Plain language summary
Physical activity programs for older adults
To improve health, is it better to do an exercise programme at home or at a hospital center?
To answer this question scientists from the Cochrane Group found and analyzed 6 studies. These studies tested over 370 people over 50 years old who had heart disease (or high risk of heart disease), Chronic Obstructive Airways Disease (COPD). The studies compared people who did an exercise programme at home to those who did an exercise programme at a hospital or center up to 2 years. This review provides the best evidence we have today.
What is the difference between exercise programmes at home or at a center? Why research whether one is better than the other?
Active living benefits the health of people 50 years and older. One of the important benefits is being able to do your everyday activities better and walking better (physical function). There are many ways to increase activity. You can do an exercise programme at home on your own, at your own convenience and at maybe a cost to you, but no cost to the health care system. Or you can join a programme at a center or hospital run by trained health care professionals. Most times these programmes are covered and do not cost you anything but they do cost the health care system. It is therefore important to know which type of programme improves health more, which programme people will stick with in the long run and which programme is worth the cost.
Which type of programme was better in the studies?
In people who had heart disease or an increased risk of heart disease
After 6 months, most studies show that exercise programmes, whether at home or at a center improve physical function, quality of life, blood cholesterol levels, walking speed and leg pain after walking due to poor blood flow. When comparing the two exercise programmes, the studies found that improvements were similar but that exercising at a center may improve walking speed and leg pain after walking more than at home.
One large study shows that many more people tend to stick with exercising after a home based programme compared with a center programme in the long-term.
In people who had COPD
Most studies show that exercise programmes, whether at home or at a center, improve physical function, decrease blood pressure, and improve some tests for exercise. But quality of life and other tests for exercise did not improve. When comparing the two exercise programmes, one study shows that improvements at home were similar to a center at 3 months. But at 18 months exercising at home was better than at a center. Another study shows that exercising at a center was better than at home at 2 months but the same at 13 months.
No studies looked at costs or use of the health care system.
Were there any problems with the programmes?
This review did not report any problems with the programmes.
What is the bottom line?
There is 'silver-level' evidence (www.cochranemsk.org) that both exercising at home or at a center improves the health and physical function of older adults. But, people tend to stick with exercising at home more than in a center.
People with heart disease or a high risk of heart disease may show more improvements exercising at a center than at home in the short-term (3 months). In people with COPD, it is still not clear whether exercising at home or at a center is better.
More research is still needed to test which type of programme might be better for people with osteoarthritis and what the costs are in general.