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Introduction
Aging is a biological and inevitable phenomenon associated with molecular and cellular damage that occurs over time (McMurdo, 2000; World Health Organization (WHO), 2022), leading to a decline in physical and intellectual capacities (Peinado et al., 2000). This process may also be influenced by social changes, such as retirement, where individuals may face challenges in managing their newfound free time, potentially leading to reduced mobility and physical activity (González, 2005; WHO, 2022).
The global population is undergoing a demographic transformation (Cardona Arango and Peláez, 2012). According to WHO (2002), it is estimated that by 2050, the number of people over 60 years old will significantly increase from 10% to 21%. Currently, 19.3% of the global population are older individuals, as supported by statistical data from the National Institute of Statistics (2022), mirroring the situation in Spain (Pérez et al., 2020; Fernández-Ballesteros and Sánchez-Izquierdo, 2020).
This aging process brings functional limitations, such as reduced walking speed (Doherty, 2003), an increased risk of falls (Rhonda et al., 2008), and a loss of independence in daily activities (Puyol and Abellán, 2006). Furthermore, the loss of independence and morbidity is closely related to the physiological syndrome known as frailty (Fried et al., 2001). Frailty poses a significant health risk (Rockwood et al., 1999), involving physical (Clegg et al., 2013), cognitive (Miyamura et al., 2019), and psychological challenges (Morley et al., 2006).
Frailty can be considered a clinical sign distinguishing between a healthy older adult and a vulnerable one, with an increased risk of adverse events and higher mortality rates (Rockwood, 2005; Jürschik et al., 2012). Numerous studies define frailty as a clinical syndrome with specific symptoms (Rockwood, 2005; Fried et al., 2001; Béland and Zunzunegui, 1999), related to various physical capacities: strength, speed, and balance (Reeve et al., 2018; Diaz et al., 2019). An increase or decrease in these capacities indicates the presence of frailty (Izquierdo, 2019).
Various functional assessments, such as the Time Up to Go (Podsiadlo & Richardson, 1991), and frailty level assessment protocols, including the Barder questionnaire (Barber et al., 1980), Clinical Frailty Scale (Church et al., 2020), or the FRAIL scale (Morley et al., 2006), are used to detect these symptoms. The most widely used internationally is Fried’s phenotype, proposing five physical indicators (Fried et al., 2001): unintended weight loss, muscle weakness, fatigue or exhaustion, slow walking speed, and low physical activity level. To be considered frail, an individual must meet at least 3 of these indicators (Fried et al., 2001), and depending on the number of indicators, they are classified as robust (no indicators), pre-frail (1 or 2 indicators), or frail (3 or more indicators) (Vellas et al., 2012).
On the other hand, aging also involves cognitive decline (Casanova et al., 2004), defined as “the loss of cognitive functions, depending on both physiological and environmental factors, subject to considerable interindividual variability” (Borras et al., 2016). Cognitive functions encompass areas such as memory, language, information processing, attention, and perception (Borras et al., 2016). Cognitive decline ranges from minor forgetfulness to interfering with daily life operations (American Psychiatric Association, 1995). This decline is not only linked to aging but is also associated with the individual’s prior pathologies, mood, and the presence of other syndromes, such as frailty (Benavides Caro, 2017). Cognitive decline also influences the appearance of various frailty factors, such as slow walking (Hervás and García de Jalón, 2005). Various tools, such as the Pfeiffer test (De la Iglesia et al., 2001), Fototest (Vilar et al., 2007), or the Folstein Mini-Mental State Examination (Folstein et al., 2002), are used to detect cognitive decline.
Additionally, physical activity tends to decrease with age, leading to increased sedentary behavior (González, 2005). This sedentary lifestyle significantly impacts physical condition, resulting in greater bone mass loss and an increased risk of falls (Batty, 2002; Gregg et al., 2003). Sedentary behavior is also associated with a higher risk of cardiovascular diseases (McPhee et al., 2016), type II diabetes (García-Molina et al., 2010), osteoporosis (Cenarruzabeitia et al., 2003), as well as decreased walking pattern, autonomy (Pahor et al., 2014; Kehler et al., 2018), increased cognitive decline, and consequently, a higher risk of frailty (Falck et al., 2017). Sedentary behavior is also a risk factor for depressive disorders (Wilson-Escalante et al., 2009; Cenarruzabeitia et al., 2003), contributing to a lower quality of life (Varo et al., 2003).
To address issues related to low physical activity, poor physical condition, and the subsequent presence of frailty and cognitive decline, multicomponent exercise programs are proposed. These programs have been proven to be most suitable for working with older individuals (Cadore et al., 2014; Casas-Herrero et al., 2022; Plaza-Carmona et al., 2022). These programs include strength, aerobic, balance, and flexibility exercises (Jiménez et al., 2020; Plaza-Carmona et al., 2022; Izquierdo, 2019). Moreover, numerous studies reference the Vivifrail program for carrying out interventions. This program comprises seven tests assessing functional capacity and the risk of falls. After evaluation, participants are categorized into seven types, ranging from Type A (person with disability) to Type D (robust individual), depending on their level of functionality. Based on this classification, different multicomponent exercise programs are proposed, considering the duration and types of exercises participants can perform (Izquierdo, 2019). This program is part of the health promotion and quality of life strategy of the European Union, as well as within the Ministry of Health and Consumer Affairs in Spain. For this reason, this type of program is most suitable for frailty management (Viladrosa et al., 2017), as it not only prevents functional deterioration but also has a positive impact on the effects of aging, improving physical and psychological well-being (Izquierdo, 2019).
Therefore, the aim of this systematic review is to assess the effectiveness of multicomponent physical exercise programs in individuals over 65 years, focusing on their effects on reducing signs of frailty and cognitive decline.
Materials and methods
Search Strategy and Databases Used
For this literature review, a search was conducted based on PRISMA guidelines (Liberati et al., 2009). The databases Pubmed, Google Scholar, Scielo, and Dialnet were utilized. The search involved the combination of different keywords connected with boolean connectors, with the search strategy being: “multicomponent exercise” AND “cognitive decline” OR “frailty.”
Initially, titles and abstracts of all identified articles in various databases were reviewed. Potentially relevant publications were selected according to the established inclusion criteria.
Out of a total of 562 initially found articles, 56 were excluded as duplicates across different databases. The remaining 506 underwent a review of titles and abstracts, with 300 selected for a detailed full-text analysis. During this phase, 20 were excluded for not aligning with the study’s objectives.
Finally, a total of 8 articles that met the inclusion criteria were included in the comprehensive review. These review and selection processes are visually detailed in Figure 1 using the PRISMA flowchart.
Study Selection Criteria
Inclusion Criteria
The following inclusion criteria were applied for article selection: (1) multicomponent exercise interventions for individuals over 65 years old, (2) study participants showing symptoms of frailty or cognitive decline, and (3) articles including pre-post measures of frailty and cognitive decline, either through subjective tests or assessments of physical condition related to these frailty indices.
Results
Table 1 Summary table of research studies on the effects on frailty and cognitive impairment in people over 65 years of age after completing a multicomponent exercise program
| Author | Sample | Fraility assessment | Cognitive impairment assessment | Multicomponent intervention characteristics | Results |
|---|---|---|---|---|---|
| Cadore et al., 2014 | n=24 (17 women y 7 men) Divided into CG (n=13) and IG (n=11) | -Fried criteria | TUG with dual task | During a period of 12 weeks, 2 sessions per week were carried out, each lasting 40 minutes, distributed as follows: | GI vs GC |
| -TUG | -Warm up 5' | ↑ Gait speed | |||
| -GTV | -Upper and lower limb strength 20' (8-10 | ↑ Balance | |||
| -Barthel Index | -Stretching 5' | ↓ Fall rate | |||
| ↑ Muscle strength in upper and lower limb | |||||
| ↓ Time in single and dual TUG | |||||
| ↑ Grip strength | |||||
| ↓ Barthel Index Score | |||||
| ↑ Power and muscle mass in lower extremities | |||||
| Casas-Herrero et al., 2022 | n= 188 (132 women and 56 men) | -Fried criteria | -MEC-Lobo | 12 week period | GI vs GC |
| Divided into CG (n=100) and IG (n= 88) | -Barthel Index | -MOCA | -3 sessions a week of strength, balance and | ↑ Punctuation SPPB | |
| -Battery SPPB | -5 walking sessions | ↑ Muscle strength in upper and lower limb | |||
| Both following the intensity, volume and frequency criteria of the Vivifrail program. | ↓ Number of people with disabilities | ||||
| ↑ Grip strength | |||||
| ↑ PunctuationMOCA | |||||
| ↑ Punctuation MEC-Lobo | |||||
| Sánchez-Sánchez et al., 2022 | n=188 (132 women and 56 men) | -Fried criteria | -MOCA | 12 week period | VG vs GC |
| Divided into CG (n=100) and IG (n= 88) | -Barthel Index | -3 sessions a week of strength, balance and | Improvement of Intrinsic Capacity in terms of: | ||
| -Battery SPPB | -5 walking sessions Both following the intensity, volume and frequency criteria of the Vivifrail program. | ↑ Locomotion | |||
| ↑ Punctuation MOCA | |||||
| ↑ Vitality (Hand pressure strength) | |||||
| Plaza- Carmona et al., 2022 | n=118 (96 women and 22 men) Two groups were created: IG1 (n=58) who begin physical maintenance activities and IG2 (n= 62) with ≥ 2 years of participation in maintenance activities. | -Battery SPPB where not fraile (SPPB ≥10) And fraile (SPPB < 10) | Duration of 12 weeks with 3 sessions a week of 60’ duration with aerobic, strength, joint mobility, balance and coordination exercises The exercises followed the volume and design of the Vivifrail program. | Both groups improved their muscle strength in the upper and lower limb, however, GE1 had significant improvements in gait speed and GE2 had ↓ SPPB score. Likewise, significant changes were observed in terms of classifying people from pre-frail to robust in both groups. | |
| Tarazona- Santabalbina et al., 2016 | n=100 Dividided into two groups: IG (n=51) and CG (n=49) | -Fried criteria | MMSE | Duration of 24 weeks with 5 sessions a week of 65’. The distribution was: | GI vs GC |
| -Edmonton Frailty Scale | -Proprioception + balance 10-15' | ↑ SPPB Score | |||
| -Barthel Index | -Endurance 40' (initially 40% HRMáx and progression up 65% HRmáx) | ↑ Barthel Index | |||
| -TUG | -Resistance (initially 25% de 1RM and progression up 75% 1RM) | ↑ Gait speed | |||
| -Battery SPPB | -Stretching 5' | ↓ Risk of Falls | |||
| -6MW | ↑ Muscular strength in upper and lower limb | ||||
| -FAC | ↑ MMSE Score | ||||
| -Tinetti Scale | ↓ Fragilty Score where it stands out that there was a significant change in subjects who went from being classified as frail to robust. | ||||
| Concha-Cisternas et al., 2020 | n=28 (17 women and 11 men) | Freid Criteria | -Duration 6 weeks 90’ sessions 2 days a week. | After participating in the intervention, the group of older adults show significant improvements regarding fragilty | |
| -Warm up 15' | |||||
| -Endurance training 25' (55-70% HRMáx) | |||||
| -Resistance training 15-20' (8-10 reps at 20% 1RM until progressing to a 40% 1RM) | |||||
| -Agility and balance 10-15’ combined with resistance and endurance. | |||||
| -Static flexibility of 30'' for each muscle group | |||||
| Sadjapong et al., 2020 | n=64 Divided into two groups: IG (n=32) and CG (n=32) | Freid Criteria | -24-week program, where the first 12 were carried out in a center and the next 12 in homes. Sessions of 60’ were carried out 3 times a week. | GI vs GC | |
| TUG | -Warm up 5-10' | Balance | |||
| 6MWT (Vo2Máx) | -Endurance 30' (initially 40% HRMáx until progressing to 65% HRMáx) | Tour in 6'(V02máx) | |||
| BBS | -Resistance (initially 65% 1RM of 1-2 series of 6-8 reps, after 1 month ↑85% 1RM of 3 series of 8-12 reps | Fall rate | |||
| -Static + dynamic balance 15' | Grip strength | ||||
| Muscular strength in upper and lower limb | |||||
| Frailty Score which highlights that there was a significant change in subjects who went from fragilty to pre-fragilty | |||||
| Martínez-Velilla et al., 2019 | n=370 (209 women and 161 men). | -Battery SPPB | -MMSE | The duration depends on the length of hospitalization. Carrying out 2 daily sessions of 20’ (one session was carried out in the morning and the other in the afternoon) | GI vs GC |
| Divided in IG (n=185) and CG (n=85) | -Barthel Index | The exercises followed the Vivifrail program. | ↑ SPPB Score | ||
| -Grip strength | ↑ Grip strength | ||||
| ↑ Barthel Index | |||||
| ↑ MMSE Score | |||||
| Reverses functionall deterioration in elderly patients undergoing acute hospitalization. |
Note: GC: Control Group, IG: Intervention Group, TUG: Time up and go, GTV: 4-meter walking speed test, 6MWT: 6-minute walking test, FAC: Functional Ambulation Categories, BBS: Berg Balance Scale, 1RM: Maximum repetition, HRMáx: Maximum Heart Rate, SPPB: Short Physical Performance Battery, MEC-Lobo: Minimental Cognitive State Examination of Lobo, MOCA: Montreal cognitive assessment, MMSE: Mini Mental de Folstein.
Discussion
The aim of this systematic review is to assess the effectiveness of multicomponent physical exercise programs in individuals over 65 years, focusing on their impacts on reducing indicators of frailty and cognitive decline.
Based on the found data, it is relevant to emphasize that various components of physical fitness, such as strength, balance, and walking speed, play a crucial role in frailty (Reeve, 2018; Diaz et al., 2019). In addition to the results found in this study, other studies, like Reeve’s (2018), highlight how grip strength and walking speed are key indicators of frailty. However, walking speed and balance are categorized as the best indicators of this syndrome (Kim et al., 2010), closely linked to the risk of falls and gait disturbance, both frailty factors (Kim et al., 2010; Toraman and Yildirim, 2010). The importance of intervening in these components of physical fitness in frail or pre-frail patients to delay or reduce frailty presence is also emphasized (Izquierdo, 2019).
Regarding muscle strength, this systematic review includes several studies (Cadore et al., 2014; Casas-Herrero et al., 2022; Plaza-Carmona et al., 2022; Tarazona- Santabalbina et al., 2016; Sadjapong et al., 2020) where improvements in both lower and upper limb strength were observed after a multicomponent exercise interven tion, leading to enhancements in physical fitness factors such as balance and walking speed. These findings align with other studies like Font-Jutglà et al. (2020), where they observed that strength and power training not only improves components like balance and walking speed but could also be a functional tool to prevent pre-frail older adults from developing frailty. Similarly, within the context of muscle strength, it’s important to highlight the significant improvement in grip strength in the dominant hand (Cadore et al., 2014; Casas-Herrero et al., 2022; Martínez-Velilla et al., 2019; Sadjapong et al., 2020). This grip strength is closely related to overall body muscle strength and, in turn, linked to sarcopenia (Clark et al., 2017), being a clear indicator of frailty influencing the predisposition to disability (Kim et al., 2010).
In relation to disability, defined by Fernández-López et al. (2009) as a “generic term that includes deficiencies in functions and structures, limitations in activity, and/or par ticipation restrictions in society,” there is a higher prevalence of deficiencies, such as reduced mobility, loss of sight, hearing, short-term memory, and lack of skill, in older people (Mejía et al., 2014). It has been established that factors such as frailty and cog nitive decline are considered antecedents to disability (Jauregui and Rubin, 2012). This systematic review includes articles that measure disability through different tools, such as the Barthel Index (Cadore et al., 2014; Casas-Herrero et al., 2022; Martínez-Velilla et al., 2019; Tarazona-Santabalbina et al., 2016; Sánchez-Sánchez et al., 2022; Concha-Cisternas et al., 2020). These measurements are crucial for planning multicomponent interventions since, similar to frailty, it’s essential to adapt exercises to the individual capacities of participants. This classification follows the guidelines of different Vivifrail programs, which also divide subjects by measuring their disability (Cadore et al., 2014; Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Plaza-Carmona et al., 2022). Within these programs, the importance of addressing modifiable factors such as strength, walking speed, and balance in frail or pre-frail patients is emphasized with the goal of delaying or reducing the presence of disability (Concha-Cisternas et al., 2020; Tarazona-Santabalbina et al., 2016; Casas-Herrero et al., 2022). Similar to the results found in this study, Makizako et al. (2015) pointed out in their study that the presence of frailty and impaired cognitive func tion are significant drivers of disability over a period of approximately two years.
Regarding gait speed, we found significant differences after the implementation of an 8-12-week multicomponent program (Cadore et al., 2014; Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Plaza-Carmona et al., 2022; Tarazona-Santabalbina et al., 2016; Sadjapong et al., 2020). These findings indicate an increase in gait speed after the multicomponent intervention. In contrast, the control group showed negative values in various measurements, implying a decrease in gait speed over time (Cadore et al., 2014). This difference between the experimental and control groups underscores the effectiveness of the multicomponent program in improving gait speed. These results support the importance of considering specific multicomponent training interventions to address and enhance walking ability in vulnerable populations or those at risk of frailty. In relation to this, the results presented by Vellas et al. (2012) show how gait speed is an indicative marker of frailty highly associated with the risk of falls, which is why increasing this speed directly contributes to a significant reduction in frailty.
Our review findings include an increase in gait speed, a decrease in the number of falls, and improvements in balance, which align with other studies, such as Cigarroa et al. (2021), supporting that achieving an increase in gait speed and balance after a multicomponent program not only reduces the number of falls in subjects but also has a significant positive impact on frailty.
In the context of balance, various studies show significant differences when com paring the intervention group with the control group after the implementation of the multicomponent program, similar to the study conducted by Sadjapong et al. (2016), where the experimental group showed improvements in balance, and the control group
As shown in the PRISMA diagram (Figure 1), out of a total of 562 articles found, 476 were excluded after title and abstract screening for not meeting the inclusion criteria. The remaining 30 were selected for full-text analysis, with 22 being excluded for not aligning with the study’s objectives. Finally, 8 articles that met the selection criteria were included as the final study sample.
The aim of this systematic review is to assess the effectiveness of multicomponent physical exercise programs in individuals over 65 years, focusing on their impacts on reducing indicators of frailty and cognitive decline.
Based on the found data, it is relevant to emphasize that various components of physical fitness, such as strength, balance, and walking speed, play a crucial role in frailty (Reeve, 2018; Diaz et al., 2019). In addition to the results found in this study, other studies, like Reeve’s (2018), highlight how grip strength and walking speed are key indicators of frailty. However, walking speed and balance are categorized as the best indicators of this syndrome (Kim et al., 2010), closely linked to the risk of falls and gait disturbance, both frailty factors (Kim et al., 2010; Toraman and Yildirim, 2010). The importance of intervening in these components of physical fitness in frail or pre-frail patients to delay or reduce frailty presence is also emphasized (Izquierdo, 2019).
Regarding muscle strength, this systematic review includes several studies (Cadore et al., 2014; Casas-Herrero et al., 2022; Plaza-Carmona et al., 2022; Tarazona Santabalbina et al., 2016; Sadjapong et al., 2020) where improvements in both lower and upper limb strength were observed after a multicomponent exercise intervention, leading to enhancements in physical fitness factors such as balance and walking speed. These findings align with other studies like Font-Jutglà et al. (2020), where they observed that strength and power training not only improves components like balance and walking speed but could also be a functional tool to prevent pre-frail older adults from developing frailty. Similarly, within the context of muscle strength, it’s important to highlight the significant improvement in grip strength in the dominant hand (Cadore et al., 2014; Casas-Herrero et al., 2022; Martínez-Velilla et al., 2019; Sadjapong et al., 2020). This grip strength is closely related to overall body muscle strength and, in turn, linked to sarcopenia (Clark et al., 2017), being a clear indicator of frailty influencing the predisposition to disability (Kim et al., 2010).
In relation to disability, defined by Fernández-López et al. (2009) as a “generic term that includes deficiencies in functions and structures, limitations in activity, and/or participation restrictions in society,” there is a higher prevalence of deficiencies, such as reduced mobility, loss of sight, hearing, short-term memory, and lack of skill, in older people (Mejía et al., 2014). It has been established that factors such as frailty and cognitive decline are considered antecedents to disability (Jauregui and Rubin, 2012). This systematic review includes articles that measure disability through different tools, such as the Barthel Index (Cadore et al., 2014; Casas-Herrero et al., 2022; Martínez-Velilla et al., 2019; Tarazona-Santabalbina et al., 2016; Sánchez-Sánchez et al., 2022; Concha-Cisternas et al., 2020). These measurements are crucial for planning multicomponent interventions since, similar to frailty, it’s essential to adapt exercises to the individual capacities of participants. This classification follows the guidelines of different Vivifrail programs, which also divide subjects by measuring their disability (Cadore et al., 2014; Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Plaza-Carmona et al., 2022). Within these programs, the importance of addressing modifiable factors such as strength, walking speed, and balance in frail or pre-frail patients is emphasized with the goal of delaying or reducing the presence of disability (Concha-Cisternas et al., 2020; Tarazona-Santabalbina et al., 2016; Casas-Herrero et al., 2022). Similar to the results found in this study, Makizako et al. (2015) pointed out in their study that the presence of frailty and impaired cognitive function are significant drivers of disability over a period of approximately two years.
Regarding gait speed, we found significant differences after the implementation of an 8-12-week multicomponent program (Cadore et al., 2014; Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Plaza-Carmona et al., 2022; Tarazona-Santabalbina et al., 2016; Sadjapong et al., 2020). These findings indicate an increase in gait speed after the multicomponent intervention. In contrast, the control group showed negative values in various measurements, implying a decrease in gait speed over time (Cadore et al., 2014). This difference between the experimental and control groups underscores the effectiveness of the multicomponent program in improving gait speed. These results support the importance of considering specific multicomponent training interventions to address and enhance walking ability in vulnerable populations or those at risk of frailty. In relation to this, the results presented by Vellas et al. (2012) show how gait speed is an indicative marker of frailty highly associated with the risk of falls, which is why increasing this speed directly contributes to a significant reduction in frailty.
Our review findings include an increase in gait speed, a decrease in the number of falls, and improvements in balance, which align with other studies, such as Cigarroa et al. (2021), supporting that achieving an increase in gait speed and balance after a multicomponent program not only reduces the number of falls in subjects but also has a significant positive impact on frailty.
In the context of balance, various studies show significant differences when comparing the intervention group with the control group after the implementation of the multicomponent program, similar to the study conducted by Sadjapong et al. (2016), where the experimental group showed improvements in balance, and the control group not only performed worse than in the pretest but also increased the risk of experiencing any falls. Additionally, the use of the SPPB battery in several studies (Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Plaza-Carmona et al., 2022; Tarazona-Santabalbina et al., 2016; Martínez-Velilla et al., 2019) has allowed for significant improvements in various aspects of physical condition, enabling the classification of subjects based on the risk of frailty and observing if there is improvement compared to the control group (Tarazona-Santabalbina et al., 2016).
The results regarding the improvement of physical condition and frailty align with other studies such as Cigarroa et al. (2021), showing the close relationship of improving physical condition to prevent or decrease frailty. However, it is interesting to note that the study by Theou et al. (2011) suggests that, although exercises at moderate intensity can improve physical abilities in pre-frail subjects, they do not show improvements in frail subjects.
Regarding cognitive decline, which is closely linked to frailty due to common pathophysiological data such as disability, falls, and even death (Benavides-Caro, 2017), the relationship is so strong that various authors propose the term “cognitive frailty” (Chacón-Valenzuela et al., 2019).
Frailty and dementia share symptoms such as decreased daily activities and gait speed (Kelaiditi et al., 2013). Therefore, within our review, several articles study cognitive decline along with frailty, concluding that multicomponent exercise plays a crucial role in reducing both syndromes (Cadore et al., 2014; Casas-Herrero et al., 2022; Sánchez-Sánchez et al., 2022; Tarazona-Santabalbina et al., 2016; Martínez-Velilla et al., 2019). In line with this, we find that a week of multicomponent exercise performed both in the morning and afternoon can have a positive impact on reversing cognitive decline in hospitalized patients (Martínez-Velilla et al., 2019). Additionally, the study by Subirats et al., (2012) reinforces the idea that a combination of aerobic, strength, and flexibility exercises can be effective not only in reducing cognitive decline but also in decreasing falls and increasing functional dependence.
Conclusion
The results obtained in this systematic review reveal that the implementation of a multicomponent exercise program with a minimum duration of 8-12 weeks leads to improvements in various physical aspects, such as muscle strength, gait speed, fall rate, endurance, and balance in frail individuals with cognitive impairment. Similarly, multicomponent exercise appears to be an effective tool for preventing and/or reducing disability, frailty, and cognitive decline
