***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background evidence on the effectiveness of interventions to prevent frailty is scarce . Objective to assess the effect of an intervention in preventing frailty progression in pre-frail older people . Study design a r and omised , open label , controlled trial with two parallel arms . Population community-dwelling pre-frail older people ( ≥70 years ) consulting in primary care .  Intervention nutritional assessment ( and derivation to a Nutritional Unit for usual care in the event of nutritional risk ) and a physical activity programme including aerobic exercise and a set of mixed strengthening , balance and coordination exercises .  Control group patients receiving the usual care . Main outcome measure prevalence of frailty ( Fried criteria ) at 12 months . Secondary outcomes measures functional capacity ( Barthel index ) , falls and nutritional status ( Short-Form Mini Nutritional Assessment ) on follow-up at 12 months . Results one hundred and seventy-two participants were recruited and r and omised ( mean age : 78.3 years ; mean number of Fried criteria : 1.45 ) . Thirty-nine participants ( 22.6 % ) were dropped out during the study . At follow-up , 4.9 % of the intervention group and 15.3 % of the control group had evolved to frailty , for a crude odds ratio ( OR ) of 0.29 ( 95 % confidence interval [ CI ] : 0.08 - 1.08 ; P = 0.052 ) and an adjusted ( by age , gender and number of co-morbidities ) OR of 0.19 ( 95 % CI : 0.04 - 0.95 ; P = 0.044 ) . Intervention group showed a higher outdoors walking hour per day ( 0.97 versus 0.73 ; P = 0.019 ) but no difference was observed in muscle strength , gait speed or other functional indicators . Conclusion an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals . Clinical Trials.gov identifier NCT02138968 Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Background Few r and omized controlled trials ( RCTs ) report interventions targeting improvement of frailty status as an outcome . Methods This RCT enrolled 117 older adults ( 65 - 79 years of age ) in Toufen , Taiwan who scored 3 - 6 on The Chinese Canadian Study of Health and Aging Clinical Frailty Scale Telephone Version and then score ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty ( CHS_PCF ) . With a two by two factorial design , subjects were r and omly assigned to interventions ( Exercise and nutrition , EN , n = 55 or problem solving therapy , PST , n = 57 ) or controls ( non-EN , n = 62 or non-PST , n = 60 ) . Educational booklets were provided to all . EN group subjects received nutrition consultation and a thrice-weekly exercise-training program while PST group subjects received 6 sessions in 3 month . Subjects were followed at 3 , 6 , and 12 months . Primary outcome was improvement of the CHS_PCF by at least one category ( from pre-frail to robust , or from frail to pre-frail or robust ) from baseline assessment s. One hundred and one completed final assessment s. Intention-to-treat analysis with the generalized estimating equation model was applied with adjustment for time and treatment-by-time interactions . Results Mean age was 71.4 ± 3.7 years , with 59 % females . Baseline characteristic were generally comparable between groups . EN group subjects had a higher improvement rate on the primary outcome than non-EN group subjects ( 45 % vs 27 % , adjusted p = 0.008 ) at 3 months , but not 6 or 12 months . They also had more increase of serum 25(OH ) vitamin D level ( 4.9 ± 7.7 vs 1.2 ± 5.4 , p = 0.006 ) and lower percentage of osteopenia ( 74 % vs 89 % p = 0.042 ) at 12 months . PST group subjects had better improvement ( 2.7 ± 6.1 vs 0.2 ± 6.7 , p = 0.035 , 6-month ) and less deterioration ( −3.5 ± 9.7 vs −7.1 ± 8.7 , p = 0.036 , 12-month ) of dominant leg extension power than non-PST subjects . Some secondary outcomes were also improved in control groups ( non-EN or non-PST ) . No adverse effects were reported . Conclusions The three-month EN intervention result ed in short-term ( 3-month ) frailty status improvement and long-term effect on bone mineral density and serum vitamin D ( 12-month ) among Taiwanese community-dwelling elders . The effect of PST was less pronounce . Trial registration Clinical Trials.gov : BACKGROUND Little is known about the natural course of frailty . We performed a prospect i ve study to determine the transition rates between frailty states and to evaluate the effect of the preceding frailty state on subsequent frailty transitions . METHODS We studied 754 community-living persons , aged 70 years or older , who were nondisabled in 4 essential activities of daily living . Frailty , assessed every 18 months for 54 months , was defined on the basis of weight loss , exhaustion , low physical activity , muscle weakness , and slow walking speed .  Participants were classified as frail if they met 3 or more of these criteria , as prefrail if they met 1 or 2 of the criteria , and as nonfrail if they met none of the criteria . RESULTS Of the 754 participants , 434 ( 57.6 % ) had at least 1 transition between any 2 of the 3 frailty states during 54 months . The rates were 36.8 % , 21.5 % , and 9.2 % for 1 , 2 , and 3 transitions , respectively . During the 18-month intervals , transitions to states of greater frailty were more common ( rates up to 43.3 % ) than transitions to states of lesser frailty ( rates up to 23.0 % ) , and the probability of transitioning from being frail to nonfrail was very low ( rates , 0%-0.9 % ) , even during an extended period . The likelihood of transitioning between frailty states was highly dependent on one 's preceding frailty state . CONCLUSIONS Frailty among older persons is a dynamic process , characterized by frequent transitions between frailty states over time . Our findings suggest ample opportunity for the prevention and remediation of frailty Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining . The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining . Methods 69 prefrail community-dwelling older adults , aged 65–94 years were r and omly assigned into three groups : muscle strength training ( ST ) , muscle power training ( PT ) or controls . The exercise interventions were performed for 60 minutes , twice a week over 12 weeks . Physical function ( Short Physical Performance Battery = SPPB ) , muscle power ( sit-to-st and transfer = STS ) , self-reported function ( SF-LLFDI ) and appendicular lean mass ( aLM ) were measured at baseline and at 12 , 24 and 36 weeks after the start of the intervention . Results For the SPPB , significant intervention effects were found at 12 weeks in both exercise groups ( ST : p = 0.0047 ; PT : p = 0.0043 ) . There were no statistically significant effects at 24 and 36 weeks . In the ST group , the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged . No effects were found for muscle power , SF-LLFDI and aLM . Conclusions The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining . The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training . However , more research is needed on the residual effects of both interventions . Taken the drop-out rates ( PT : 33 % , ST : 21 % ) into account , muscle power training should also be used more carefully in prefrail older adults . Trial registration This trial has been registered with clinical trials.gov ( NCT00783159 BACKGROUND Progressive resistance exercise training ( PRT ) has been shown to increase muscle strength and fat-free mass ( FFM ) in elderly persons . Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons . METHODS Ninety-one community-dwelling sedentary men and women , 78 years and older with physical frailty ( defined using st and ardized objective criteria ) were enrolled in a 9-month trial of exercise training ( ET ) . Physical frailty was defined as having 2 of the 3 following criteria : modified Physical Performance Test score between 18 and 32 , peak aerobic power between 10 and 18 ml/kg/min , or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living . Participants were r and omly assigned to either a control ( CTL ) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT . RESULTS After completion of PRT , ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension ( mean Delta + 5.3 + /- 13 ft/lb vs + 1.1 + /- 11 ft/lb , p = .05 ) , measured using isokinetic dynamometry . Total body FFM ( measured using dual energy x-ray absorptiometry ) increased in the ET group , but not in the CTL group ( mean Delta + 0.84 + /- 1.4 kg vs + 0.01 + /- 1.5 kg , p = .005 ) . Total , trunk , intra-abdominal , and subcutaneous fat mass ( measured using dual energy x-ray absorptiometry and (1)H-magnetic resonance imaging ) did not change in response to PRT . CONCLUSIONS Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail , community-dwelling elderly women and men . This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population OBJECTIVE To examine the impact of a muscle resistance program ( MRP ) on muscular and functional performance and on interleukin 6 ( IL-6 ) and soluble tumor necrosis factor receptor-1 ( sTNFr1 ) plasma levels in prefrail community-dwelling women . DESIGN R and omized controlled trial crossover design with a postintervention and short-term follow-up . SETTING University hospital . PARTICIPANTS Prefrail community-dwelling women ( N=32 ; ≥65y ) . INTERVENTION The MRP was design ed based on the exercise at 75 % of each participant 's maximum load ( 10wk , 3 times/wk ) . MAIN OUTCOME MEASURES Plasma concentrations of IL-6 and sTNFr1 ( high-sensitivity enzyme-linked immunosorbent assay kits ) , muscle strength of the knee extensors ( isokinetic ) , and functional performance ( Timed Up & Go [ TUG ] test and 10-meter walk test [ 10MWT ] ) . RESULTS There were significant differences in functional and muscular performance between the pre-MRP , post-MRP , and 10-week follow-up period . After the 
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Conclusions Currently the evidence base is of insufficient size , quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty .