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Geriatr Gerontol Int 2016; 16: 492–499

ORIGINAL ARTICLE: EPIDEMIOLOGY,

CLINICAL PRACTICE AND HEALTH

Effects of two physical exercise protocols on physical

performance related to falls in the oldest old: A randomized
controlled trial
Juliana Hotta Ansai, Thais Rabiatti Aurichio, Raquel Gonçalves and José Rubens Rebelatto

Postgraduate Program of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil

Aim: To compare the effects of 16-week multicomponent and resistance training, and 6-week detraining on
physical variables related to a higher risk of falls in very old people.
Methods: A randomized, three-arm, controlled trial was carried out. A total of 69 community-dwelling older adults
aged 80 years and older were allocated to three groups: control, multicomponent training and resistance training.
They were assessed at baseline, after 16-week training and 6-week detraining. The control group did not perform any
intervention. The multicomponent group performed protocol consisting of warm-up, aerobic, strength, balance and
cool-down exercises. The resistance group underwent strength exercises using six adapted machines. The training
sessions had progressive intensity, lasted 16 weeks and 12 included three 1-h sessions per week. The assessment
consisted of anamneses, five-repetition sit-to-stand, one-leg standing, tandem and dual task tests. For statistical
analysis, α = 0.05 was used.
Results: There were no significant differences between groups and assessments in any variable when analyzed by
intention to treat. However, when analyzed, the older adults who adhered to the training, the multicomponent group,
had a significant improvement in the sit-to-stand and the one-leg standing (right support) tests. There was a
significant main effect between times on the one-leg standing (left support) test.
Conclusion: In very old people, multicomponent training seems to be more beneficial and presents fewer adverse
events when the adherence to protocol is higher. Geriatr Gerontol Int 2016; 16: 492–499.

Keywords: exercise, falls, oldest old, postural balance, randomized controlled trial.

Introduction muscle fibers of the lower limbs are lost.3 In addition,

People aged over 85 years are more vulnerable to mul-
tiple chronic conditions and disabilities, therefore con-
cerns about healthcare are increasing in this age group.1
Haber et al. found that balance, lower limb strength and
gait in healthy community-dwelling women are main-
tained until 45–55 years-of-age.2 After this age, there is
a non-linear relationship between increasing age and
deterioration of these abilities. Falkner et al. reported
that after 80 years-of-age, approximately 50% of the
Accepted for publication 22 February 2015.
Correspondence: Master Juliana Hotta Ansai MD, Physiotherapy
Department, Washington Luiz highway, 235 km, postal code
13565-905, São Carlos, Brazil. Email: julianaansai@gmail.com
Permanent address: Physiotherapy Department, Washington Luiz
highway, 235 km, postal code 13565-905, São Carlos, Brazil.
physical and functional limitations, and advanced age
are important risk factors for falls.4
To prevent or compensate motor changes and main-
tain functionality in the elderly, the effectiveness of dif-
ferent protocols of physical activity have been studied.5
Forte et al. compared multicomponent training and
resistance training in older adults.6 After 3 months,
there were improvements in both forms of training on
gait speed (normal gait and associated with a motor
task), but only resistance training improved lower limb
strength. However, Gillespie et al. suggested that multi-
component training is more effective in reducing the
risk of falls in older adults than other forms of training.7
Additionally, multicomponent training is recommended
by the American College of Sports in Medicine to
improve and maintain physical function in the elderly.8
None of the aforementioned studies verified the effects
of different forms of training in those aged over
80 years.

492 | doi: 10.1111/ggi.12497 © 2015

. Japan
. Geriatrics Society
 Exercises protocols in oldest old
Although studies report that physical exercise helps
mitigate the physiological effects of aging, there is insuf-
ficient evidence on which protocols are recommended
more for factors related to falls in those aged over
80 years.9–11 The purpose of the present study was to
compare the effects of 16-week multicomponent and
resistance training programs on physical variables
related to a higher risk of falls, and the fall rate in
community-dwelling oldest-old people. Furthermore,
the same variables were analyzed after 6 weeks of
detraining. It was hypothesized that there would be
improvements for both training programs after the
intervention, but with higher benefits for the multicom-
ponent training. After detraining, a trend in worsening
performance in both intervention groups would be
expected.
Materials and methods
Study design
A randomized, three-arm, controlled trial was carried
out at the Federal University of São Carlos (UFSCar,
São Paulo, Brazil; Clinical Trials Registration ID:
NCT01983397). The study was approved by the
UFSCar Ethics Research Committee (ID: 72053/2012).
All participants signed the informed consent form.
Participants and randomization
Participants were recruited through telephone contact
among older adults from health centers and the Open
University for older adults (São Carlos-SP). In addition,
the study was disclosed by flyers, radio channels and
local television. The inclusion criteria were being aged
over 80 years, community-dwelling individual, seden-
tary, able to walk alone and reported availability to come
to the training site three times a week. The exclusion
criteria were the presence of any injury listed in the
absolute contraindications of the Physical Activity
Readiness Medical Examination; relative cognition,
neurological or skeletal muscle contraindications,
which made participation in protocols impossible; and a
Mini-Mental State Examination score below the cut-off
designated by educational level minus one standard
deviation.12
Initially, there were 570 eligible older adults. Of these,
69 met the inclusion criteria and were randomized into
three groups (control [CO], multicomponent training
[MT] or resistance training [RT]) after initial assessment
(n = 23 per group) by a computerized random-number
generator, with blocks of variable sizes (3, 6, 9). All
randomizations were concealed. The process of ran-
domization was carried out by a researcher not affiliated
with the study. According to the sequence of random-
ization, each volunteer corresponded to an opaque and
© 2015 Japan Geriatrics Society
sealed envelope, which contained a card stating which
group the volunteer would be allocated to. The enve-
lopes were opened after the first evaluation.
Interventions
The CO group did not carry out any intervention. The
MT and RT groups underwent a 1-week familiarization
period. The training lasted 16 weeks and included three
1-h sessions per week on non-consecutive days. The
same researcher who carried out the assessment moni-
tored the interventions with help from trained physical
educators.
After the intervention period, the participants under-
went a 6-week detraining period. There was no guid-
ance during the detraining phase.
MT group
Each MT session had the following structure: 5 min of
warm-up using a cycle ergometer; 13 min of aerobic
exercise using a cycle ergometer; 15–20 min of strength
exercises of major muscle groups (diagonal upper limb,
abdominal, squat and ankle strengthen); 10 min of
balance activities; and 5 min of cool-down exercise
(stretching of the major muscle groups and deep
breathing).
The aerobic exercise intensity ranged from 60 to 85%
reserve heart rate, adjusted by age and sex.9 We used an
interval protocol with increased and decreased intensity
every 3 min.13 The reserve heart rate progression was
increased every 3 weeks.
The intensity of strength exercises ranged from 14 to
17 on the Borg conventional scale (6–20).14 Progression
was carried out by increasing repetitions (up to 15),
series (up to three) and incremental load of 1 kg.
Balance exercises included static balance, dynamic
and static weight transfer, walking on a line, walking on
unstable surfaces, obstacle transposition, and deviation.
The difficulty level was gradually increased if the volun-
teer could carry out exercises properly through reducing
sensory inputs, reducing the support base, increasing
the complexity of movements and adding motor/
cognitive tasks to disturb their center of gravity.
RT group
Six machines adapted for older adults were used for the
RT group: leg press, chest press, calf, back extension,
abdominal and rowing. The participants carried out
three sets of 10–12 maximal repetitions at moderate
speed (2 s for the concentric phase and 3 s for the
eccentric phase) and 1-min resting periods between
sets. The participants carried out the first two sets of 12
repetitions and the third set until fatigue. The load was
adjusted so that fatigue occurred between the 10th and
| 493
 J Hotta Ansai et al.
12th repetition of the third set.15 The upper and lower
limbs exercises were interspersed during training.
Measures
The volunteers were assessed at baseline, after training
and after detraining. Descriptive variables were assessed
using a questionnaire at baseline and the volunteers
were asked about falls in the past 3 months.16
Physical performance outcomes
Muscle strength of the lower limbs was assessed
through the five-repetition sit-to-stand test, and the
time spent was noted (in seconds).17
The one-leg standing and tandem tests were used to
assess balance. In both tests, the participants were
instructed to keep their eyes opened, have bare feet,
keep their arms alongside their body and stare at a
reference point 1 m away. The one-leg standing and the
tandem tests were carried out as described by
Michikawa et al.18 and El-Sobkey,19 respectively.
The dual task was assessed using the Timed Up and
Go test (TUGT) at a normal pace while carrying a full
cup of water (TUGT-motor), as described by Hofheinz
and Schusterschitz.20 A total of 10 volunteers used a
cane to walk, and the test was carried out with a cane. A
pretest was carried out for familiarization with a 1-min
interval between attempts.
Fall outcomes
After baseline assessment, the volunteers received a fall
calendar, which should be completed until the end of
the study. Once a month, they were asked about falls by
phone or during days of training.
Statistical analysis
The sample size was calculated using G*Power 3.1 soft-
ware (Universität Düsseldorf, Düsseldorf, Germany).
Assuming the type of study design (MANOVA), type I
error at 5%, statistical power at 80% and an effect size of
0.4, a minimum of 66 participants should constitute the
total sample.
For analysis, a significance level of α = 0.05 was used,
and SPSS software was used (version 17.0; SPSS,
Chicago, IL, USA) to run the tests. The analysis was
carried out by intention to treat. Rejecting the normality
hypothesis, the z-score calculation was used to standard-
ize quantitative data. Descriptive analysis was carried out
using the χ2-test of association and the one-way ANOVA.
The χ2-test of association was used to verify differences
in the frequency of fallers between groups and between
the first two assessments. Because of the low frequency of
loss of water in the TUGT-motor test, it was not possible
494 |
to carry out a comparative analysis. The MANOVA test was
used to verify interaction and differences between groups
and assessments. If a significant interaction was identi-
fied, analyses of simple main effects by group and
post-hoc (Tukey test) tests were carried out.
Because of the low adherence to training sessions, in
addition to the analysis by intention to treat, differences
were analyzed at baseline among the CO group and
people who adhered (attended at least 24 sessions for
16 weeks) or not to training sessions using one-way
ANOVA and χ2-tests. The MANOVA test was used to verify
the interaction and differences between the participants
who adhered in the MT, RT and CO groups, and the
assessments.
Results
After 16 weeks from the baseline, all volunteers were
re-evaluated, except one individual from the MT group
who refused to participate. After the detraining phase,
three elderly individuals from the CO group did not
carry out the assessment (one because of failure to
contact and two because of refusal; Fig. 1).
Table 1 shows the major sociodemographic charac-
teristics of the sample. There were no differences
between groups for the sociodemographic characteris-
tics, except for the percentage of osteoarthritis, which
was higher in the MT group and lower in the CO group.
All volunteers were independent in basic activities of
daily living. Among participants who reported falls in
the previous 3 months, there was no difference between
groups regarding the number, location or consequences
of falls (52% reported any consequences). There was an
average of 1.1 falls.
Adherence to treatment
Overall, 34.7% of the MT group and 56.5% of the RT
group carried out at least 24 sessions for 16 weeks (half
of the intervention). The reasons for not participating or
participating in less than one-quarter of the sessions for
the MT group were transportation problems (n = 3),
personal health problems (n = 6), spouse health (n = 4)
and refusal to participate (n = 1). Possible adverse effects
were mild muscle pain (n = 4), mild hematoma (n = 1)
and dizziness (n = 1). The reasons for participating in
less than one-quarter of the sessions for the RT group
were personal health problems (n = 3) and refusal to
participate (n = 2). Possible adverse effects were mild
muscle pain (n = 9).
At baseline, the participants who adhered in the MT
group carried out the sit-to-stand test significantly
slower (mean = 25.1 s [3.9 s]) than the participants who
adhered in the RT group, those who did not adhere
in the MT group and those in the CO group. The
© 2015 Japan Geriatrics Society
 Exercises protocols in oldest old

Assessed for elegibility (n=570)

Excluded (n=501)
 Not being sedentary (n=26)
 Health problems/Problemas de saude/unable to
walk alone (n=145)
 Low MMSE score (n=6)
 Difficulty in transport/long distance (n=109)
 Unavailability related to spouse health (n=14)
 Refusal to participate for other reasons (n=201)

Randomized (n=69)

Allocated to MT (n=23) Allocated to RT (n=23) Allocated to CO (n=23)

 Received at least a quarter of allocated
intervention (n=9)
-difficulty in transport (n=3)
-health problems (n=6)
-spouse health (n=4)
-refusal to participate (n=1)
 Received at least a quarter of allocated
intervention (n=18)
 Received less than a quarter/did not
received allocated intervention:
-health problems (n=3)
-refusal to participate (n=2)

Post intervention (16 weeks)

 Analyzed (n=22)  Analyzed (n=23)  Analyzed (n=23)

 Lost to follow-up (refusal
to participate) (n=1)

Detraining (6 weeks)

 Analyzed (n=22)  Analyzed (n=23)  Analyzed (n=20)

 Lost to follow-up:
-refusal to participate (n=2)
-failure to contact (n=1)

Figure 1 Participants’ flowchart. CO, control group; MMSE, Mini-Mental State Examination; MT, multicomponent training
group; RT, resistance training Group.

Table 1 Descriptive data

Variable Total Control group Multicomponent Resistance P-value

(n = 69) (n = 23) group (n = 23) group (n = 23)
Mean age, years (SD) 82.4 (2.4) 82.6 (2.6) 81.9 (1.9) 82.8 (2.8) 0.412
Female, n (%) 47 (68.1) 15 (65.2) 17 (73.9) 15 (65.2) 0.766
Mean body mass index, kg/m2 (SD) 28.1 (4.5) 27.5 (4) 28 (5) 28.8 (4.6) 0.641
Mean educational level (SD) 4.7 (5.2) 5.6 (5.2) 3.3 (3) 5.4 (6.8) 0.255
Not using walking aid, n (%) 57 (82.6) 22 (95.6) 16 (69.5) 19 (82.6) 0.219
Not wearing bi/multifocal glasses 49 (71) 18 (78.2) 14 (60.8) 17 (73.9) 0.612
No complaint of dizziness 50 (72.4) 18 (78.2) 16 (69.5) 16 (69.5) 0.862
Mean no. medications (SD) 3.8 (2.3) 3.4 (2.6) 3.9 (2.2) 4.1 (2.2) 0.607
Diseases
Mean total n, (SD) 3.6 (1.9) 3.4 (2.6) 3.7 (1.8) 3.7 (1.3) 0.837
Diabetes, n (%) 16 (23.2) 5 (21.7) 6 (26.1) 5 (21.7) 0.922
Hypertension, n (%) 47 (68.1) 15 (65.2) 18 (78.3) 14 (60.9) 0.420
Osteoarthritis, n (%) 30 (43.5) 4 (17.4)† 16 (69.6)† 10 (43.5) 0.002**
Depression, n (%) 12 (17.4) 2 (8.7) 5 (21.7) 5 (21.7) 0.403
Fall in the past 3 months, n (%) 25 (36.2) 8 (34.8) 10 (43.5) 7 (30.4) 0.645
Mean MMSE, 0–30 (SD) 24.9 (3.3) 25.3 (3.5) 24.3 (3.3) 25.1 (3.4) 0.603
**P < 0.01 (χ2 = 12.73), †Residual adjustment ≥2 (multicomponent group tended to have osteoarthritis and control group tended
not to have osteoarthritis). MMSE, Mini-Mental State Examination; SD, standard deviation.

© 2015 Japan Geriatrics Society | 495

 J Hotta Ansai et al.

percentage of osteoarthritis was higher for volunteers

DT (n = 20)

18.7 (11.9)

2 (10.0)
6 weeks of

15.5 (6.3)
5.5 (5.9)

7.0 (7.7)

25.3 (9.3)

24.7 (6.9)
who adhered (75%) than for those who did not (69%) in

5 (25)
the MT group, and lower for the CO group (17.4%).
Other baseline variables did not differ between the
subgroups.

17.6 (12.3)

28.0 (15.2)

8 (34.8)
16.4 (5.4)
4.9 (8.0)

5.5 (7.1)

25.8 (7.0)
2 (8.7)
16 weeks
Physical performance outcomes

Data presented as mean (standard deviation). P > 0.05 for all analyses between groups and assessments. DT, detraining; TUGT, Timed Up and Go Test.
(n = 23)
Five elderly participants from the CO group, two from
the MT group and one from the RT group were not

Control group
entered into the analysis of the sit-to-stand performance

16.5 (11.6)

8 (34.8)
(four older adults did not participate in any assessment

16.0 (4.7)
5.1 (6.5)

5.4 (6.0)

25.3 (8.4)

24.9 (5.1)
1 (4.3)
Baseline
and four older adults failed to carry out the test).

(n = 23)
Table 2 shows the performance of groups at each
assessment on the physical tests. There was no signifi-
cant interaction between group and assessment for any
variable. There was no significant main effect for groups

DT (n = 23)

18.2 (12.8)

26.7 (22.2)

26.9 (14.0)
6 weeks of

15.0 (7.3)
6.7 (7.4)

7.9 (8.1)

1 (4.3)

1 (4.3)
or assessments by intention to treat. Although the MT
group presented a growing improvement in the one-leg
standing test (right support), this change was not statis-
tically significant.
When analyzing the older adults who adhered to the

20.6 (12.2)

28.1 (15.3)

27.6 (13.4)
8 (34.8)
interventions, there was a significant interaction

16.2 (6.4)
7.0 (7.0)

7.4 (7.1)
16 weeks
(n = 23)

0 (0)
between groups and assessments in the sit-to-stand
(F = 5.316, P = 0.001) and the one-leg standing (right
Resistance group

support) (F = 5.780, P < 0.001) tests. The MT group

had a significant improvement in the sit-to-stand and

18.3 (11.6)

29.0 (15.5)

27.7 (12.1)
7 (30.4)
the one-leg standing (right support) tests between the
18.1 (8.8)
6.0 (6.7)

6.6 (7.7)

2 (8.7)
Baseline
(n = 23)

first and second assessments, and between the first and

the third assessments. There was a significant main
effect between times regarding the one-leg standing (left
support) test (P = 0.035; Table 3, Fig. 2).
DT (n = 22)

11.1 (11.7)

10.7 (11.0)

19.8 (13.1)

29.8 (13.1)
6 weeks of

16.1 (5.1)

27.2 (9.7)
1 (4.5)

2 (9.1)
Fall outcomes
The volunteers were instructed to deliver the fall calen-
dar at the third assessment. However, 25 volunteers did
not deliver the calendar and four calendars were not
10.9 (11.8)

10.3 (11.2)

17.9 (12.7)

31.1 (22.8)

4 (18.2)
15.8 (7.7)

27.0 (9.2)

delivered because of sample loss. The results obtained

Multicomponent group
16 weeks
Table 2 Physical performance and fall outcomes

(n = 22)

0 (0)

from the calendars and the calls were compatible in 31

of the elderly individuals, but one volunteer noted more
falls on the calendar and eight volunteers reported more
falls during the calls. Thus, we used only the data
8.7 (10.5)

17.3 (12.9)

30.4 (12.2)

10 (43.5)

obtained from the calls for analysis.

18.9 (8.6)
7.1 (8.6)

26.4 (7.2)
Baseline
(n = 23)

0 (0)

There was no difference in the frequency of

fallers between groups or between the first and the
second assessments. However, we verified a clinically
relevant decrease in the frequency of fallers between
One-leg standing (right

assessments in the MT group (Table 2). Among people

Loss of water, n (%)
support), s (0–30)

support), s (0–30)
One-leg standing (left

Report of falls, n (%)

who adhered in the interventions, there was no signifi-

Tandem, s (0–30)

cant difference in the frequency of fallers.

Sit-to-stand (s)

TUGT-motor

No. steps

Discussion
Time, s

The purpose of the present study was to analyze

the effect of 16-week multicomponent and resistance

496 | © 2015 Japan Geriatrics Society

 Exercises protocols in oldest old

training protocols on physical variables related to risk of

P-value

<0.001
<0.001
>0.05
>0.05

>0.05
>0.05
falls in community-dwelling people aged over 80 years.
Furthermore, the same variables were analyzed after a
6-week detraining period. In the analysis by intention to
treat, no significant differences between groups and

Groups of adherence to resistance training (n = 13), multicomponent training (n = 8) and control (n = 20) groups. †Analysis between resistance training (n = 12),
F2.35 value

assessments were found for any variable. When analyz-

5.316 ing the older adults who adhered in the interventions,
5.780 the MT group had a significant improvement in the
– sit-to-stand and the one-leg standing (right support)
–

–
–
tests between the first and second assessments, as well
as between the first and the third assessments. There
Multicomponent group –

was a significant main effect of assessments in the one-

leg standing (left support) test, with a tendency to
improve from the first to the second assessment.
Other studies found some positive effects of multi-
1.0 (−10.5–12.6)
Absolute mean difference between groups (confidence interval 95%)

3.6 (−4.1–11.4)

5.3 (−5.5–16.3)
4.3 (−3.4–12.0)
control group

component training on strength, balance and rate of

2.5 (−2.5–7.6)

1.2 (−5.8–8.4)

falls, analyzed by no intention to treat.21,22 Clemson et al.

found that home multicomponent training integrated
with daily activities was effective in increasing static
balance and decreasing the rate of falls in elderly fallers
(mean age 83 years).22 Thus, a multicomponent proto-
col could effectively improve physical performance in
Resistance group –

people aged over 80 years.

3.5 (−3.1–10.1)

1.8 (−8.0–11.7)

−2.0 (−11.4–7.2)

Additionally, some studies found positive effects

−1.3 (−5.8–3.1)

3.5 (−2.5–9.6)

−1.9 (−8.5–4.6)
control group

of resistance training on strength and balance.23,24

Caserotti et al. found that community-dwelling people
aged over 80 years who underwent resistance training
with high intensity showed similar improvements on the
multicomponent training (n = 8) and control (n = 18). TUGT, Timed Up and Go Test.

muscle strength of their lower limbs compared with

people aged between 60 and 65 years.24 The aforemen-
tioned studies did not analyze data by intention to treat,
multicomponent group
Table 3 Physical performance outcomes between adherence groups

and had a greater adherence to training, which could

have accounted for the discrepancies of results.
Resistance group –

0.7 (−11.6–13.2)

Physical performance was maintained between the

−7.4 (−19.2–4.3)
−6.2 (−14.6–2.0)
−3.8 (−9.4–1.6)
−0.1 (−8.5–8.2)
2.2 (−5.4–9.8)

short detraining phase and after the MT protocol. Other

studies also found positive changes in the detraining
phase after multicomponent training on the dual task
and sit-to-stand tests compared with baseline.11,25
Toraman and Ayceman analyzed responses to detrain-
ing after only a 9-week training protocol.26 In people
aged over 80 years, there was a worsening in the perfor-
One-leg standing (right support), s (0–30)

mance of the sit-to-stand test after the 2-week detrain-

One-leg standing (left support), s (0–30)

ing. After the 6-week detraining, the performance of

TUG declined, but strength gains were maintained
compared with baseline. By comparing the results of the
present study, we suggest that a long training period
(≥16 weeks) is enough to maintain physical benefits for
more than 2 months, regardless of the type of training
Loss of water, n (%)

used.
Serra-Rexach et al. studied the effects of 8-week train-
Tandem, s (0–30)
Sit-to-stand (s)†

ing focused on strength in institutionalized nonagenar-

TUGT-motor

ian people.27 After a 4-week detraining period, the gains

Time (s)

in strength of the lower limbs and the TUG, and the

decreases in the number of falls were maintained.
However, Kalapotharakos et al. found that a 6-week
detraining protocol led to a decrease in performance on

© 2015 Japan Geriatrics Society | 497

 J Hotta Ansai et al.
Figure 2 Strength and balance performance outcomes between adherence groups. *P < 0.05, **P < 0.01.
the TUG and sit-to-stand tests in the elderly individuals
aged over 80 years who underwent 8-week resistance
training.28 Intensity and duration of training as well as
the previous physical condition of people who under-
went training could be decisive for outcomes after
detraining.
We did not identify any significant change in the
frequency of falls, but there was a clinically relevant
decrease after the MT training. Gillespie et al. suggested
multicomponent exercise protocols and home safety
interventions to reduce the rate of falls.7 People aged
over 80 years could require a combination of interven-
tions to reduce the incidence of falls, because this event
is multifactorial. Still, they suggested that falls should be
recorded daily and monitored monthly. Hannan et al.29
and Fleming et al.30 suggested the calendar was the pre-
ferred method for screening falls. However, the present
study did not have good adherence to the calendar,
perhaps because of differences in the methods of
screening and the sample’s level of education.
This study presents some limitations, such as lack of
blinding, high standard deviations of variables because
498 |
of the diversity of the older adults aged over 80 years,
difference in sit-to-stand performance between the sub-
groups of adherence, and poor adherence to the fall
calendar and training, especially in the MT group. The
RT group used the same space as the younger elderly
participants who practiced physical exercise, had more
social contact and a better view of the benefits of physi-
cal activity, which could have influenced the difference
in the adherence between the groups. Literature involv-
ing only older adults aged over 80 years and analyzing
data by intention to treat is limited, which makes com-
parison of the results difficult. Nevertheless, the authors
used tests with less risk of adverse events that were more
functional and focused on clinical practice. This study
presented new information about the effects of physical
activity and a detraining phase in elderly individuals
aged over 80 years on variables related to a higher risk of
falls.
No significant differences between training and
assessments were found in any variable related to the
risk of falls. However, multicomponent training seems
to be more beneficial and present fewer adverse events
© 2015 Japan Geriatrics Society
 Exercises protocols in oldest old
when the adherence to protocol is higher. There is a
need for new approaches regarding dosages and com-
ponents of interventions as well as new studies to deter-
mine how long the benefits of exercise can be
maintained in older adults aged over 80 years.
Disclosure statement
No potential conflicts of interest were disclosed.
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