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Zhou J, Yu M, Zheng Y, Zhou X. Supervised Group-Based Exercise for Preventing Falls Among Older Adults in the Community: A Systematic Review and Meta-Analysis. J Nurs Care Qual 2024; 39:E54-E60. [PMID: 39167923 DOI: 10.1097/ncq.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Supervised group exercise may have greater health benefits than no exercise or exercise alone. PURPOSE The purpose of this systematic review and meta-analysis was to investigate the effectiveness of supervised group-based exercise on the risk of falls among community-dwelling older adults compared to no exercise or exercise alone. METHODS Four databases were searched up to March 1, 2024 for eligible randomized controlled trials. RESULTS Seventeen randomized controlled trials were eligible for this meta-analysis. Meta-analyses showed that compared with no exercise, supervised group-based exercise had a significant effect on preventing falls, injurious falls, and fall-related fractures. Compared with exercise alone, supervised group-based exercise significantly reduced falls and injurious falls. CONCLUSIONS Moderate-quality evidence suggests that compared with no exercise or exercise alone, supervised group-based exercise is more effective at preventing falls among community-dwelling older adults.
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Affiliation(s)
- Jianhong Zhou
- Authors Affiliation: Department of Psychiatry, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hanzghou, Zhejiang, China
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Wu S, Guo Y, Cao Z, Nan J, Zhang Q, Hu M, Ning H, Huang W, Xiao LD, Feng H. Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials. Arch Gerontol Geriatr 2024; 124:105470. [PMID: 38718487 DOI: 10.1016/j.archger.2024.105470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
BACKGROUND Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed. OBJECTIVE To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP. METHODS We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed. RESULTS Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks. CONCLUSION The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.
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Affiliation(s)
- Shuang Wu
- Xiangya School of Nursing, Central South University, China; College of Nursing and Health Sciences, Flinders University, Australia
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, China
| | - Zeng Cao
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital, Central South University, China
| | - Jiahui Nan
- The first affiliated hospital of Zhengzhou University, Zhengzhou University, China
| | - Qiuxiang Zhang
- The Third Xiangya Hospital, Central South University, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, China
| | - Weiping Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Hui Feng
- Xiangya School of Nursing, Central South University, China; Xiangya-Oceanwide Health Management Research Institute, Central South University, China; Xiangya Research Center of Evidence-Based Healthcare, Central South University, China.
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Colón-Emeric CS, McDermott CL, Lee DS, Berry SD. Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. JAMA 2024; 331:1397-1406. [PMID: 38536167 DOI: 10.1001/jama.2024.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2024]
Abstract
Importance Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures. Observations Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions. Conclusions and Relevance More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.
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Affiliation(s)
- Cathleen S Colón-Emeric
- Division of Geriatrics, Duke University, Durham, North Carolina
- Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina
| | | | - Deborah S Lee
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sarah D Berry
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Marcus Institute for Aging Research & Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts
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Valsecchi N, Alhambra-Borrás T, Doñate-Martínez A, Korenhof SA, Raat H, Garcés-Ferrer J. Self-efficacy as a mediator between frailty and falls among community-dwelling older citizens. J Health Psychol 2024; 29:347-357. [PMID: 38279556 DOI: 10.1177/13591053231223879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Frailty is one of the most challenging issues among older adults, and the relationship between frailty and falls has already been assessed numerous times in literature. In the present study, we explored the mediating role of self-efficacy related to falls (FSe) in the relationship between frailty and fall risk. In a cross-sectional design, 1080 community-dwelling older adults from Rotterdam (Netherlands) and Valencia (Spain) completed a questionnaire and data were then analyzed via mediation analysis using a bootstrapping approach. Results show that higher frailty is associated with higher fall incidence, and higher FSe is a partial mediator of this association, with a confidence interval for the indirect effect of 0.131-0.247. Moreover, results showed gender differences in FSe levels; women had lower FSe scores. Deepening research on the construct of FSe may give potential explanations that account for the emerged gender differences, and it could be more targeted in fall prevention programs.
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Affiliation(s)
| | | | | | | | - Hein Raat
- Erasmus Medical Center, The Netherlands
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Yi M, Zhang W, Zhang X, Zhou J, Wang Z. The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105083. [PMID: 37390692 DOI: 10.1016/j.archger.2023.105083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults. OBJECTIVE To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty. METHODS We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors. RESULTS 10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people. CONCLUSIONS The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.
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Affiliation(s)
- Mo Yi
- School of Nursing, Peking University, China
| | | | - Xu Zhang
- School of Nursing, Peking University, China
| | - Jia Zhou
- School of Nursing, Peking University, China
| | - Zhiwen Wang
- School of Nursing, Peking University, China.
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Li D, Zha F, Wang Y. Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke: A Cross-sectional Study. J Nurs Care Qual 2023; 38:E25-E31. [PMID: 36729956 DOI: 10.1097/ncq.0000000000000679] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Activities of daily living comprise an important risk factor for falls among patients who have suffered a stroke. PURPOSE To investigate the incidence of falls in patients with stroke, categorized by their Longshi grades (bedridden, domestic, community), and to explore their risk factors for falls. METHODS A cross-sectional descriptive design was used. Patients completed a survey during face-to-face interviews. RESULTS Of the 869 participants, 15.7% experienced a fall. Those in the domestic Longshi group had the highest rate of falls. Approximately 30% experienced either a moderate or severe injury as a result of falling. In addition, being older than 70 years was significantly correlated with fall risk. Intermediate Longshi grades, from moderately dependent to slightly dependent, were also positively correlated with falls. CONCLUSION Patients with stroke in the domestic Longshi group have a higher rate of falls. The risk of falling increased significantly in those with intermediate Longshi grades.
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Affiliation(s)
- Dongxia Li
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Chan U, Ayliffe L, Visvanathan R, Headland M, Verma M, Jadczak AD. Judo-based exercise programs to improve health outcomes in middle-aged and older adults with no judo experience: A scoping review. Geriatr Gerontol Int 2023; 23:163-178. [PMID: 36737880 DOI: 10.1111/ggi.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/22/2022] [Accepted: 12/26/2022] [Indexed: 02/05/2023]
Abstract
The practice of judo appears to impact positively on physical performance, muscle strength and flexibility in older people, while also benefiting bone mineral density in middle-aged adults. This scoping review aimed to map the range, scope and type of relevant studies conducted to examine the safety, feasibility and effects of judo interventions on various health-related outcomes designed for middle-aged and older adults (≥45 years) with no previous experience in judo. Six databases as well as gray literature were searched using a developed search strategy. Two independent reviewers screened the titles and abstracts, as well as full-texts of relevant articles using data extraction tools developed for the purpose of this study. Fifteen original studies were included, comprising 648 participants (mean age 45-77.8 years). All 15 studies reported significant positive results of ≥1 health-related outcome. Quality of life and bone mineral density seemed to improve only after longer interventions (≥9 or ≥12 months, respectively), while results regarding fear of falling and physical activity levels were mixed. Five studies showed improvements in fear of falling while four studies reported no change. Similarly, two studies showed improvements in physical activity, while another study showed no change. Five studies reported on safety and deemed their intervention to be safe (no adverse events), with two studies confirming feasibility. Findings suggest that judo interventions can positively impact health-related outcomes in middle-aged and older adults. However, studies had small sample sizes and more research is needed to confirm these findings. Geriatr Gerontol Int 2023; 23: 163-178.
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Affiliation(s)
- Udella Chan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Laura Ayliffe
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Michael Headland
- Adelaide University Judo Club, Adelaide, South Australia, Australia
| | - Meera Verma
- Adelaide University Judo Club, Adelaide, South Australia, Australia
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
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Wiedenmann T, Held S, Rappelt L, Grauduszus M, Spickermann S, Donath L. Exercise based reduction of falls in communitydwelling older adults: a network meta-analysis. Eur Rev Aging Phys Act 2023; 20:1. [PMID: 36707758 PMCID: PMC9883964 DOI: 10.1186/s11556-023-00311-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Traditional meta-analyses with pairwise direct comparison revealed that a variety of exercise-based training interventions can prevent falls in community-dwelling older adults. This network meta-analysis adds value by comparing and ranking different exercise training strategies based on their effects on fall risk reductions determined by analysis of direct and indirect comparisons. METHODS The studies included in this network meta-analysis were identified through a comprehensive search in five biomedical databases (PubMed, SportDiscus, CINAHL, Web of Science and EMBASE). We included (randomized) controlled trials (RCTs) that compared the occurance of fall events in older adults who received different interventional treatments. RESULTS Seventy six comparisons from 66 RCTs with 47.420 (61% male / 39% female) participants aged 77 ± 4 (68 - 88) years were included in this network meta-analysis. The network model revealed low heterogeneity (I2 = 28.0, 95%CI 1.0 to 47.7%) and inconsistency (Q between designs = 15.1, p = 0.37). Postural control training was found to be most effective in preventing falls (Postural Control Training: (home): Risk Ratio (RR) = 0.66, 95%-CI [0.49; 0.88], P-score = 0.97;Postural Control Training: RR = 0.82, 95%-CI [0.75; 0.91], P-score = 0.82). Combined and multifactorial interventions also display a robust but smaller effect (RR = 0.88-0.93, P-score = 0.65-0.47). CONCLUSION Physical activity that includes balance training presents itself to be the most effective. Multifactorial approaches are well investigated but could be slightly less effective than isolated postural control training.
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Affiliation(s)
- Tim Wiedenmann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Steffen Held
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Ludwig Rappelt
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Martin Grauduszus
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Sofie Spickermann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
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Arkkukangas M, Strömqvist Bååthe K, Ekholm A, Tonkonogi M. Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15140. [PMID: 36429859 PMCID: PMC9690656 DOI: 10.3390/ijerph192215140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.
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Affiliation(s)
- Marina Arkkukangas
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, 721 23 Vasteras, Sweden
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Karin Strömqvist Bååthe
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
| | - Anna Ekholm
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Michail Tonkonogi
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
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High Challenge Exercise and Learning Safe Landing Strategies among Community-Dwelling Older Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127370. [PMID: 35742618 PMCID: PMC9223480 DOI: 10.3390/ijerph19127370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6−9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p < 0.001) and learning falling techniques (p < 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries.
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Effects of a modified Otago exercise program delivered through outpatient physical therapy to community-dwelling older adult fallers in Greece during the COVID-19 pandemic: a controlled, randomized, multicenter trial. Eur Geriatr Med 2022; 13:893-906. [PMID: 35606677 PMCID: PMC9126757 DOI: 10.1007/s41999-022-00656-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022]
Abstract
Aim To investigate the effectiveness of a video-supported OTAGO exercise program (OEP) in balance, functional ability, fear of falls and number of falls in Greek older adults with a history of falls. Findings A 6-month OEP helped older adults to improve their balance and functional ability test scores as well as reduce fear and number of falls, both after the intervention and at the 12-month follow-up. However, the adherence to the program remained unaffected. Message The OEP contributes to the well-being of older adults with a history of falls by improving all their relevant skills and scores. More long-term research under less adverse conditions is required to solidify these findings. Background The pandemic has led to the isolation and social exclusion of older adults and cut them off from any exercise activity. Thus, it is more than ever necessary to implement organized interventions to prevent falls in older people as they remain a global health problem associated with serious injuries, chronic disability, and high costs for the healthcare system. Otago exercise program (OEP) can effectively reduce the number of falls. Aim To study the effect of a 6 months modified video supported OEP in balance, functional ability, fear of falls and number of falls in Greek older people who have fallen. Method 150 fallers aged 65–80 years [Median age 70 (67–74), 88.7% women] were divided into two groups (intervention and control). Primary outcomes included changes in Short FES-I, CONFbal scale, 4-Stage Balance test, BBS, TUG test and number of falls, while the secondary outcome consists of the monthly adherence to exercise after the intervention. Analysis of variance with repeated measures was applied. Results There were statistically significant between groups differences after 6 months with the OEP group to shows improved values in TUG time score (17.8 vs 3.9%, p < 0.001, 95% CI), 4-Stage Balance Test (6.85 vs 1.09%, p < 0.05 95% CI), 30-Second Chair Stand Test 7.35 vs 2.93%, p < 0.001), BBS score (13.27 vs 3.89%, p < 0.001, 95% CI), Short FES-I (35.78 vs 13.01%, p < 0.001, 95% CI) and number of falls (69.12 vs 18.70%, p < 0.001, 95% CI). All the above differences remained statistically significant in the 12 months follow-up (p < 0.05), when differences in the CONFbal score were also observed (p < 0.001, 95% CI). No differences were found in adherence to OEP (p > 0.05). Conclusions A modified OEP decreases the number of falls, improves the balance and functional ability of older adults and reduces the fear of falling. However, it did not contribute to satisfactory adherence to exercise. Trial registration number/date of registration NCT04330053/April 1, 2020.
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Huberty S, Mattle M, Theiler R, Freystätter G. [Evidence of Physical Training Programs for Fall Prevention in Seniors]. PRAXIS 2022; 111:815-821. [PMID: 36285409 DOI: 10.1024/1661-8157/a003922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Evidence of Physical Training Programs for Fall Prevention in Seniors Abstract. It has been shown that physical exercise reduced fall risk by 23-42% in community-dwelling adults aged 65+. This is particularly true for physical exercises with functional, balance and strength components. Growing evidence shows that functional training is particularly effective in reducing fall risk. Functional training is composed by exercises which reflect activities of daily life, supported by weights and other aids.
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Affiliation(s)
- Sarah Huberty
- Universitäre Altersmedizin, Felix Platter Spital, Basel, Schweiz
| | - Michèle Mattle
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
| | - Robert Theiler
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
| | - Gregor Freystätter
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
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The Relation between Functional Performance, Falls and Previous Falls Among Participants in the Otago Programme: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126501. [PMID: 34208713 PMCID: PMC8296346 DOI: 10.3390/ijerph18126501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022]
Abstract
Fall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.
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Bruce J, Hossain A, Lall R, Withers EJ, Finnegan S, Underwood M, Ji C, Bojke C, Longo R, Hulme C, Hennings S, Sheridan R, Westacott K, Ralhan S, Martin F, Davison J, Shaw F, Skelton DA, Treml J, Willett K, Lamb SE. Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess 2021; 25:1-114. [PMID: 34075875 DOI: 10.3310/hta25340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls and fractures are a major problem. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of alternative falls prevention interventions. DESIGN Three-arm, pragmatic, cluster randomised controlled trial with parallel economic analysis. The unit of randomisation was the general practice. SETTING Primary care. PARTICIPANTS People aged ≥ 70 years. INTERVENTIONS All practices posted an advice leaflet to each participant. Practices randomised to active intervention arms (exercise and multifactorial falls prevention) screened participants for falls risk using a postal questionnaire. Active treatments were delivered to participants at higher risk of falling. MAIN OUTCOME MEASURES The primary outcome was fracture rate over 18 months, captured from Hospital Episode Statistics, general practice records and self-report. Secondary outcomes were falls rate, health-related quality of life, mortality, frailty and health service resource use. Economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit. RESULTS Between 2011 and 2014, we randomised 63 general practices (9803 participants): 21 practices (3223 participants) to advice only, 21 practices (3279 participants) to exercise and 21 practices (3301 participants) to multifactorial falls prevention. In the active intervention arms, 5779 out of 6580 (87.8%) participants responded to the postal fall risk screener, of whom 2153 (37.3%) were classed as being at higher risk of falling and invited for treatment. The rate of intervention uptake was 65% (697 out of 1079) in the exercise arm and 71% (762 out of 1074) in the multifactorial falls prevention arm. Overall, 379 out of 9803 (3.9%) participants sustained a fracture. There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71). There was no difference in falls rate over 18 months (exercise arm: rate ratio 0.99, 95% confidence interval 0.86 to 1.14; multifactorial falls prevention arm: rate ratio 1.13, 95% confidence interval 0.98 to 1.30). A lower rate of falls was observed in the exercise arm at 8 months (rate ratio 0.78, 95% confidence interval 0.64 to 0.96), but not at other time points. There were 289 (2.9%) deaths, with no differences by treatment arm. There was no evidence of effects in prespecified subgroup comparisons, nor in nested intention-to-treat analyses that considered only those at higher risk of falling. Exercise provided the highest expected quality-adjusted life-years (1.120), followed by advice and multifactorial falls prevention, with 1.106 and 1.114 quality-adjusted life-years, respectively. NHS costs associated with exercise (£3720) were lower than the costs of advice (£3737) or of multifactorial falls prevention (£3941). Although incremental differences between treatment arms were small, exercise dominated advice, which in turn dominated multifactorial falls prevention. The incremental net monetary benefit of exercise relative to treatment valued at £30,000 per quality-adjusted life-year is modest, at £191, and for multifactorial falls prevention is £613. Exercise is the most cost-effective treatment. No serious adverse events were reported. LIMITATIONS The rate of fractures was lower than anticipated. CONCLUSIONS Screen-and-treat falls prevention strategies in primary care did not reduce fractures. Exercise resulted in a short-term reduction in falls and was cost-effective. FUTURE WORK Exercise is the most promising intervention for primary care. Work is needed to ensure adequate uptake and sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN71002650. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ray Sheridan
- General Medicine/Care of the Elderly, Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Katharine Westacott
- Elderly Care Department, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Shvaita Ralhan
- Gerontology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Finbarr Martin
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Davison
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Shaw
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Treml
- Geriatric Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,College of Medicine and Health, University of Exeter, Exeter, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Arkkukangas M, Bååthe KS, Ekholm A, Tonkonogi M. A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults. BMC Public Health 2021; 21:744. [PMID: 33865349 PMCID: PMC8052647 DOI: 10.1186/s12889-021-10775-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 04/06/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Falls and fall-related injuries are major threats not only for older adults but also for younger age groups such as working-age adults. It has been shown that it is possible to reduce the risk of falls and fall-related injuries, to some extent. However, interventions aiming at reducing both the risk of falls and mitigating fall-related injuries through teaching safe falling techniques are still sparsely investigated. The aim with this study was to investigate the effect of a 10-week workplace-based judo inspired exercise programme (Judo4Balance). The measures in the study include physical functions, fall-related self-efficacy and safe falling techniques. METHODS A total of 142 working-age adults participated in this non-randomised controlled study. The participants were allocated to the Judo4Balance group (n = 79), or to a waiting list control group (n = 63). The mean age was 47 years (18-68). The recruitment period was from May 2018 to October 2019. A total of 128 participants were included in the analysis. Logistic Regression models were used to analyse the outcomes: physical function, balance and fall-related self-efficacy as well as falling techniques (backwards and forwards). RESULTS At the 10-week follow-up, the results displayed significant differences between the two groups in all measurements, except for the fall-related self-efficacy with OR = 1.8. Techniques for falling forwards and backwards displayed the highest OR = 124.1 and OR = 98.9. Physical function and balance showed OR = 3.3 and OR = 6.4. CONCLUSIONS This exercise programme under study displayed significant differences in strength, balance and safe falling techniques between the groups. It is suggested that these functions, which were studied here, can effectively be trained in working-age adults by using the Judo4Balace exercise programme. Thus, it may be beneficial to further investigate and include training in proper falling techniques when designing fall prevention exercise programmes. Furthermore, it may be a novel way of addressing fall-related injuries, which are of utmost importance to prevent in near future. TRIAL REGISTRATION NCT04294342 . Registered 4 March 2020 - The Impact of Specifically Adapted Judo-based Training Program on Risk Factors for Falls Among Adults - Full Text View - ClinicalTrials.gov.
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Affiliation(s)
- Marina Arkkukangas
- Research and Development in Sörmland, Eskilstuna, Sweden. .,Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Karin Strömqvist Bååthe
- Department of Medicine, Sport and Fitness Science, School of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
| | - Anna Ekholm
- Research and Development in Sörmland, Eskilstuna, Sweden
| | - Michail Tonkonogi
- Department of Medicine, Sport and Fitness Science, School of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
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The effect of the group-based Otago exercise program on frailty among nursing home older adults with cognitive impairment. Geriatr Nurs 2021; 42:479-483. [PMID: 33714906 DOI: 10.1016/j.gerinurse.2021.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/20/2022]
Abstract
This study investigated the effect of the group-based Otago exercise program (OEP) on frailty and physical function in older adults with cognitive impairment. We recruited eighteen older adults with cognitive impairment from a nursing-home to perform the OEP three times a week, for a period of three months in a nursing home. The intervention was feasible with attending an average of 21 out of 36 sessions. The frailty score decreased significantly (p<0.05). Physical function including Time Up and Go test (TUG), 30 seconds Sit-To-Stand Test (30 s-SST) and Four-Stage Balance Test was significantly positive after intervention (all p<0.001). The group-based OEP is a potentially effective strategy for reversing frailty and improving physical function among older adults with cognitive impairment.
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Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton DA, Bergland A. Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial. BMC Musculoskelet Disord 2020; 21:471. [PMID: 32682416 PMCID: PMC7368978 DOI: 10.1186/s12891-020-03495-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background Exercise is recommended for individuals with vertebral fractures, but few studies have investigated the effect of exercise on outcomes of importance for this population. Post-intervention effects of exercise are even less studied. The objective of this study was to evaluate habitual walking speed and other health-related outcomes after cessation of a 3-month exercise intervention. Methods This follow-up study was conducted 3 months post-intervention of a randomised controlled trial. A total of 149 community-dwelling Norwegian women aged 65 years or older, diagnosed with osteoporosis and vertebral fracture were randomised into either exercise or control group. Primary outcome was habitual walking speed at 3 months. Secondary outcomes were other measures of physical fitness – including the Four Square Step Test (FSST), functional reach, grip strength and Senior Fitness Test – measures of health-related quality of life and fear of falling. Herein we report secondary data analysis of all outcomes at 6 months (3 months post-intervention). Data were analysed according to the intention-to-treat principle, linear mixed regression models were employed. Results For the primary outcome, habitual walking speed, there was no statistically significant difference between groups (0.03 m/s, 95%CI − 0.02 to 0.08, p = 0.271) at the 3-month post-intervention follow-up. For secondary outcomes of physical fitness, statistically significant differences in favour of the intervention group were found for balance using the FSST (− 0.68 s, 95%CI − 1.24 to − 0.11, p = 0.019), arm curl (1.3, 95%CI 0.25 to 2.29, p = 0.015), leg strength using the 30-s sit to stand (1.56, 95%CI 0.68 to 2.44, p = 0.001) and mobility using the 2.45-m up and go (− 0.38 s, 95%CI − 0.74 to − 0.02, p = 0.039). There was a statistically significant difference between the groups regarding fear of falling in favour of the intervention group (− 1.7, 95%CI − 2.97 to − 0.38, p = 0.011). No differences between groups were observed for health-related quality of life. Conclusion The results show the improved effects of a multicomponent exercise programme on outcomes like muscle strength, balance and mobility as well as fear of falling in a group of older women with osteoporosis and vertebral fracture 3 months post-intervention. Trial registration ClinicalTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.
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Affiliation(s)
- Brita Stanghelle
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Hege Bentzen
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Are Hugo Pripp
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Dawn A Skelton
- School of Health and Life Sciences, Institute of Applied Health Research, Centre for Living, Glasgow Caledonian University, Glasgow, UK
| | - Astrid Bergland
- Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Filar-Mierzwa K, Długosz-Boś M, Marchewka A, Aleksander-Szymanowicz P. Effect of different forms of physical activity on balance in older women. J Women Aging 2020; 33:487-502. [PMID: 31977290 DOI: 10.1080/08952841.2020.1718579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to analyze the effect of two types of physical activity, dance, and general exercises, on balance in older women. Study participants comprised two groups of women. The participants attended 45-min DMT (n = 20) or GRE sessions (n = 19) three times per week for 12 weeks. Before and after the training, the participants underwent the Postural Stability Test, the Limits of Stability Test, and the Fall Risk Test. Improvement of the balance was confirmed for only one test both for the dance group and the general exercises group.
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Affiliation(s)
- Katarzyna Filar-Mierzwa
- Department of Occupational Therapy, University of Physical Education in Krakow, Krakow, Poland
| | | | - Anna Marchewka
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
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Abstract
The purpose of this study was to describe physical activity and function of older adults in assisted living communities and test the association between moderate and vigorous activity and falls. This study used baseline data from 393 participants from the first two cohorts in the Function-Focused Care in Assisted Living Using the Evidence Integration Triangle study. The majority of participants were female (N = 276, 70%) and White (N = 383, 97%) with a mean age of 87 years (SD = 7). Controlling for age, cognition, gender, setting, and function, the time spent in moderate or vigorous levels of physical activity was associated with having a fall in the prior 4 months. Those who engaged in more moderate physical activity were 0.6% less likely to have a fall (OR = 0.994, Wald statistic = 5.54, p = .02), and those who engaged in more vigorous activity were 2% less likely to have a fall (OR = 0.980, Wald statistic = 3.88, p = .05).
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20
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Knee-Hip-Spine Syndrome: Improvement in Preoperative Abnormal Posture following Total Knee Arthroplasty. Adv Orthop 2019; 2019:8484938. [PMID: 31355006 PMCID: PMC6634073 DOI: 10.1155/2019/8484938] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
An ergonomic upright body posture is maintained by the alignment of the spine, pelvis, and lower extremities, and the muscle strength of body trunk and lower extremities. The posture varies with age because of the degenerative changes in the involved structures and the weakening of the muscles. The compensatory mechanisms underlying these changes have recently been evaluated, and the loss of lumbar lordosis results in spinal kyphosis, pelvic retroversion, hip extension, knee flexion, and ankle dorsiflexion. These mechanisms are referred to as the hip–spine and knee–spine syndromes. The spine, hip, and knee are anatomically connected, and the pain and discomfort of the lower back, hip, and knee frequently arise due to degenerative changes of these structures. Thus, these mechanisms are considered as the knee–hip–spine syndrome. Spinal fusion, total hip arthroplasty, and total knee arthroplasty are the surgical procedures for severe degeneration, and their clinical outcomes for the affected sites are promising. However, despite surgeries, other structures may degenerate and result in complications, such as proximal junctional kyphosis and hip dislocation, following spinal fusion. Therefore, it is necessary to evaluate each patient under specific conditions and to treat each section while considering associations between the target structure and entire body. The purpose of this article is to introduce postural maintenance, variations with age, and improvements with surgical interventions of spine, hip, and knee as the knee–hip–spine syndrome.
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Arkkukangas M, Johnson ST, Hellström K, Anens E, Tonkonogi M, Larsson U. Fall Prevention Exercises With or Without Behavior Change Support for Community-Dwelling Older Adults: A Two-Year Follow-Up of a Randomized Controlled Trial. J Aging Phys Act 2019; 28:34-41. [PMID: 31188707 DOI: 10.1123/japa.2019-0116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.
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Affiliation(s)
- Marina Arkkukangas
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
- 2 Centre for Clinical Research Sörmland County Council and Uppsala University, Sweden
| | | | - Karin Hellström
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
| | - Elisabeth Anens
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
| | - Michail Tonkonogi
- 3 School of Education, Health and Social Studies, department of Medicine, Sport and Fitness Science, Högskolan Dalarna, Falun, Sweden
| | - Ulf Larsson
- 2 Centre for Clinical Research Sörmland County Council and Uppsala University, Sweden
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Skelton DA, Rutherford OM, Dinan-Young S, Sandlund M. Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis. J Frailty Sarcopenia Falls 2019; 4:11-19. [PMID: 32300711 PMCID: PMC7155371 DOI: 10.22540/jfsf-04-011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Falls Management Exercise (FaME) has been shown to reduce falls in frequent fallers and in lower risk sedentary older people. The effects of FaME on the strength, power, physical function and bone health of frequently falling older women are yet to be established. METHODS This paper reports secondary analysis of data from the original randomised controlled trial of FaME in 100 community dwelling women aged ≥65 years with a history of ≥3 falls in the previous year. Intervention was group delivered, weekly one hour tailored dynamic balance and strength exercise classes and home exercise for nine months. OUTCOME MEASURES INCLUDED strength (handgrip, quadriceps, hamstrings, hip abductors, ankles), lower limb explosive power and functional tests (timed up and go, functional reach, timed floor rise and balance), analysed using Linear Mixed Model analysis. Bone Mineral Density (BMD) at hip and spine was measured in a smaller sub-group and analysed using t-tests. RESULTS Significant time*group interactions in all measures of strength, except isometric ankle dorsiflexion, concentric hamstring and eccentric quadriceps strength. These improvements in strength equated to average improvements of 7-45%. There were also significant improvements in explosive power (W/kg) (18%, p=0.000), timed up and go (16%, p=0.000), functional reach (17%, p=0.000), floor rise (10%, p=0.002) and eyes closed static balance (56%, p=0.000). There was a significant loss of hip BMD in the control group (neck of femur p<0.05; ward's triangle p<0.02). CONCLUSION The FaME intervention improves lower limb strength, power and clinically relevant functional outcomes in frequently falling older women.
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Affiliation(s)
- Dawn A. Skelton
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Olga M. Rutherford
- Division of Applied Biomedical Research, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Susie Dinan-Young
- Research Dept. of Primary Care & Population Health, University College London, Royal Free Campus, London, UK
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1:CD012424. [PMID: 31789289 PMCID: PMC6360922 DOI: 10.1002/14651858.cd012424.pub2] [Citation(s) in RCA: 433] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. MAIN RESULTS We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control. AUTHORS' CONCLUSIONS Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.
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Affiliation(s)
- Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Nicola J Fairhall
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Geraldine K Wallbank
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Anne Tiedemann
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Zoe A Michaleff
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Kirsten Howard
- The University of SydneySchool of Public HealthSydneyNSWAustralia2006
| | - Lindy Clemson
- The University of SydneyFaculty of Health SciencesEast St. LidcombeLidcombeNSWAustralia1825
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Sarah E Lamb
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
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Effects of Physical Activity Governmental Programs on Health Status in Independent Older Adults: A Systematic Review. J Aging Phys Act 2018; 27:265-275. [PMID: 29989461 DOI: 10.1123/japa.2017-0396] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This systematic review analyzes the evidence of the effects of physical activity governmental programs oriented toward the health of independent older adults. Medline, Web of Science, PsycINFO, and Psychology & Behavioral Sciences Collection databases were used for data mining, and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations were followed. Five studies (n = 2,545 participants) fulfilled the established inclusion criteria. The physical activity programs had beneficial effects on the older adults' quality of life, fall risk, activities of daily living, physical activity levels, nutritional risk, body mass index, arterial pressure, resting heart rate, blood glucose, triglycerides, and/or cholesterol, but did not significantly alter their body fat mass percentage. Programs involving diverse physical capacities seem to be more effective for healthy aging. It is recommended that governments start to disseminate the outcomes of these programs within society and the scientific community.
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Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis. Physiotherapy 2018; 105:187-199. [PMID: 30846193 DOI: 10.1016/j.physio.2018.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise. OBJECTIVES To assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults. DATA SOURCES Searches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017. STUDY SELECTION Randomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group. DATA EXTRACTION/ DATA SYNTHESIS Pairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR). RESULTS Twenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years post intervention. CONCLUSIONS Falls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42017062461.
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Albornos-Muñoz L, Moreno-Casbas MT, Sánchez-Pablo C, Bays-Moneo A, Fernández-Domínguez JC, Rich-Ruiz M, Gea-Sánchez M. Efficacy of the Otago Exercise Programme to reduce falls in community-dwelling adults aged 65-80 years old when delivered as group or individual training. J Adv Nurs 2018; 74:1700-1711. [PMID: 29633328 DOI: 10.1111/jan.13583] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/22/2023]
Abstract
AIM This study will compare how falls can be reduced in non-institutionalized older Spanish adults aged 65-80 years by providing group or individual exercise sessions using the Otago Exercise Programme. BACKGROUND The Otago Exercise Programme is a progressive home-based exercise programme, where trained health professionals help people engage in strength, balance and endurance exercises. Its format is based on the evidence from four clinical trials. The benefits of the Otago Exercise Programme are the same for people who have and have not suffered falls and it can also be used for visually impaired people. DESIGN A multicentre, simply blinded, randomized, non-inferiority clinical trial, with two arms-group training and individual training-that started in January 2017 and will continue until December 2019. METHODS Each study group has 364 subjects, who will take part in four individual or group sessions delivered mainly by nurses over an 8-week period, with a reinforcement session 6 months later. Data will be collected at baseline and after 6 and 12 months. The fall percentage will be the most relevant clinical variable and we will also consider safety, viability, compliance, economic analysis and therapeutic value. Approval and funding was granted in December 2016 for this 3-year study by the Spanish Health Research Fund (PI16CIII/00031). DISCUSSION Older people from 65-80 years old tend to be more isolated and tackling worries about falls can improve social activities and independence. It has been shown that group training provides better adherence to exercise than individual training and this study will test that hypothesis for the Otago Exercise Programme.
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Affiliation(s)
- Laura Albornos-Muñoz
- Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain.,REDISSEC, Red de Investigación en Servicios de Salud de Enfermedades Crónicas, Madrid, Spain
| | - María Teresa Moreno-Casbas
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | | | - Ana Bays-Moneo
- Department of Health Sciences, Public University of Navarra, Navarra, Spain
| | - Juan Carlos Fernández-Domínguez
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Balearic Islands, Palma, Spain
| | - Manuel Rich-Ruiz
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.,Instituto Maimónides de Investigación Biomédica (IMIBIC)/Universidad de Córdoba/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Montserrat Gea-Sánchez
- Grup de Recerca de Cures de Salut, GRECS, Institut de Recerca Biomèdica, Lleida, Spain.,Grupo de Estudios Sociedad, Salud, Educación y Cultura, GESEC, Departament d'Infermeria i Fisioteràpia, Facultat d'Infermeria i Fisioteràpia, Universitat de Lleida, Lleida, Spain
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27
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Skelton DA, Mavroeidi A. Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review. J Frailty Sarcopenia Falls 2018; 3:85-104. [PMID: 32300697 PMCID: PMC7155323 DOI: 10.22540/jfsf-03-085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 12/29/2022] Open
Abstract
Physical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events. This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g. having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment). The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months. Some minor adverse effects mainly transient musculoskeletal pain) have been reported. For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate. People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naïve to those activities. For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk. For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated.
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Affiliation(s)
- Dawn A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alexandra Mavroeidi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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28
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Resnick B, Galik E, Boltz M, Vigne E, Holmes S, Fix S, Zhu S. Physical Activity and Function in Assisted Living Residents. West J Nurs Res 2018; 40:1734-1748. [PMID: 29560808 DOI: 10.1177/0193945918764448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to consider the feasibility, reliability, and validity of MotionWatch 8. A total of 249 residents were recruited from 26 assisted living settings. Data collection included demographics, comorbidities, function (Barthel Index), physical activity (MotionWatch 8), and falls. The mean age of participants was 86.86 ( SD = 7.0), the majority were women 179 (74%) and White ( N = 232, 96%). A total of 86% of participants wore the MotionWatch 8. There were no significant differences in physical activity over 3 days of testing. The MotionWatch 8 findings were significantly associated with activities of daily living (ADL) function. There were no significant differences in ADL function or physical activity between those who did and did not fall. The study provides additional support for the feasibility, reliability, and validity of the MotionWatch 8 and confirms that older adults living in assisted living settings spend the majority of their time in sedentary activity.
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Affiliation(s)
| | | | - Marie Boltz
- 2 Pennsylvania State University, University Park, USA
| | - Erin Vigne
- 1 University of Maryland, Baltimore, MD, USA
| | | | - Steven Fix
- 1 University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- 1 University of Maryland, Baltimore, MD, USA
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29
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Cheng P, Tan L, Ning P, Li L, Gao Y, Wu Y, Schwebel DC, Chu H, Yin H, Hu G. Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29534531 PMCID: PMC5877043 DOI: 10.3390/ijerph15030498] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Falls are a major threat to older adults worldwide. Although various effective interventions have been developed, their comparative effectiveness remains unreported. Methods: A systematic review and network meta-analysis was conducted to determine the most effective interventions to prevent falls in community-dwelling adults aged 60 and over. Combined odds ratio (OR) and 95% credible interval (95% CrI) were calculated. Results: A total of 49 trials involving 27,740 participants and 9271 fallers were included. Compared to usual care, multifactorial interventions (MFI) demonstrated the greatest efficacy (OR: 0.64, 95% CrI: 0.53 to 0.77) followed by interventions combining education and exercise (EDU + EXC) (OR: 0.65, 95% CrI: 0.38 to 1.00) and interventions combining exercise and hazard assessment and modification (EXC + HAM) (OR: 0.66, 95% CrI: 0.40 to 1.04). The effect of medical care performed the worst (OR: 1.02, 95% CrI: 0.78 to 1.34). Model fit was good, inconsistency was low, and publication bias was considered absent. The overall quality of included trials was high. The pooled odds ratios and ranking probabilities remained relatively stable across all sensitivity analyses. Conclusions: MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations.
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Affiliation(s)
- Peixia Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Liheng Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Li Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Yuyan Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - Yue Wu
- Department of Environmental and Occupational Health, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
| | - David C Schwebel
- Department of Psychology, University of Alabama, Birmingham, AL 35294, USA.
| | - Haitao Chu
- Division of Biostatistics, The University of Minnesota, Minneapolis, MN 55455, USA.
| | - Huaiqiong Yin
- Central South University Library, 172 Tongzipo Rd., Changsha 410013, China.
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China.
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30
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Whipple MO, Hamel AV, Talley KMC. Fear of falling among community-dwelling older adults: A scoping review to identify effective evidence-based interventions. Geriatr Nurs 2018; 39:170-177. [PMID: 28941942 PMCID: PMC5862787 DOI: 10.1016/j.gerinurse.2017.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
Fear of falling presents a significant problem for many older adults by reducing physical function and increasing the risk of future falls. Several different types of interventions have improved fear of falling and a summary of efficacious interventions will help clinicians recommend treatment options. Using the Arksey and O'Malley Framework for scoping reviews, the purpose of this review was to identify efficacious interventions for treating fear of falling among community-dwelling older adults in order to provide a list of potential treatment options for care providers. A total of 45 publications were identified for inclusion in this review.
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Affiliation(s)
- Mary O Whipple
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA.
| | - Aimee V Hamel
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
| | - Kristine M C Talley
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55455, USA
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31
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Bento JR, Sousa ND. Exercício físico na prevenção de quedas do idoso da comunidade: revisão baseada na evidência. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc12(39)1658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A prevenção de quedas do idoso é um urgente desafio de saúde pública. O exercício físico tem-se comprovado uma intervenção preventiva eficaz. Objetivo: Rever a evidência científica mais recente, relativa à recomendação do exercício físico na prevenção de quedas do idoso da comunidade. Identificar modalidade física e regimes de frequência com maior benefício. Métodos: Efetuou-se uma pesquisa bibliográfica, utilizando os termos MeSH “aged”, “accidental falls/prevention and control” e “exercise”, nas bases de dados PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine e NICE Evidence Search, nos últimos 5 anos. Foram incluídos artigos que avaliassem o exercício como intervenção isolada na prevenção de quedas do indivíduo da comunidade, com ≥60 anos. Resultado avaliado: incidência de quedas. Resultados: De 637 potenciais artigos, 4 cumpriam critérios de inclusão: 2 ensaios clínicos aleatorizados controlados (ECACs), 1 estudo coorte e 1 meta-análise (MA). Globalmente, os resultados demonstram um efeito protetor do exercício físico. A MA obteve uma razão de taxas de incidência (RTI) de 0,79 (p<0,001), com o treino de equilíbrio (RTI=0,85, p=0,04) e maior dose semanal (RTI=0,77, p=0,03) a demonstrarem-se mais efetivos. Contrariamente, um ECAC demonstrou superioridade na marcha. O estudo coorte revelou maior benefício em participações ≥3 anos (RTI=0,90; p=0,03). Conclusão: O exercício físico é efetivo na prevenção de quedas do idoso da comunidade. Treinos de equilíbrio e práticas semanais ≥3 horas demonstraram melhores resultados (SORT A). A sua manutenção deve ser incentivada a longo prazo (SORT B).
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Carpenter H, Audsley S, Coupland C, Gladman J, Kendrick D, Lafond N, Logan P, Skelton DA, Timblin C, Timmons S, Ward D, Orton E. PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol. Inj Prev 2018; 25:453-458. [PMID: 29305397 DOI: 10.1136/injuryprev-2017-042627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/01/2017] [Accepted: 12/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Falls in older people are a leading causes of unintentional injury. Due to an ageing population, injuries are likely to increase unless more is done to reduce older people's falls risk. In clinical trials, the Falls Management Exercise (FaME) programme has reduced the rate of falls and falls-related injuries in community-dwelling older adults. However, the commissioning of FaME is inconsistent across England, potentially due to a lack of evidence that FaME can be delivered effectively in a 'real world' setting. The PHysical activity Implementation Study In Community-dwelling AduLts (PHISICAL) study is designed to study the implementation of FaME in a range of different settings in England. METHODS The PHISICAL study will use a mixed-methods, triangulation, multilevel design to explore the implementation of FaME. Framework analysis of semistructured interviews with up to 90 stakeholders (exercise programme users, service providers, referrers and commissioners) and observational data from locally led communities of practice will identify the factors that influence FaME's implementation. Quantitative, anonymised, routine service data from up to 650 exercise programme users, including measures of falls and physical activity, will allow assessment of whether the benefits of FaME reported in clinical trials translate to the 'real world' setting. CONCLUSION The findings from this study will be used to develop a toolkit of resources and guidance to inform the commissioning and delivery of future FaME programmes. This study has the potential to inform public health prevention strategies, and in doing so may reduce the number of falls in the older population while delivering cost savings to health and social care services.
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Affiliation(s)
- Hannah Carpenter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Audsley
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - John Gladman
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Natasher Lafond
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philippa Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Glasgow, UK
| | - Clare Timblin
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Business School, University of Nottingham, Nottingham, UK
| | - Derek Ward
- College of Health and Social Care, University of Derby, Derby, UK
| | - Elizabeth Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Buchner DM, Rillamas-Sun E, Di C, LaMonte MJ, Marshall S, Hunt J, Zhang Y, Rosenberg D, Lee IM, Evenson KR, Herring AH, Lewis CE, Stefanick ML, LaCroix AZ. Accelerometer-Measured Moderate to Vigorous Physical Activity and Incidence Rates of Falls in Older Women. J Am Geriatr Soc 2017; 65:2480-2487. [PMID: 28755415 PMCID: PMC5681400 DOI: 10.1111/jgs.14960] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine whether moderate to vigorous physical activity (MVPA) measured using accelerometry is associated with incident falls and whether associations differ according to physical function or history of falls. DESIGN Prospective study with baseline data collection from 2012 to 2014 and 1 year of follow-up. SETTING Women's Health Initiative participants living in the United States. PARTICIPANTS Ambulatory women aged 63 to 99 (N = 5,545). MEASUREMENTS Minutes of MVPA per day measured using an accelerometer, functional status measured using the Short Physical Performance Battery (SPPB), fall risk factors assessed using a questionnaire, fall injuries assessed in a telephone interview, incident falls ascertained from fall calendars. RESULTS Incident rate ratios (IRRs) revealed greater fall risk in women in the lowest quartile of MVPA compared to those in the highest (IRR = 1.18, 95% confidence interval = 1.01-1.38), adjusted for age, race and ethnicity, and fall risk factors. Fall rates were not significantly associated with MVPA in women with high SPPB scores (9-12) or one or fewer falls in the previous year, but in women with low SPPB scores (≤ 8) or a history of frequent falls, fall rates were higher in women with lower MVPA levels than in those with higher levels (interaction P < .03 and < .001, respectively). Falls in women with MVPA above the median were less likely to involve injuries requiring medical treatment (9.9%) than falls in women with lower MVPA levels (13.0%) (P < .001). CONCLUSION These findings indicate that falls are not more common or injurious in older women who engage in higher levels of MVPA. These findings support encouraging women to engage in the amounts and types of MVPA that they prefer. Older women with low physical function or frequent falls with low levels of MVPA are a high-risk group for whom vigilance about falls prevention is warranted.
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Affiliation(s)
- David M. Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Eileen Rillamas-Sun
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo of The State University New York, Buffalo, NY
| | - Stephen Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Julie Hunt
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yuzheng Zhang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Dori Rosenberg
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kelly R. Evenson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Amy H. Herring
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cora E. Lewis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marcia L. Stefanick
- Departments of Medicine, and Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - Andrea Z. LaCroix
- Department of Preventive and Family Medicine, University of California San Diego, San Diego, CA
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Musich S, Wang SS, Ruiz J, Hawkins K, Wicker E. Falls-Related Drug Use and Risk of Falls Among Older Adults: A Study in a US Medicare Population. Drugs Aging 2017; 34:555-565. [PMID: 28580498 PMCID: PMC5488077 DOI: 10.1007/s40266-017-0470-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Approximately one-third of community-dwelling older adults fall each year, and approximately 10% have falls requiring medical services. Among other factors, research studies have linked certain medications with an increased risk of falls. Objective The aim of this study was to examine the risk of falls relative to use patterns among new and continuing falls-related drug (FRD) users. Methods A 10% random sample, insured in AARP® Medicare Supplement and AARP Medicare Part D Rx plans, was utilized to define new and continuing FRD users. New users had a 12-month pre-period without FRD use, whereas continuing users had at least one FRD in the pre-period. Both groups had 12-month follow-up after initiating or continuing FRD use. Characteristics associated with the risk of falls for new and continuing users were determined using multivariate logistic regression models. Results Among insureds, 44% used at least one of the FRD classes. Of these, 29% were new users (N = 35,340) and 71% were continuing users (N = 121,488). Fall rates for the two subgroups were similar at 7 and 8%, respectively. Characteristics associated with the risk of falls were previous injurious fall, use of two or more classes of FRDs, older age, poorer health, and being female. New users were at higher risk than continuing users. Conclusion New users of FRDs were at highest risk of falls, and continuing users were at increased risk, especially with higher numbers of FRD classes. Both groups could benefit from falls awareness and prevention programs.
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Affiliation(s)
- Shirley Musich
- Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI, 48108, USA.
| | - Shaohung S Wang
- Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI, 48108, USA
| | - Joann Ruiz
- Medicare and Retirement, UnitedHealthcare Alliances, PO Box 9472, Minneapolis, MN, 55440, USA
| | - Kevin Hawkins
- Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI, 48108, USA
| | - Ellen Wicker
- , 601 E. Street, N.W., Washington, DC, 20049, USA
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Effect of Modified Otago Exercises on Postural Balance, Fear of Falling, and Fall Risk in Older Fallers With Knee Osteoarthritis and Impaired Gait and Balance: A Secondary Analysis. PM R 2017; 10:254-262. [DOI: 10.1016/j.pmrj.2017.08.405] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 01/08/2023]
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Finnegan S, Bruce J, Skelton DA, Withers EJ, Lamb SE. Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT). Physiotherapy 2017; 104:72-79. [PMID: 28801033 PMCID: PMC5840509 DOI: 10.1016/j.physio.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 06/15/2017] [Indexed: 11/27/2022]
Abstract
Objective This paper describes the development and implementation of an exercise intervention to prevent falls within The Prevention of Fall Injury Trial (PreFIT), which is a large multi-centred randomised controlled trial based in the UK National Health Service (NHS). Design Using the template for intervention description and replication (TIDieR) checklist, to describe the rationale and processes for treatment selection and delivery of the PreFIT exercise intervention. Participants Based on the results of a validated falls and balance survey, participants were eligible for the exercise intervention if they were at moderate or high risk of falling. Interventions Intervention development was informed using the current evidence base, published guidelines, and pre-existing surveys of clinical practice, a pilot study and consensus work with therapists and practitioners. The exercise programme targets lower limb strength and balance, which are known, modifiable risk factors for falling. Treatment was individually tailored and progressive, with seven recommended contacts over a six-month period. Clinical Trials Registry (ISCTRN 71002650).
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Affiliation(s)
- Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Dawn A Skelton
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK; Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
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Boongird C, Keesukphan P, Phiphadthakusolkul S, Rattanasiri S, Thakkinstian A. Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled trial. Geriatr Gerontol Int 2017; 17:2157-2163. [PMID: 28436154 DOI: 10.1111/ggi.13052] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/19/2017] [Accepted: 02/20/2017] [Indexed: 12/27/2022]
Abstract
AIM To investigate the effects of a simple home-based exercise program on falls, physical functioning, fear of falling and quality of life in a primary care setting. METHODS Participants (n = 439), aged ≥65 years with mild-to-moderate balance dysfunction were randomly assigned to an exercise (n = 219) or control (n = 220) group. The program consisted of five combined exercises, which progressed in difficulty, and a walking plan. Controls received fall prevention education. Physical functioning and other outcomes were measured at 3- and 6-month follow-up visits. Falls were monitored with fall diaries and phone interviews at 3, 6, 9, and 12 months respectively. RESULTS The 12 months of the home-based exercise program showed the incidence of falls was 0.30 falls per person year in the exercise group, compared with 0.40 in the control group. The estimated incidence rate ratio was 0.75 (95% CI 0.55-1.04), which was not statistically significant. The fear of falling (measured by the Thai fall efficacy scale) was significantly lower in the exercise than control group (24.7 vs 27.0, P = 0.003). Also, the trend of program adherence increased in the exercise group. (29.6% to 56.8%). CONCLUSIONS This simple home-based exercise program showed a reduction in fear of falling and a positive trend towards exercise adherence. Further studies should focus on factors associated with exercise adherence, the benefits of increased home visits and should follow participants longer in order to evaluate the effects of the program. Geriatr Gerontol Int 2017; 17: 2157-2163.
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Affiliation(s)
- Chitima Boongird
- Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prasit Keesukphan
- Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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