Table 2 Detailed results concerning intervention content, effects on health outcomes, and feasibility aspects of included studies in the field of health-promoting and preventive interventions for community dwelling older people in the Nordic countries from inception to 2019

  [32]

No

Component/s: Moderate resistance exercise and balance exercise

Modes of delivery: Groups of 5–7 participants lead by a physiotherapist

Duration: Twice weekly (60 min) for 6 months

Control: No intervention

End of intervention period 6 month: Isometric knee extension strength Newton meter (Nm) 13.5*, dynamic knee flexion (60°/180° /s, Nm) 7.2/8.1*** isometric trunk extension (Nm) 78***, isometric trunk flexion (Nm) 55***, habitual walking speed (m/s) 0.11 ***, maximal walking speed (m/s) 0.13***, Bergs Balance Scale (BBS) 1.98***. No sig. Difference in balance confidence, dynamic knee extension strength, isometric knee flexion strength, leg extension power.

One-year: Between-group effects were maintained in most of the variables.

Assessed for eligibility n = 405

Eligible n = 261

Randomized n = 65 (I = 32; C = 33)

Dropouts: I = 8; C = 4

No feasibility study identified

  [33]

No

Component/s: Combined exercise program (aerobic strength, balance, coordination)

Modes of delivery: Group sessions, led by a physiotherapist

Duration: Twice weekly (50 min) for 1 year

Control: No intervention

End of intervention period 1 year: Isometric grip strength 9,9%* higher, maximum walking speed 11,4%** higher, bone mineral density of the Wards triangle (BMD) 8,4%** higher. No sig. Difference on knee extension, one leg standing, or balance, BMD (total body, arms, lumbar spine, femoral neck, trochanter).

Volunteers assessed for eligibility n = 56

Eligible n = 48

Randomized n = 48 (I = 24; C = 24)

Dropouts: I = 3; C = 3

No feasibility study identified

  [34]

No

Component/s: Individually designed exercise program

Modes of delivery: Home-based, delivered by 27 nursing assistants, 20 physiotherapists (PT) and 17 occupational therapist (OT)

Duration: 8 home visits under 5 months

Control: No intervention, daily calendar registration of physical exercise, walks and occurrence of fall

End of intervention period 5 month: BBS 2.8 points higher*, improved ADL ability*, lower bodily pain (SF-36) 13.96**, health transitions over time** (proportion with better health 10/59 in intervention vs. control 5/56). No effects for improvement of walking ability, leg strength, perceived balance, fear of falling or in health-related quality of life.

1-year: Less hospital care due to fractures* (proportion with hospital visits due to fractures 0/59 in intervention vs. control 5/56), no sig. Difference on number of falls.

Assessed for eligibility n = 214

Eligible n = 212

Randomized n = 148 (I = 76; C = 72)

Dropouts: I = 16; C = 16

No feasibility study identified.

  [35]

[57]

[58]

Component/s: Progressive, specific, and individually adjusted balance-training in groups

Modes of delivery: Groups of 7–8 participants, led by two physiotherapists.

Duration: 3 times weekly (45 min) for 12 weeks

Control: No intervention

End of intervention period 3 month: Lower concern of falling (FES-I reported in median: I = 20.5 vs control C = 26)**, dual-task step execution (median: I = 1.73 vs C = 1.99)*, single task preferred walking gait in cadence (steps/min) (reported in mean I = 113 vs C = 109)*. Fast speed walking gait in velocity (m/s) (Mean: I = 1.60 vs C = 1.48)** and cadence (steps/min) (Mean: I = 1.34 vs C = 1.30)*** [35]. Improvement in overall function Cohen’s d = 0.69*, lower extremity function (basic and advanced) (Cohen’s d = 0.57* and d = 0.64*). No sig. Difference in likelihood for depression, step execution ST (initiation/step execution phase), step execution DT (initiation phase) Halvarsson et al., 2011), upper extremity function, disability (overall limitation/frequency) [57].

9-month: Between-group effects were maintained only in fast gait speed **, dual task step execution **, fear of falling***.

15-month: Between-group effects were maintained only in fear of falling* [58].

Assessed for eligibility n = 146

Eligible n = 59

Randomized n = 59 (I = 38 and C = 21)

Dropouts: I = 4; C = 0

No feasibility study identified

  [36]

[59]

Component/s: Two balance/strength exercise regimens, home training (HT) versus combined training (CT)

Modes of delivery: HT, individual self-managed home-based training and 3 group meetings with 6 participants led by physiotherapists. CT, group training with 5–8 participants led by two physiotherapists and the same home exercises.

Duration: (HT) 2 times daily HT and 3 group meetings; (CT) 2 times daily HT and 2 times weekly classes (1 h) for 3 months.

End of intervention period 3 month: Mental health index (SF-36)* improved more in CT. No sig. Difference in physical health index (SF-36), walking speed (preferred/fast gait speed) [59]., functional tasks (Figure of Eight, Timed Pick-up, Sit-to-stand, Timed Up & Go, Maximum Step Length), postural sway, isometric muscle strength [36]..

9-month: Higher number of weekly outdoor walks* and improvement in preferred walking speed only in* CT [59]. No sig. Difference in any scale of SF-36, role emotional, mental health index, physical health index, functional tasks, walking speed, postural sway, isometric muscle strength, fall rate or time to first fall [36].

Assessed for eligibility n = 127

Eligible n = 91

Randomized n = 77 (HT = 38; CT = 39)

Dropouts: HT = 10; CT = 14

No feasibility study identified

  [37]

[60]

[61]

[62]

Component/s: Group discussions on e.g., physical activity, nutrition, home safety, field visits, group and home exercise and home visits (HV)

Modes of delivery: Group meetings of 7–8 participants, led by two therapists (occupational therapist and physiotherapist)

Duration: 12 discussion groups (2 h) for nine months and 2 individually tailored home visits

Control: Standard primary health care

End of intervention period 9 month: No sig. Difference on Perceived Participation and Autonomy Swedish version (IPA-S), perceived Occupational Gaps Questionnaire (OGQ) [37].

12-month: Decrease in the odds of fear of falling (FES-I) OR 0.123**. No sig. Difference in accidental falls [60], in any IPA-S domain or OGQ [37].

Assessed for eligibility n = 138

Eligible n = 137

Randomized n = 131 (I = 74; C = 57)

Dropouts: I = 7; C = 9

No feasibility study identified

  [38]

No

Component/s: Nintendo Wii (balance and muscle exercise)

Modes of delivery: Sessions with 2 participants, led by a trained physiotherapist

Duration: 2 times weekly (53 ± 5 min) for 10 weeks

Control: Daily use of ethylene vinyl acetate (EVA) copolymer shoe insoles

End of intervention period 10 weeks: maximal voluntary contraction strength 8% higher (between-group difference = 269 N N)***, rate of force development (RFD) 811 N/s*, timed up and go test (TUG) -1.4 s*, fear of falling (FES-I short score) -1.2*, 30 s repeated Chair Stand Test 1.1 n**. No sig. Difference in postural balance (CoP-VM) and center of pressure velocity moment.

Assessed for eligibility n = 212

Eligible n = 123

Randomized n = 58 (I = 28; C = 30)

Dropouts: I = 5; C = 1

No feasibility study identified

  [10]

[63]

[54]

[64]

Component/s: Multicomponent exercise including resistance training (RES) or

balance-jumping training (BAL) or a combination of resistance and balance- jumping training (COMB)

Modes of delivery: Group exercise of 8–11 participants in RES and COMB, 17–21 participants in BAL, led by an exercise leader

Duration: 3 times weekly (50 min) for 1 year

Control: No intervention

End of intervention period one year: Self-rated physical functioning (Rand 36-items health survey) improved 10% more in COMB vs. control, dynamic balance (figure-of-8 running time, s) improved more in BAL and COMB vs. RES (6 and 8% respectively), leg extensor force (Leg press, N/k) improved more in RES and COMB vs. control (14 and 13% respectively), tibial shaft bone strength index (BSI, mm³) decreased 2% less in COMB vs. control, femoral neck in in section modulus in RES vs. COMB showed 4% higher treatment (Z, mm³). No sig. Difference in bone health parameters: bone mineral content (BMC) at proximal femur, distal tibia, distal radius, radial shaft [10].

No sig. Difference in health-related quality of life (HRQoL), fear of falling (FoF) [54].

1-year: Improvement in dynamic balance remained in COMB vs. control (4%), tibial shaft bone strength preserved 2% benefit in COMB vs. control. No effects remained in self-rated physical functioning, leg extensor force, section modulus (Z) at the femoral neck [63], HRQoL, FoF [54].

6-year: Rate of injured fallers was 62% lower in COMB HR 0.38 vs all, COMB group had 51% less injurious falls RR 0.49 and 74% less fractures RR 0.26 vs control, RES, BAL [64].

Assessed for eligibility n = 241

Eligible n = 166

Randomized n = 149 (RES n = 37, BAL n = 37, COMB n = 38, C = 37)

Dropouts: RES = 0; BAL = 2; COMB = 2; C = 1

No feasibility study identified

  [39]

No

Component/s: Otago exercise program (Balance and muscle strengthening program), group-based (GT) vs. home-based (HT)

Modes of delivery: Groups of 4–5 participants, led by a physiotherapist or independent home-training

Duration: 2 times weekly group training (45 min) or 3 times weekly home training (30 min) supported with 4 visits from a physiotherapist over a period of 12 weeks

End of intervention period 3 months: BBS 3.2 points higher*, improvement in Sit-to-Stand test (STS) 2.2 * and Physical Health Index (SF-36-PH) 45 (0 − + 100) ** in favor of GT. No sig. Difference in mobility (Timed Up-and-Go), mental health (SF-36-MH), fall efficacy (FES-I).

6-month: Improvement STS 2.2 (number of trials)** and TUG − 2.4 s* in favor of GT. No sig. Difference in BBS, falls efficacy, physical/mental health index.

Assessed for eligibility n = 205

Eligible n = 171

Randomized n = 125 (GT = 62; HT = 63)

Dropouts: GT = 22; HT = 20

No feasibility study identified

  [17]

No

Component/s: Multifactorial intervention including: strength and balance training, medication review and referrals, proper nutrition, home hazard assessment and modifications of home environment

Modes of delivery: Baseline assessment and intervention implementation was carried out as appropriate by a nurse, physician, and physiotherapist

Duration: Each participant received on average 5 interventions or recommendations over 1 year

Control: Received a general injury prevention brochure of the Finnish Prevention of Home Accidents Campaign

End of intervention period 1 year: Falls rate was lower in the intervention group (95 falls per 100 person-year) vs. control (131 falls per 100 person-year) (IRR = 0.72, 95% CI 0.61–0,86)***, ratio of fallers was 22% lower in I compared to C at any time point during the intervention (HR = 0.78, 95% CI 0.67–0.91)***. Fall-induced injuries for I was n = 351 compared to the C n = 468 (IRR = 0.74, 95% CI 0.61–0.89)**. No sig. Difference in the number of fractures.

Assessed for eligibility n = 1601

Eligible n = 1570.

Randomized n = 1314 (I = 661; C = 653).

Dropouts: I = 72; C = 97

No feasibility study identified

  [40]

No

Component/s: Community-based intervention consisting of Information, treating somatic and psychiatric illnesses, and dealing with improper drug consumption, diet insufficiencies and physical and mental inactivity and home visits with follow-up, removing physical hazards in the home

Modes of delivery: Leaflets and talks on clubs for senior citizens and home visits to people, 70–74-year-old, by utilizing existing municipal personnel e.g. nurses or practitioners, home helpers

Duration: 18 months. Training was delivered once in the beginning of the intervention and once halfway through

Control: Four other municipalities offering the standard healthcare

End of intervention period 18 month: Reduction of lower extremity fractures in the IG by 33% (OR = 0.63, 95% Cl 3–63)*. In women, the reduction of lower extremity fractures was 46% (95% Cl 8–84)* whereas in men, there was no sig. Effect. No sig. Difference reduction in the number of all fractures.

Study population n = 26,221 (I = 13,921 and C = 12,300)

Randomized n = 26,221 (I = 12,905 five municipalities; C = 11,460 four municipalities)

Dropouts: not reported.

No feasibility study identified

  [41]

[65]

[66]

[67]

[68]

[69]

[70]

[71]

Component/s: individual geriatric assessment, Individual guidance on fall prevention, physical exercise in small groups, lectures, psychosocial group activities, home exercise, home hazards assessments

Modes of delivery: Individually based, home-based and group sessions. Led by health professionals, student nurse, public health nurse.

Duration: 1 occasion of geriatric assessment, 1 occasion of oral and written information, 2 times monthly group exercise of 4–10 participants (about 50 min), 1 time monthly lectures on preventive aspects of falling, 1 time monthly psychosocial activities organized in two groups, those with lower social contacts and scores over 10 on Geriatric Depressive scale joint a smaller support group, the rest joined a bigger group, 1 time weekly home exercise for one year, 1 home hazard assessment in the beginning of the intervention and 1 six month after the intervention period.

Control: 1 counselling session on fall prevention at baseline

End of intervention period 1 year: Sig. differences only in women (I vs C): Velocity moment in standing balance decreased with a median change of − 0.54 mm²/s* [65], improvements in usual activity (cumulative odds ratio (COR) 1.4, CI 95% 1.0–1.8)** and in discomfort/symptoms (COR 1.4, 95% 1.1–1.8)* [66], extension strength of the left/right knee increased 5% /3%** more in I vs C [68].Sig. differences only in men (I vs C): Depressive symptoms decreased in I vs control only in men with a mean difference of − 2.5** [71]. Improvement on some dimensions of health-related quality of life: depression (COR 10.1, 95% 1.5–67.0)* and distress (COR 5.6, 95% 1.6–19.3)* [66].

Falls incidence decreased in those with higher number of depressive symptoms IRR = 0.50**, 95% CI = 0.92–1.57 and vice versa, in those with at least three previous falls IRR = 0.59**, 95% CI = 0.38–0.91, in subjects with high perceived risk of falling IRR = 0.77*, 95% CI = 0.55–1.06 [68]. No sig. Difference in hand grip strength, knee flexion (right/left) [68], incidence of falls overall [71] or in the incidence of falls requiring medical treatment [69], depressive symptoms [70], dynamic balance [65].

2-year and 3-year: No sig. Difference between I vs control in the incidence of falls requiring medical treatment [69]..

Assessed for eligibility n = 612

Eligible n = 591

Randomized n = 591 (I = 293; control = 298)

Dropouts: I = 32; control = 29

No feasibility study identified

  [42]

[72]

[73]

[74]

[55]

Component/s: Vitamin D and exercise combinations consisting of No exercise + Placebo (D-Ex-) or No exercise + vitamin D (D + Ex-) or Exercise + Placebo (D-Ex+) or Exercise + vitamin D (D + Ex+) (Uusi-Rasi et al., 2015)

Modes of delivery: Groups of 5–10 participants and home exercises, led by 1 or 2 exercise leaders

Duration: 2 times weekly exercise sessions (60 min) for the first year, 1 weekly exercise sessions (60 min) during the second year, including maximum 20 participants, and home exercise (5–10 min) on days without groups exercises during the first year and at least 3 time per week during the second year

End of intervention period 2 year: Leg strength (mean change: 14.1, 95% CI = 8.0–20.2 in exercisers; 1.6, 95% CI = -4.5 to 7.7 in no exerciser regardless vitamin D or placebo group) ***. Chair stand time also differed between groups (7.4, 95% CI = 3.8–10.8% in exercisers; 2.4, 95% = CI − 1.6-6.2 in no exerciser regardless vitamin D or placebo group) **. Neither exercise nor vitamin D reduced falls. Fall rates per 100 person-years were 118.2, 132.1, 120.7, and 113.1 in the D-EX-, D + EX-, D-EX+, D + EX+. Injurious fall rates were 13.2,12.9,6.5, and 5.0, respectively. Hazard ratios for injured fallers were lower among D + EX+ (HR = 0.38, 95% CI = 0.17–0.83) and D-EX+ (HR = 0.47, 95% CI = 0.23–0.99). Irrespective of vitamin D exercise improved muscle strength (mean increase in lower limb extension strength almost 15%)***, D-EX+ improved more than 6% in Chair stand test*. Vitamin D maintained femoral neck bone mineral density.

No sig. Differences in TUG, grip strength, total falls incidence rate ratio [74].

4-year: All treatment groups had less medically attended injurious fallers (HR = 0.62, 95% CI 0.39–1.00 for D + EX-), (HR = 0.46, 95% CI 0.28–0.76 for D-EX+) and HR = 0.55, 95% CI 0.34–0.88 for D + EX+) compared with D-EX-. Leg extensor muscle strength (N/kg) remained about 10% higher in D-EX+ and about 12% higher in D + EX+ vs D-EX- (Uusi-Rasi et al., 2017). Isometric leg extension strength improved in exercisers with a mean difference of 12.5%***, chair stand time reduced in exercisers with mean difference of 5%**, fast walking speed improved with 4.3%** in exercisers vs controls, greater probability in exercisers to complete backward walking test vs control (6.1 m)*** (74.3% of exercisers vs 48.8% control) [74].

Assessed for eligibility n = 1213

Eligible n = 433

Randomized n = 409

D-Ex- (n = 102),

D + Ex- (n = 102),

D-Ex+ (n = 103),

D + Ex+ (n = 102)

Dropouts: D-Ex- =7; D + Ex- =14; D-Ex+ =12; D + Ex+ = 6

No feasibility study identified

  [43]

[75]

[76]

[77]

[78]

[79]

[15]

[80]

[81]

[7]

Component/s: Senior group meetings (SM) and 1 follow-up home visit or a single preventive home visit (PHV)

Modes of delivery: Senior group meetings with a maximum of 6 participants or a single home visit led either by an occupational therapist, physiotherapist, registered nurse or social worker

Duration: Weekly SM sessions (2 h.) for 4 weeks+ 1 PHV or a single PHV.

Control: Access to the ordinary range of services for older persons provided by the urban district

3-month: SM vs. control: postponed dependence in activities of daily living (ADL) OR 1.95 **. PVH vs. control: delayed deterioration in self-rated health OR 2.21*. All vs control: no sig. Difference in frailty [7], functional balance, walking speed, physical activity, falls efficacy [77].

1-year: SM vs. control: positive effect on social support (regarding someone to turn to when in need of advice and backing) OR 1.72** [79], postponed independence in ADL OR 1.92** [81], delayed deterioration in self-rated health OR 0.55* [78], larger physical activity performance OR 1.82* [77], delayed deterioration in morbidity OR 0.61* [78], maintained satisfaction with physical health OR 0.57* [78]. PVH vs. control: larger physical activity performance OR 1.99* [77], delayed deterioration in morbidity OR 0.44** [78], maintained satisfaction with physical health OR 0.49* [78]. All vs. control: lower odds of dissatisfaction with psychologic health OR 0.34**/0.45* [78]. No sig. Difference on loneliness, social network, or other aspects of social support [79], walking speed, falls efficacy [77], frailty [15].

2-year: SM vs. control: larger physical activity performance OR 1.73* [77], higher odds of having a total score of 48 or higher on BBS OR 1.96** [77], lower concern of falling Short Falls Efficacy Scale International (FES-score)a (9.0 vs 13.0)*, delayed deterioration in morbidity OR 0.52*, maintained satisfaction with physical health OR 0.28** [78]. PVH vs. control: larger physical activity performance OR 2.10** [77], higher odds of having a total score of 48 or higher on BBS OR 1.80** [77], lower concern of falling (FES-score), (11.1 vs 13.0)*, delayed deterioration in morbidity OR 0.60* [78], lower odds of dissatisfaction with physical health OR 0.43** [78]. All vs. control: lower odds of dissatisfaction with psychologic health OR 0.40**/0.30*** [78]. No sig. Difference in ADL, self-rated health, frailty, mean walking speed.

Assessed for eligibility n = 546

Eligible n = 491

Randomized n = 384 (PVH = 174; SM = 171; Control n = 39)

Dropouts: PVH = 35; SM = 38; C = 19

No feasibility study identified

  [44]

[82]

[83]

[84]

[79]

[85]

[86]

[87]

Component/s: Senior group meetings (SM) discussing different aspects of self-management of health and a follow-up home visit

Modes of delivery: Groups of 4–6 participants and one follow-up home visit, led by a multidisciplinary team

Duration: Weekly SM sessions for 4 weeks

Control: No intervention

6-month: Increase in the total score of sense of coherence (SOC-13) (OR = 2.23, 95% Cl 1.05–4.77)* [86]. No sig. Difference in maintaining independence in ADL, maintaining/improving self-rated health [84].

1-year: Positive effects on social support (having someone to turn to when in need of advice and backing) OR 1.72** [79]. No sig. Difference in SOC [86], maintaining independence in ADL, maintaining/improving self-rated health [84], on loneliness, social network, or other aspects of social support (e.g. having someone to trust and confide, to turn to for practical help) [79].

Assessed for eligibility n = 873

Eligible n = 779

Randomized n = 131 (I = 56; C = 75

Dropouts: I = 9; C = 13 [84].

Pilot study assessing the feasibility of an adapted protocol of Senior meetings from “Elderly in the risk zone” [43]

  [18]

[88]

[89]

[90]

[91]

[92]

[93]

Component/s: Case management comprised of four dimensions: Case management tasks, General information, Specific information, Safety and continuity.

Modes of delivery: Individually home-based, including a care plan monitored by case managers (2 nurses and 2 physiotherapists) and a physical training program performed by the participant

Duration: At least 1-time monthly home visit for 1 year

Control: One year waiting list to get the intervention

3-month: Intervention group performed leisure activities in general to a greater extent than the control group (median: number of activities n = 13 vs n = 11). No sig. Difference on social participation [89].

6-month: Complete case analysis: risk for depressive symptoms RR = 0.49* and life satisfaction ES = 0.41* in the intervention group vs. control.

6 months to 12 months: Intention to treat analysis: no sig. Difference in loneliness, life satisfaction, depressive symptoms [88].. Fewer emergency department visits not leading to hospitalization in the intervention group vs. control (mean: 0.08 vs 0.37)*. Fewer visits to physicians in outpatient care (mean: 4.09 vs. mean 5.29)* [93].

End of intervention period 1 year: Intention to treat analysis: no sig. Difference in depressive symptoms [88]. Complete case analysis: sig. Difference in depressive symptoms ES = 0.47* [88]. No sig. Difference in preventing falls or injurious falls [18], life satisfaction, loneliness [88].

Assessed for eligibility n = 1079

Eligible n = 848

Randomized n = 153 (I = 80; C = 73)

Dropouts: I = 21; C = 15

Pilot study aiming to test sampling and sample characteristics

  [45]

No

Component/s: Social intervention of choice (exercise program-EP or social activity program-SP or personal counseling-PC)

Modes of delivery: Group meetings for the EP and SP program. EP was led by qualified instructors at the municipality gym, SP was led by healthcare students in the city library, PC was led by a rehabilitation counselor in a healthcare center

Duration: Weekly sessions for the EP and SP program (altogether 19–21 times). PC every third week, 4–5 meetings per participant (during the 6-month intervention)

Control: One counseling session

End of intervention period 6 month: Social integration increased in I (EP + SP + PC analyzed as one single intervention) but not in control (Generalized estimating equations-GEE group x time 0.041) *. No sig. Difference in Attachment and guidance, feelings of loneliness and melancholy, depressive symptoms.

12-month: No sig. Difference in loneliness and melancholy.

Assessed for eligibility n = 985

Eligible n = 475

Randomized n = 257 (I = 129; C = 128)

Dropouts: I = 24; C = 10

No feasibility study identified

  [46]

[94]

[95]

[96]

Component/s: Individual nutritional advice and group sessions on nutrition (N) or physical training (T) or combined nutrition and physical intervention (N + T)

Modes of delivery: Individually based and group sessions. (T) led by a physiotherapist and trained instructor, (N) led by dietitians

Duration: (T) 2 times weekly group meetings (1 h.), (N) 1 individual counseling and 5 group sessions for 3 months

Control: General physical training advice and general dietary advice

End of intervention period 3 month: Resting metabolic rate (RMR) varied in T with a mean difference of 4.8 Mj/d* [96]. Leg press improved in T + N and T vs N (mean difference: 11.4 kg respective 14.3 kg)*. Improvement in dips in T + N and T vs C (mean diff: 2.9 kg respective 3 kg)**, improvement for step test in T vs T + N 4.3* [46]. Lower extremity muscle strength increased in T and T + N vs N (mean diff: 87 kg respective 81 kg). Activity level increased in T and T + N vs C (median level: 3 vs 3)*. Walking duration increased* for combined (T and T + N) vs N and C [94].

No sig. Differences in balance, mobility, nutritional measures (e.g. body weight, energy intake) [46, 96], aerobic capacity (maximal work-load or work time) [95].

9-month: Only effects in physical activity level preserved in T vs C and N [94]. No effects were preserved on: RMR, leg press, dips, step test, muscle strength [46], Aerobic capacity (maximal work-load or work time) [95], ADL [94].

Assessed for eligibility n = 2012

Eligible n = 672

Randomized n = 96 (N n = 25, T n = 23, N + T n = 25, C = 23)

Dropouts: T = 3; N = 3; N + T = 7, C = 4

No feasibility study identified

  [16]

No

Component/s: Telephone calls focused on self-care habits, eating habits and nutrition, physical activity, health promotion, identity and self-esteem and one meeting

Modes of delivery: Telephone calls following a single meeting with all health professionals involved in the intervention (two occupational therapists and one physiotherapist)

Duration: Five self-care telephone calls (30 min) over a period of 19 weeks

Control: No intervention

End of intervention period 19 week: Mental health GHQ-30 (Goldberg’s General Health Questionnaire) improved in I with 4 scores vs C who experienced a decrease with 4 score*.

No sig. Difference in Self-Care Ability scale for the elderly, Appraisal of self-Care Agency, sense of Coherence.

Assessed for eligibility n = 1044

Eligible n = 284

Randomly chosen sample n = 226

Answered baseline questionnaire (I = 15 city A; C = 64 city B)

Randomized (those who answered baseline questions): (I = 15 city A; C = 15 city B).

Dropouts: I = 0; C = 0

No feasibility study identified

  [8]

[13]

Component/s: Three different occupation-focused interventions: individual intervention (IG) or activity group (AG) or discussion group (DG)

Modes of delivery: Home-based and telephone calls (IG), or group sessions in the format of a discussion group (DG) or an activity group (AG). Led by experienced occupational therapists

Duration: IG three to eight contacts either as home visits or telephone calls. AG 8 weekly sessions of 5–8 participants (1,5 h.), DG one 2 h-meting including 7–9 participants

Control: No intervention

3-month: DG had a small effect on reducing decline in leisure engagement compared to the control group. (Cohen’s d 0.27). The IG and DG had a small effect in maintaining ADL ability (Cohen’s d 0.29 and 0.31 respectively) [8]. AG and DG had a positive effect on self-rated health *(Zingmark et al., 2015.

12-month: IG had a small effect on reducing decline in leisure engagement (Cohen’s d 0.41). IG, AG and DG had a small effect in maintaining ADL ability (Cohen’s d 0.30, 0.38 and 0.30 respectively) [8]. No intervention had an effect on self-rated health at 12 months.

Assessed for eligibility n = 680

Eligible n = 549

Randomized n = 177

(IG = 41, AG = 49, DG = 41, C = 46)

Dropouts: IG = 1; AG = 1; DG = 6; CG = 4

No feasibility study identified

  [47]

No

Component/s: Resistance training (RT).

Modes of delivery: Group training with different intensity, led by trained personnel

Duration: Twice weekly resistance exercise for all groups (1 h) for the 3 first months. Allocated frequencies during 4th to 9th month. Group 1 (RT1) exercised once weekly, group 2 (RT2) twice weekly group 3 (RT3) three times weekly.

Control: No exercise

3-month: Improvements in exercise self-efficacy, coping planning (group × time)*, intrinsic motivation to training (group × time)** No sig. Difference in other volitional or motivational parameters (action planning, external/introjected/identified/intrinsic motivation to training or physical activity).

3 to 9 months (end of intervention period): No sig. Difference in any motivational or volitional parameters.

Baseline to 9 months: Action planning improved in all groups vs. control***. Coping planning and intrinsic motivation related to physical activity improved in RT2 and RT3 vs. control*. Intrinsic motivation related to training improved in RT2 and RT3 vs RT1 and control***.

12-months: 54% of participants did not continue self- directed regular resistance training, 22% continued regular resistance training once- a- week, and 24% twice- a- week.

Assessed for eligibility n = 454

Eligible n = 148

Randomized n = 106 (RT1 n = 26; RT2 n = 27; RT3 n = 28; C = 25)

Dropouts: RT1 = 1; RT2 = 2; RT3 = 0; C = 2

No feasibility study identified

  [48]

No

Component/s: Rocking-chair training program (RCG) and 10 different movements

Modes of delivery: Home-based exercise

Duration: Twice daily sessions (15 min) for 6 weeks

Control: No intervention

End of intervention period 6 weeks: BBS score (Mean: 51.5 vs 49.4)***, maximal knee extension strength (N) (mean: RCG 266.1 vs CG 225.9)**, maximal walking speed (m/s) (mean: 1.4 vs 1.4)* in favor of RCG. No sig. Difference in standing on one leg, hand grip, or chair rise parameters.

Assessed for eligibility n = 112

Eligible n = 97

Randomized n = 51 (I = 26; C = 25)

Dropouts: I = 1; C = 1

No feasibility study identified

  [49]

No

Component/s: Aerobic and strengthening exercise

Modes of delivery: Home-based video-exercise (consisting of a videotape showing the exercises, booklet describing the exercises and an elastic resistance band) and bi-weekly telephone calls, an exercise instructor assisted the first training session

Duration: three times weekly (26 min) for 5 months

Control: no intervention, received same telephone calls as the intervention group

End of intervention period 5 months: Improvement in EQ-5D in I vs C (mean: 0.77 vs 0.64) **. No sig. Difference in physiological measures e.g. handgrip strength, biceps strength or functional ability measures e.g. maximal walking speed, physical performance, self-rated health (S-R health). Significant within group improvement ranging from 8 to 35% in physical performance test, mobility, handgrip, biceps strength, chair rise, 10 m maximal walking speed.

Assessed for eligibility n = 650 women

Eligible n = 454

Randomized n = 61 (I n = 30; control n = 31)

Dropouts: I = 5; C = 3

No feasibility study identified

  [50]

[97]

[98]

Component/s: Physical activity counselling

Modes of delivery: Individually based telephone calls by a physiotherapist

Duration: One single individual motivational face-to-face physical activity counseling sessions and phone calls every 4 months from a physiotherapist for 2 years

Control: No intervention

End of intervention period 2 years: Perceived difficulty in advanced mobility (walk 2 km) was lower in the I group vs. control (OR = 0.84, 95% CI 0.70–0.99)* [97]. Higher proportion of participants in I vs control increased activity level from sedentary till at least moderate (83% vs 72%, OR 2.0, 95% CI: 1.3–3.0). Lower proportion of participants in I vs control reduced their physical activity level from at least moderate to sedentary (17% vs 28%, OR 0.51, 95% 0.3–0.8) [97]. No sig. Difference on basic mobility (walk 0,5 km) [97], IADL disability (preparing meals, washing clothes, shopping and more) [50].. Subgroup analysis (according to IADL status at baseline): intervention resulted in a reduced incidence disability in those without disability at baseline (RR = 0.68, 95% CI 0.47–0.97)*, no sig. Difference for IADL disability.

3.5-year: Treatment effect on perceived difficulty in advanced mobility preserved (OR 0.82, 95% 0.68–0.99)*.

Assessed for eligibility n = 1310

Eligible n = 1040

Randomized n = 632 (I = 318; C = 314)

Dropouts: I = 23; C = 31

No feasibility study identified

  [51]

[99]

[100]

Component/s: Multidisciplinary check-ups, physical activity counselling and supervised strength and balance training

Modes of delivery: Individual multidisciplinary check-ups led by a physician, nurse and physiotherapist and one-time group-based muscle strength and balance training and once weekly resistance training

Duration: one annually physical activity counselling (75 min, including 15-min warming-up and balance exercise), one opportunity to participate in supervised strength and balance training and once weekly resistance training for 2 years

Control: no intervention, annual healthcare and physical performance evaluation

End of intervention period 2 year: BBS 1.13 points higher***, maximal walking speed 0.05 m/s better***, TUG 0.97 s quicker in completing the test*** [51].

Improved chair rise capacity in physically active women with − 1.67 s*. No improvement in inactive women or in men, regardless of their physical activity level [99].

The intervention prevented the loss of ability to walk 400 m among pre-frail and frail persons OR 0.74** (95% CI 0.59–0.93). The treatment effect was not significant among non-frail participants [100].

3-year: Between-group effects were maintained in balance, maximal walking speed, and TUG [51].

Assessed for eligibility n = 1000 (random sample)

Eligible n = 1000

Randomized n = 928 (Active = 461; inactive = 467) [99]

Dropouts: I = 197; C = 221

No feasibility study identified

  [52]

[101]

Component/s: exercise program consisting of home exercise or walking exercise or group exercise or self-care exercise or in combination

Modes of delivery: delivered based on individual risk factors planned and assessed prior intervention by a regional geriatric team (physiotherapist, occupational therapist, physician)

Duration: home exercise recommended to be conducted three times per day (5–15 repetitions) for 1 year and 4 months or group exercise in small groups or self-care exercise.

Control: Were asked to visit their family physicians without a written intervention form

End of intervention period 16 months: Mobility performance improved in favor of home exercise group (median 0.5, interquartile range 0–2.0)* [52]. Impaired balance less common in intervention vs control (n = 64; 45% vs n = 89; 59%)* [101].

No sig. Difference in admission into long-term institutional care, severe mobility restriction, ADL [52]. Falls and time to first four falls [101].

Assessed for eligibility n = 555

Eligible n = 486.

Randomized n = 486 (I = 243, C = 243)

Dropouts: I = 37; C = 65

No feasibility study identified

  [53]

[102]

[103]

[104]

[105]

[106]

Component/s: Regular education and a short assessment program for healthcare personal (home visitors) providing standard preventive home visits in 17 Danish municipalities (two annual home visits to all citizens aged 75 years or older).

Education consisted of emphasizing the importance of psychological, social as well as health factors, focusing on early signs of disability, empowering strategies and social relations with respect to the individual’s autonomy, stressing the importance of physical activity and focusing on relevant geriatric problems.

Modes of delivery: Group education program

Duration: Regular education (17 municipal meetings) for home visitors during 3 years and one education programme (2 h) for GPs in the first year

Control: No intervention (education program) for home visitors in another 17 control municipalities.

End of intervention period 3 year: Reduction in functional decline (among 80-year-olds) in intervention municipalities I vs control municipalities C, OR 1.83**, 95% CI 1.21–2.77. Intervention in coordination with GP was related to better functional ability only for women OR 1.26**, 95% 1.08–1.47. Accepting and receiving preventive home visit was also related with improved functional ability only in women OR 1.36**, 95% CI = 1.16–1.60 [105]. No sig. Difference on Nursing home admission or mortality [103].

4,5-year: Lower risk for progressive decline in intervention municipalities vs control RR 0.66**, 95% CI 0.50–0.86. In participants who declined home visits was related with increased risk for catastrophic functional decline RR 1.49***, 95% CI 1.27–1.74 [106]. Fewer persons (80-year-olds) in the intervention group had moved to a nursing home HR 0.59*, 95% CI 0.37–0.94 [103]. Effects on functional ability in women were preserved OR 1.22*, 95% CI 1.03–1.44. No sig. Difference in functional ability for men [104]. No sig. Difference in functional decline or mortality in both man and women [103].

Eligible n = 5788 (invited participants)

Randomized n = 4034 (I municipalities = 2092; control municipalities = 1942)

Dropouts: I = 31; C = 27 [105]

No feasibility study identified