Resistance training effects on gait parameters in older adults—a systematic review with multilevel meta-analysis and meta-regression

Falls are a leading cause of morbidity in older adults, and muscle weakness accompanied by gait impairments is a major contributing risk factor. Although current guidelines refer to resistance training, the literature lacks high-quality moderator analyses to evidentially guide clinicians to best treatment practice. This systematic review with meta-analysis opposed pooled resistance training effects to passive controls or active alternative interventions to distinguish specific resistance training effects from generally enhanced physical activity on gait and falls relevant outcomes. Effect sizes (ES) were pooled using robust variance estimation generally and for potential moderators. Ninety-two (92) studies with 5932 participants (mean age 73.1 ± 4.9 years) revealed large improvements in strength (ES = 0.86, p < 0.001) and moderate magnitude effects on gait outcomes (ES = 0.59, p < 0.001). Largest effects were reached for timed up-and-go (ES = 0.97), followed by gait distance (ES = 0.65), sit-to-stand (ES = 0.42), and gait speed (ES = 0.41) when compared with passive control. Active comparator analyses (stretching, walking, multicomponent exercises) outlined superior effectivity in the timed up-and-go performance (ES = 0.42) only. Supervision, progressive intensity regulation, and inclusion of multi-joint lower-limb exercises (leg press, squat, ankle plantarflexion, knee extension) positively affected results. Spatiotemporal and kinetic gait parameters were not significantly affected in general. Although some positive effects were observed when compared against a passive control, for most outcomes, the analysis questioned current guidelines as the specificity of resistance training effects was blurred by neglectable differences to alternative training interventions. This could be attributed to a dearth of high-quality evidence (long-term studies, reasonable intensity, and volume) on gait parameters in older adults.