Level of Evidence = B
Exercising at home or at a center both appear to improve the health and physical function of older adults. People at high risk of heart disease may benefit more when exercising at a center than at home in the short-term but the adherence appears to be better at home.
A Cochrane review  included six studies with a total of 372 subjects. In patients with peripheral vascular disease (intermittent claudication; 3 trials), center based programs were superior to home at improving distance walked and time to claudication pain at up to 6 months. However the risk of a training effect may be high. Home based programs appeared to have a significantly higher adherence rate than center based programs (68% vs. 36% at two year follow-up; one trial). In patients with COPD (2 trials) the evidence is conflicting. One study showed similar changes in various physiological measures at 3 months that persisted in the home based group up to 18 months but not in the center based group. The other study showed significantly better improvements in physiological measures in the center based group after 8 weeks but again the possibility of a training effect is high.
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