Exercise combined with cognitive interventions ranks highest for improving frailty in older adultsExercise and Cognitive Training Show Promise for Managing Frailty

AIM: The purpose of this study was to compare the efficacy of different non-pharmacological multicomponent interventions in community-dwelling older adults with frailty or prefrailty and to determine the most effective non-pharmacological multicomponent interventions. BACKGROUND: Frailty or prefrailty is highly prevalent among community-dwelling older adults and contributes to significant distress among older adults and increases the caregiver burden. Non-pharmacological multicomponent interventions are recommended for first-line management; however, the comparative efficacy among interventions remains unclear. METHODS: A systematic electronic literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Wanfang, VIP and Sinomed databases up to July 1, 2025. Randomized controlled trials (RCTs) evaluating the efficacy of non-pharmacological multicomponent interventions compared with routine care or other interventions in community-dwelling older adults with frailty or prefrailty were included. A random effects model based on restricted maximum likelihood (REML) estimation was used for the network meta-analysis. Efficacy was assessed via standardized mean differences with 95% credible intervals, and interventions were ranked via surface under the cumulative ranking curve (SUCRA) probabilities. RESULTS: Twenty-two RCTs were included in the analysis. For overall frailty level, exercise + cognitive intervention achieved the highest rank (SUCRA = 84.7%), followed by exercise + cognitive + social support intervention (SUCRA = 83%) and exercise + nutritional intervention (SUCRA = 72%). With respect to motor ability, exercise + nutrition + psychological intervention was the most effective intervention (SUCRA = 77.1%). DISCUSSION: Non-pharmacological multicomponent interventions have a positive effect on improving the physical condition of community-dwelling older adults with frailty or prefrailty. Nurses and care managers should actively prioritize the integration of the above two interventions into personalized frailty or prefrailty care plans, maximizing the efficacy of non-pharmacological management. CONCLUSIONS: Exercise + cognitive intervention is likely the most effective non-pharmacological multicomponent intervention for reducing the frailty level, and exercise + nutrition + psychological intervention is likely the most effective non-pharmacological multicomponent intervention for improving motor ability in community-dwelling older adults with frailty or prefrailty. IMPLICATIONS FOR PRACTICE: The study identified the best non-pharmacological multicomponent interventions to improve frailty or prefrailty in community-dwelling older adults, providing a basis for the development of practical interventions in later gerontological nursing practice. REGISTRATION NUMBER: PROSPERO: CRD420251115805.