori outcome)	No		No	weeks of pain reported: mean 5.4 (SD0.7) in PRT, mean 5.6 (SD 0.7) in control	health prof visits mean 2.1 (SD 0.4) for PRT; mean 2.0 (SD 0.5) for control; hospital stays mean 0.24 (SD 0.2) for PRT, mean 0.53 (SD 0.4) for control
Siplia 1996	No			3 drop-outs due to illness "not related to exercise"
Skelton 1995	Yes	No		4 execise and control participants dropped out because of ill-health "not related to exercise"
Skelton 1996	Yes	yes	patient fainted due to an arythmia during exercise	NR
Taaffe 1996	No			5 drop-outs from exercise groups for medical problems "not related to the exercie program"
Taaffe 1999	No			NR
Topp 1993	No			1 exercise drop-out due to worsening emphysema, 1 due to a stroke
Topp 1996	No			NR
Tsutsumi 1997	No			NR
Westhoff 2000	Yes (asked about complaints during exercise)	Yes	increased knee pain in person with OA, 1 person had pain from elastic band	2 drop outs becuase of medica problems (1 had increased epileptic attacks, 1 was often ill)
Haykowsky 2000	Yes	No (completed without complications)		NR
Castaneda 2001	Yes	No		No
Earles 2001	Yes (a priori outcome)	Yes	4 reported discomfort, 2 stopped program - 1 due to back pain, 1 due to lumbar disc herniation, possibly due to study intervention	Yes
Wood 2001	No	NR	stated none of the dropouts left the program as a result of adverse responses to treatment - not information about adverse events overall	No
Jubrias 2001	Yes	No		NR
Hunter 2001	No			NR
Bermon 1999	No			No
Kerr 2001	no			Yes - 3 in FITNESS group, incuding wrist and back injury
Balagopal 2001	No			NR
Tyni-Lenne 2001	Yes	Maybe	increased oedema in exercise patient	No
Ballor 1996	No			NR
Sartario 2001	No			NR
Hennessey 2001	No			NR
Vincent 2002	Yes	Yes	6 participants stopped exercise for 6 weeks due to hip/knee pain	NR

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