IMPORTANCE: Strength training exercise is recommended for improving physical function in older adults. However, whether strength training (lifting and lowering weights under control) and power training (PT) (lifting weights fast and lowering under control) are associated with improved physical function in older adults is not clear. OBJECTIVE: To evaluate whether PT versus traditional strength training is associated with physical function improvement in older adults. DATA SOURCES: Systematic searches of Medline, Embase, Cochrane Central, CINAHL, PsycINFO, PEDro, and SPORTDiscus were conducted from database inception to October 20, 2021. STUDY SELECTION: Randomized clinical trials (RCTs) that compared strength training with instructions to move the weight as fast as possible in the lifting phase with traditional strength training in healthy, community-living older adults (age >= 60 years). DATA EXTRACTION AND SYNTHESIS: Two authors independently selected trials, extracted data, assessed the risk of bias using the Cochrane risk-of-bias tool 2, and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Summary effect size measures were calculated using a multilevel random-effects model with cluster robust variance estimation and are reported as standardized mean differences (SMDs). Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. MAIN OUTCOMES AND MEASURES: Primary outcomes included physical function and self-reported physical function. Secondary outcomes included power, strength, muscle mass, walk speed, balance, and adverse effects. RESULTS: A total of 20 RCTs enrolling 566 community-living older adults (mean (SD) age, 70.1 (4.8) years; 368 (65%) women) were included. For the primary outcomes, PT was associated with an improvement in physical function with low-certainty evidence in 13 RCTs (n = 383) (SMD 0.30; 95% CI 0.05 to 0.54) and self-reported function with low-certainty evidence in 3 RCTs (n = 85) (SMD 0.38; 95% CI -0.62 to 1.37). The evidence was downgraded by 2 levels for high risk of bias and imprecision for physical function and very serious imprecision for self-reported physical function. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, PT was associated with a modest improvement in physical function compared with traditional strength training in healthy, community-living older adults. However, high-quality, larger RCTs are required to draw more definitive conclusions.

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