Reactive agility training to prevent frailty in older adults – a randomized controlled trial.
Authors: Lichtenstein Eric , Keller Martin , Roth Ralf , Ludyga Sebastian , Faude Oliver 
Published: January 2025

Introduction Alternative approaches to fall prevention programs for older adults have been called for. Agility training, which blends functional movements, stop-and-go actions, direction changes, strength, balance, and cognitive tasks (Donath et al., 2016), appears potentially more effective than traditional strength and balance training methods (Lichtenstein et al., 2020). However, long-term applications often lack considerations of individual progression and reactive decision-making (Lichtenstein et al., 2023). Addressing the need for quick, unforeseen reactions in fall-risk situations, we explored a novel training tailored to individual progress with complex reactive elements. The aim was to enhance neuromuscular and cognitive performance, as well as psychosocial health outcomes in healthy older adults.
Methods Forty-six healthy older adults (28 females, mean age 69.5 ± 6.8 years, BMI 25.9 ± 3.4 kg/m²) were randomly assigned to either a control (CON) or agility training (AT) group. The AT program, conducted over a period of 16 weeks (twice per week), involved tasks that progressed in complexity and placed high demands on cognitive skills, strength, balance by applying reactive light systems. Cognitive assessments included the Eriksen-flanker and Go/No-Go tasks, while neuromuscular assessments involved tandem stance, countermovement jump, grip strength, and leg dynamometry. Gait tests were conducted under both single and dual-task conditions. Psychosocial health was evaluated using surveys such as CES-D, WHO-QoL-Bref, ISI, FES-I, and PSS. Data analysis was performed using linear mixed-effects models, examining group×time interactions standardized to baseline standard deviation.
Results Compliance was high (85.2 ± 8.3%), and dropouts were low (10.8%). After controlling for age, sex, and BMI, the analysis revealed, on average, at least small effects in favor of the AT group for Go/No-Go task parameters (0.18 < d < 0.47), perceived stress (d = 0.42), psychosocial well-being (d = 0.33), social relationships (d = 0.26), as well as single-task gait speed (d = 0.34). In contrast, effect sizes in favor of the control group were found for reaction time (d = 0.34). Neither strength, explosiveness, and balance parameters, nor physical well-being and fear of falling data showed notable between-group differences (d < 0.2). For effects in favor of the AT group, small negative to moderate positive effects are also compatible with the data.
Discussion/Conclusion In this group of very fit and healthy older adults, agility training appears insufficient to markedly improve neuromuscular parameters but may potentially serve to slightly enhance response inhibition and mental health over a 16-week period. The application of the training program in less fit populations should be considered along with potential methods for investigating exercise performance with incorporated cognitive tasks.
References
Donath, L., van Dieën, J. H., Faude, O., & Wolf, P. (2016). Exercise-based fall prevention in the elderly: What about agility? Sports Medicine, 46, 143–149.  https://doi.org/10.1007/s40279-015-0389-5
Lichtenstein, E., Erlacher, D., & Gronwald, T. (2020). Agility-based exercise training compared to traditional strength and balance training in older adults: A pilot randomized trial. PeerJ, 8, e8781. https://doi.org/10.7717/peerj.8781
Lichtenstein, E., Erlacher, D., & Gronwald, T. (2023). Agility training to integratively promote neuromuscular, cardiorespiratory and cognitive function in healthy older adults: A one-year randomized-controlled trial. European Review of Aging and Physical Activity, 20(1), 21. https://doi.org/10.1186/s11556-023-00331-6