Exercise prescription prescriptions for frailty improvement in older adults: An evidence-based approach based on the 2024 older adult compendium

•This study examines the dose-response relationship of exercise prescriptions for improving frailty in older adults, utilizing the 2024 older adult compendium to quantify exercise intensity and energy expenditure.•A meta-analysis of 16 randomized controlled trials (RCTs) with 2716 participants revealed that low- to moderate-intensity exercise significantly improved frailty in older adults (SMD = −0.81, p < 0.001).•Results suggest that only 300 MET-minutes per week (half of the WHO's recommended minimum) is sufficient to achieve significant frailty improvement, making exercise more accessible for older adults.•High-intensity exercise did not show a statistically significant effect on frailty, indicating that low to moderate intensity is optimal for frailty improvement in older adults.•The findings support personalized exercise prescriptions tailored to the needs of older adults, emphasizing safety, adaptability, and feasibility for clinical application. This study explored the dose-response relationship of exercise prescriptions for improving frailty in older adults, based on the 2024 Older Adult Compendium. It aims to provide evidence-based support for developing frailty intervention programs and their clinical application. A comprehensive search was conducted in PubMed, OVID, Cochrane Library, Web of Science, and Scopus from inception to November 5th, 2024. Randomized controlled trials (RCTs) related to exercise interventions in older adults were included. Relevant studies meeting the inclusion criteria were selected, and data were extracted for further analysis. The quality of the included studies was assessed. Meta-analysis was performed using R, and the standardized mean difference (SMD) with 95 % confidence intervals (95 % CI) was used to quantify effect sizes. A total of 16 eligible RCTs comprising 2,716 older adults were included. The meta-analysis revealed that exercise significantly improved frailty among older adults [SMD = -0.81, 95 % CI (-1.25, -0.38), P < 0.001]. However, high-intensity exercise did not demonstrate a significant effect on frailty improvement [SMD = -0.45, 95 % CI (-0.96, 0.06), P = 0.3]. The analysis indicated a nonlinear dose-response relationship between exercise and frailty improvement. The predicted values for frailty improvement at the minimum and maximum exercise doses recommended by the World Health Organization (600 MET-minutes/week and 1200 MET-minutes/week, respectively) were -0.79 (95 % CI [-1.17, -0.41]) and -1.39