Article

The Effect of Group Exercise on Physical Functioning and Falls in Frail Older People Living in Retirement Villages: A Randomized, Controlled Trial

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Abstract

To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people. Cluster randomized, controlled trial of 12 months duration. Retirement villages in Sydney and Wollongong, Australia. Five hundred fifty-one people aged 62 to 95 (mean+/-standard deviation=79.5+/-6.4) who were living in self- and intermediate-care retirement villages. Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength. Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4+/-28.7 for the GE subjects and 31.5+/-25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance. These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.

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... In addition, targeting this loss of muscle function with PRT (without any aerobic exercise) has been shown to increase aerobic capacity by between 8-24% in older adults (58,109). Based on such evidence, aerobic interventions in frail older individuals have sometimes included endurance training within multi-component exercise programs (72,73,110,111). Thus, it may be necessary to strengthen the neuromuscular system, and improve balance, before initiating aerobic exercise to achieve adequate cardiovascular adaptations. ...
... Aerobic exercises for older adults may include walking with changes in pace and direction, (71,72) treadmill walking (73,111) step-ups, stair climbing, and stationary cycling (73), dancing or aquatic exercise. The choice of modality should depend on individual preference, accessibility, cognitive and physical comorbidities, and specific musculoskeletal issues. ...
... Programs consisting of home-based exercise interventions, weight-bearing exercises, or very low workloads are much less effective for achieving strength gains (111,222,223), or treating sarcopenia and its sequelae than higher intensity prescriptions. The use of subjective scales of perceived exertion instead of strength testing to guide the progression of loads during resistance training in older adults with frailty is another factor that may result in insufficient overload of muscles and consequently reduce the magnitude of physical adaptations (224). ...
Article
International Exercise Recommendations in Older Adults: Expert Concensus Guidelines
... In addition, targeting this loss of muscle function with PRT (without any aerobic exercise) has been shown to increase aerobic capacity by between 8-24% in older adults (58,109). Based on such evidence, aerobic interventions in frail older individuals have sometimes included endurance training within multi-component exercise programs (72,73,110,111). Thus, it may be necessary to strengthen the neuromuscular system, and improve balance, before initiating aerobic exercise to achieve adequate cardiovascular adaptations. ...
... Aerobic exercises for older adults may include walking with changes in pace and direction, (71,72) treadmill walking (73,111) step-ups, stair climbing, and stationary cycling (73), dancing or aquatic exercise. The choice of modality should depend on individual preference, accessibility, cognitive and physical comorbidities, and specific musculoskeletal issues. ...
... Programs consisting of home-based exercise interventions, weight-bearing exercises, or very low workloads are much less effective for achieving strength gains (111,222,223), or treating sarcopenia and its sequelae than higher intensity prescriptions. The use of subjective scales of perceived exertion instead of strength testing to guide the progression of loads during resistance training in older adults with frailty is another factor that may result in insufficient overload of muscles and consequently reduce the magnitude of physical adaptations (224). ...
Article
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The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
... Study design, sample size, and participant characteristics are reported in Table 1. We included 33 studies , of which 26 were RCT studies (31)(32)(33)(34)(35)(36)(37)39,40,42,(44)(45)(46)(47)(48)(50)(51)(52)54,55,57,58,(60)(61)(62)(63) and seven were quasiexperimental studies (38,41,43,49,53,56,59). We included data from 30 original research articles (31)(32)(33)(34)(35)(36)(37)39,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63) and three articles that were analyses of secondary outcomes (38,39,52). ...
... We included 33 studies , of which 26 were RCT studies (31)(32)(33)(34)(35)(36)(37)39,40,42,(44)(45)(46)(47)(48)(50)(51)(52)54,55,57,58,(60)(61)(62)(63) and seven were quasiexperimental studies (38,41,43,49,53,56,59). We included data from 30 original research articles (31)(32)(33)(34)(35)(36)(37)39,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63) and three articles that were analyses of secondary outcomes (38,39,52). A total of 4458 individuals (excluding counts from secondary outcomes articles) were studied. ...
... Nine of 33 studies included an active control group and reported cognition outcomes (32,34,39,40,47,55,56,58,63). Of these, one study indicated that MME was effective in improving measures of global cognitive function, executive functioning and memory (34), and another study reported improvements in measures of processing speed (47). ...
Article
The effects of multiple-modality exercise (MME) on brain health warrants further elucidation. Our objectives were to report and discuss the current evidence regarding the influence of MME on cognition and neuroimaging outcomes in older adults without dementia. We searched the literature for studies investigating the effects of MME on measures of cognition, brain structure, and function in individuals 55 years or older without dementia. We include 33 eligible studies. Our findings suggested that MME improved global cognition, executive functioning, processing speed, and memory. MME also improved white and gray matter and hippocampal volumes. These findings were evident largely when compared with no-treatment control groups but not when compared with active (e.g., health education) or competing treatment groups (e.g., cognitive training). MME may improve brain health in older adults without dementia; however, because of possible confounding factors, more research is warranted.
... [7][8][9] However, other studies have reported no differences in postural sway between active older adults participating in multicomponent exercise programs and inactive older adults. 10,23 Therefore, a relevant result of the present study was that older adults engaging in multicomponent exercise training offered through a public physical activity program in primary health care performed better than inactive older adults in different postural tasks, especially in those with higher levels of instability. Postural control assessment during tasks with different levels of instability was another important aspect of the study as it fills some gaps in the literature on the benefits of multicomponent exercise programs. ...
... 10,26 In addition, previous studies also showed no differences in muscle strength in older adults engaging in multicomponent exercise training. 23,27 The number of falls did not affect the variables related to COP or muscle function in the statistical model analyzed in this study. Falls have a multifactorial etiology, 18 but in this study, they were not associated with postural control or muscle function deficits. ...
Article
Full-text available
Objectives: This cross-sectional study aimed to investigate (1) postural control performance in different postural tasks and (2) muscle strength and power of the hip, knee, and ankle of active vs inactive older adults. Methods: The sample consisted of 61 healthy community-dwelling older adults, classified into 2 groups: active, consisting of participants of a multicomponent exercise program offered through the Exercise Orientation Service; and inactive. Participants were considered physically active/inactive in the past 3 months. Postural control was assessed using a force plate in 8 postural tasks. Muscle function was evaluated using an isokinetic dynamometer. T-tests were used to compare clinical characteristics between the groups. ANCOVA and MANCOVA were used to compare differences in variables of postural control and muscle function. Results: Active participants had higher levels of physical activity, clinical balance, and quality of life than inactive participants. The active group had lower values for area (center of pressure) than the inactive group under the following conditions: bipedal stance on an unstable surface with eyes open and with eyes closed, and semi-tandem stance on an unstable surface with eyes open. The active group showed greater muscle power, with higher mean power values for hip abduction and adduction, knee extension, and knee flexion and shorter time to peak torque for hip adduction and ankle dorsiflexion than the inactive group. Conclusions: Multicomponent exercise programs delivered in primary health care settings contributed to improving postural control and muscle power in this sample of older adults, which can potentially help prevent falls and improve quality of life.
... It is well documented in the literature that residing in a retirement village can improve well-being. Factors that contribute to well-being include community facilities, accessibility features and 24-hour emergency assistance [8], social contact [9,10], living independence [11] and organised group activity and exercise [12]. ...
... We substitute equations (14), (15) and (16) into (12) and (13): for t ≤τ, we have ...
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We consider the financial planning problem of a retiree wishing to enter a retirement village at a future uncertain date. The date of entry is determined by the retiree's utility and bequest maximisation problem within the context of uncertain future health states. In addition, the retiree must choose optimal consumption, investment, bequest and purchase of insurance products prior to her full annuitisation on entry to the retirement village. A hyperbolic absolute risk-aversion (HARA) utility function is used to allow necessary consumption for basic living and medical costs. The retirement village will typically require an initial deposit upon entry. This threshold wealth requirement leads to exercising the replication of an American put option at the uncertain stopping time. From our numerical results, active insurance and annuity markets are shown to be a critical aspect in retirement planning.
... Fourteen (21%) studies assessed gait speed, of which nine (64%) found an improvement through programs such as walking (Bossers et al., 2014;Gronstedt et al., 2013;Jirovec, 1991;Rolland et al., 2007) and active ball games Lazowski et al., 1999). Nine (14%) studies assessed with the 6MWT, of which five (56%) found an improvement of walking distance through interventions such as walking (Bossers et al., 2014;Ouyang et al., 2009;Sousa, & Mendes, 2013), dancing (Lord et al., 2003;Ouyang et al., 2009;Sousa, R., 2013) and active ball games (Ouyang et al., 2009). One study assessed a sit-to-stand activity (Slaughter et al., 2018), and found improvement in time to complete sit-to-stand and number of sit-to-stand within 30 seconds. ...
... For interventions that involved dancing, three (5%) studies reported a reduction in fall incidence (da Silva Borges et al., 2014;de Paula, 2014;Lord et al., 2003). ...
Article
Full-text available
The objective of this study was to explore and synthesize evidence on the effectiveness and implementation of recreational therapy programs to enhance mobility outcomes (e.g., balance, functional performance, fall incidence) for older adults in long-term care. The authors conducted a scoping review of 66 studies following the PRISMA guidelines. Two independent reviewers evaluated each article, and a third reviewer resolved discrepancies. Randomized controlled studies provided strong to moderate evidence that tai chi programs, walking, dancing, and ball games improve flexibility, functional mobility, and balance. Studies assessing program implementation highlighted that program delivery was facilitated by clear instruction, encouragement, attendance documentation, and minimal equipment. This review elucidated the benefit of recreational therapy programs on mobility. It also identified the need for customized programs based on individuals’ interests and their physical and mental abilities. These findings and recommendations will assist practitioners in designing effective and feasible recreational therapy programs for long-term care.
... Some randomized controlled exercise interventions aimed at preventing falls have had some effect (13)(14)(15) or none at all (16,17) (2 (2, , 3). Th There is u uppe pper e ex xtr tre em mit ity y w weakn i it t is s p possib ssible l th m marke k r f e g group oups s re re-n gro groups ups amon among g of of C CG G sub subjects jects b b wh lef le t kn knee ee increase increase respondi esponding ng in ncr c ea 2 2). ...
... Tai chi was performed in groups once a week, and participants were also encouraged to do tai chi exercises at home (15). Exercise interventions having no effect on muscle strength consisted either of resistance exercises for quadriceps among frail hospital discharged subjects three times per week for 10 weeks (16) or exercise classes including aerobic exercises, strengthening for lower extremities, activities for balance, coordination, and flexibility among 551 frail subjects twice a week for 12 months, with major emphasis on social interaction and enjoyment (17). In all intervention studies which were implemented among fall-prone male and female participants, no analyses were performed separately for men and women. ...
Article
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Background and aims: The aim of this study was to assess the effects of risk-based multifac-torial fall prevention program on maximal isometric strength in the community-dwelling aged. Methods: 591 subjects were randomized in two age groups (65-74 and ≥75 yrs), intervention group (IG) (n=293) and control group (CG) (n=298). A 12-month program consisted of individual geriatric assessment, individual guidance on fall prevention, home hazards assessment, physical exercises in groups, lectures, psychosocial activity groups, and home exercises. Strength was measured on an adjustable dynamometer chair. Results: Among women, the extension strength of the left knee increased by 7% in IG and 2% in CG (p=0.006), and that of the right knee by 7% and 4% (p=0.057), respectively. Subgroup analyses in the two age groups revealed a significant difference between groups among men aged 65-74 yrs, in favour of CG subjects, whose flexion strength of the left knee increased by 14% whereas the corresponding increase in IG was only 1% (p=0.042). Among women aged 65-74 yrs, the extension strength of right (increase of 8% in IG, 4% in CG) (p=0.046) and left knees (9% and 3%) (p=0.008) and flexion strength of right (10% and 4%) (p=0.042) and left knees (10% and 4%) (p=0.041) increased more in IG than in CG. Conclusions: The 12-month fall prevention program increased maximal isometric muscle strength among women only, especially those aged 65-74 years. We suggest that more intensive exercise , including the use of extra weights or resistance, is needed to increase muscle strength in men. (Aging Clin Exp Res 2008; 20: 487-493)
... Our results show that improved knee extension strength over 12 months among fall-prone aged women is associated with an improvement in managing in ADL and in self-perceived physical condition during the same period. Previous studies have shown significant improvements in older women in walking 400 meters or 6 minutes or in climbing stairs in many types of interventions (12,14,15,19,20). ...
... The increase in knee extensor strength among women over the 12-month period may be clinically significant, because quadriceps muscle strength is essential to perform functional activities successfully, such as rising from a chair (2,3,12) and walking (15,27). Quadriceps strength enhances the generation and control of momentum and maintenance of good dynamic balance, increasing safety and decreasing the risk of falls during tasks of daily living (34). ...
Article
Full-text available
Background and aims: The aim of this longitudinal study was to describe whether an increase in knee extension strength is associated with improvements in managing in activities of daily living (ADL) and in self-perceived physical condition in fall-prone community-dwelling older women. Methods: Subjects (n=417) aged ≥65 years belonged either to intervention or control groups in a 12-month randomized controlled fall prevention trial. Isometric muscle strength of knee extension was measured with an adjustable dynamometer chair. Managing in activities of daily living was measured with structured questions about abilities to climb stairs, walk at least 400 meters, toilet, bath, go to the sauna, do light or heavy housework, and carry heavy loads. A question of self-perceived physical condition was also asked. Results: Positive associations were found between increased knee extension strength and an increase in walking at least 400 meters (p<0.001), carrying heavy loads (p=0.004), and climbing stairs (p=0.007), and in self-perceived physical condition (p=0.005) over a 12-month follow-up. In addition, low age, non-use of a walking aid, low number of prescribed medications, and good functional balance at baseline were associated with an increase in performance of these ADL functions. Conclusions: An increase in knee extension strength during the 12-month follow-up was associated with improvement in some ADL functions and improvement in self-perceived physical condition during the same period in fall-prone community-dwelling women. (Aging Clin Exp Res 2011; 23: 42-48) © 2011, Editrice Kurtis INTRODUCTION Physical frailty and fall-related injuries are two of the greatest threats to the functioning and quality of life of older people. Reduction in skeletal muscle mass, which is associated with loss of strength and power, is a major factor leading to reduced functional performance and independence among the aged (1-4). Skeletal muscle strength, especially knee extensor strength, plays an important role in the performance of activities of daily living (ADL) (5, 6): for example, in dynamic stability, ability to control the center of gravity within and outside the base of support , during chair rise, walking, and recovery after tripping (7, 8). Aged women are at higher risk than aged men in reaching the threshold of muscle strength, when activities such as standing up from a chair and walking cannot be performed safely (9). Prospective studies (10-12) and a systematic review (13) indicate that muscle weakness may be a contributing factor in balance dysfunction and one of the most important risk factors of falls. Several earlier articles (14-17) indicated some positive effects of training interventions on physical functioning. The studies reported significant improvements in muscle strength and power, aerobic capacity, balance, mobility, flexibility, rate of falling, and functional performance and/or managing in ADL after training programs. However , some of the studies (16, 18-20) were relatively small, with fewer than 70 participants. Intervention periods were short (four months or less), and lasted over six months only in a few trials. Participants were relatively healthy, young-old persons in several studies (3, 18-20). The results of the randomized controlled, 12-month, risk-based multifactorial fall prevention trial implemented by our research team in 591 home-dwelling aged persons
... In many countries, measures to combat sarcopenia and frailty are becoming more important to prolong the period of time when people do not need assistance or care. Physical activity is one of the most important factors in the prevention of sarcopenia, and many researchers have found benefits from physical exercise in improving the functional capacity of frail older people [13][14][15][16][17][18]. Therefore, many researchers have been developing and publishing training methods that can be easily followed by older people. ...
Article
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The aging population is rapidly increasing worldwide. Sarcopenia is a common and important health problem among older people. The prevalence of sarcopenia among older Thai adults is increasing. Exercise intervention for sarcopenia prevention may significantly improve muscle strength, body balance, and muscle mass. Therefore, this study aimed to investigate the effects of a simple resistance intervention (SRI) program in preventing sarcopenia on physiological outcomes among community-dwelling older Thai adults. This study was a 12-week randomized controlled trial, which included 80 community-dwelling older adults in Chiang Mai, Thailand, who were randomly assigned into control (40 participants who performed usual exercise) and intervention (40 participants who performed the SRI program) groups. The SRI program was a home-based program consisting of 30 min of resistance exercise three times/week for 12 weeks, health education on sarcopenia. After 12 weeks, all physiological outcomes were measured and were significantly improved in the intervention group compared with baseline; hand grip, skeletal muscle mass index, and walking speed were significantly improved in the intervention group compared with the control group. Based on our results, the SRI program may prevent muscle weakness in community-dwelling older people in Thailand.
... Studies have shown that increased physical activity improves mobility and reduces the risk of injuries among older adults (Lord et al., 2003;VanSwearingen et al., 2011;Freiberger et al., 2012). There are also reports of improved Executive Cognitive Function (ECF) with physical activity (Verdelho et al., 2012;Gates et al., 2013). ...
Article
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Objective: Physical and cognitive impairments are common with aging and often coexist. Changes in the level of physical and mental activity are prognostic for adverse health events and falls. Dual-task (DT) training programs that can improve mobility and cognition simultaneously can bring significant improvements in rehabilitation. The objective of this mixed methods exploratory RCT was to provide evidence for the feasibility and therapeutic value of a novel game-assisted DT exercise program in older adults. Methods: Twenty-two community dwelling participants, between the ages of 70–85 were randomized to either dual-task treadmill walking (DT-TR) or dual-task recumbent bicycle (DT-RC). Both groups viewed a standard LED computer monitor and performed a range of cognitive game tasks while walking or cycling; made possible with the use of a “hands-free”, miniature, inertial-based computer mouse. Participants performed their respective 1-h DT exercise program twice a week, for 12 weeks at a community fitness centre. Semi-structured interviews and qualitative analysis was conducted to evaluate the participant’s experiences with the exercise program. Quantitative analysis included measures of standing balance, gait function (spatiotemporal gait variable), visuomotor and executive cognitive function, tested under single and DT walking conditions. Results: Compliance was 100% for all 22 participants. Four themes captured the range of participant’s experiences and opinions: 1) reasons for participation, 2) difficulties with using the technologies, 3) engagement with the computer games, and 4) positive effects of the program. Both groups showed significant improvements in standing balance performance, visuomotor and visuospatial executive function. However, significant improvement in dual task gait function was observed only in the DT-TR group. Medium to large effect sizes were observed for most balance, spatiotemporal gait variables, and cognitive performance measure. Conclusion: With only minor difficulties with the technology being reported, the findings demonstrate feasible trial procedures and acceptable DT oriented training with a high compliance rate and positive outcomes. These findings support further research and development, and will direct the next phase of a full-scale RCT.
... We used coefficients from previous studies: overdispersion in the negative binomial regression model was assumed to be 0.65 based on a previous trial. 23 We assumed: a control group rate of falls of 0.06 per personmonth over the follow-up period, as this was the rate in a study of a similar population 24 ; a design effect of 1.09 with an ICC of 0.01; and withdrawal of six clusters. An average follow-up period of 11 months was used to account for loss to follow-up. ...
Article
Background This statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology. Objective To investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over. Methods The CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services. Analysis We will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.
... Our adherence rates were similar to those previously reported in other trials on exercise in frail older adults [46][47][48][49]. A 2011 systematic review by Theou and colleagues reported adherence to an exercise program in frail older adults ranged between 42% to 100% with a mean adherence rate of 84% [50]. ...
Article
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Background Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. Methods This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants’ and providers’ experience with MoveStrong, adaptations to the model based on participant’s and provider’s experience, and program fidelity. Results We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. Conclusions Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.
... Furthermore, participants consistently valued the video demonstrations of the exercises, relating them to traditional instructor-led group classes, suggesting that welldesigned programs can simulate the supervision aspect of group-based classes that supports long-term adherence to exercise programs. [31][32][33] Another factor that contributed positively to participants' experience of StandingTall was their self-perceived improvements in balance. Participants described an increased sense of confidence in daily activities, and a greater spatial awareness through continued participation. ...
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Background and purpose: With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall, a home-based fall prevention program delivered through a tablet computer. Methods: Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes. Results and discussion: Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the program characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior. Conclusion: This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.
... Telenius et al. (2015) show that a high intensity functional exercise program improved balance and muscle strength of patients with dementia placed in nursing home patients. Systematic reviews of the literature dedicated to interventions and randomized controlled trials (RCT) consisting in training activity aimed at improving health-related quality of life, physical fitness, and balance of institutionalized older people (Weening-Dijksterhuis et al., 2011;Van Malderen et al., 2013;Chang et al., 2004;Rimland et al. 2016) show that studies almost never include both objective measures such as falls (Campbell et al. 1997;Lord et al. 2003;Province et al. 1995;Alvarez et al., 2015;Jill, 2 2018;Cameron et al., 2012;Silva et al., 2013), and self-assessed quality of life measures (Chin et al., 2004;Schoenfelder and Rubenstein, 2004;Grönstedt et al., 2013;Park et al., 2014). Experiments rarely include residents with cognitive impairment, which limits the extrapolation of their results. ...
Article
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We explore the effects of adapted physical exercise programs in nursing homes, in which some residents suffer from dementia and/or physical limitations and others do not. We use data from 452 participants followed over 12 months in 32 retirement homes in four European countries. Using a difference-in-difference with individual random effects model, we show that the program had a significant impact on the number of falls and the self-declared health and health-related quality of life of residents (EQ-5D). The wide scope of this study, in terms of sites, countries, and measured outcomes, brings generality to previously existing evidence. A simple computation, in the case of France, suggests that such programs are highly cost-efficient.
... Exercise programs have positive effects on ADL (activities of daily living) and IADL (instrumental activities of daily living) when applied for frail older adults [35]. Exercises with low-to-moderate intensity improve muscle strength, endurance, and gait [36], reduce the risk for falling [37], and maintain the physical functions of frail older adults [38,39]. Even for the very frail elderly, balance exercise can improve static balance, while gait exercise can improve dynamic balance and gait functions [40]. ...
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We compared the physical function performances of community-dwelling and day care center older adults with and without regular physical activity (PA). A total of 163 Taiwanese older adults living in rural communities participated. PA habits and physical functional performances were assessed. The participants were divided into community-dwelling (CD) and senior day care (DC) center groups that were further classified into regular physical activity (RPA) and non-physical activity (NPA) subgroups. Comparison took place between subgroups. In the CD group, only the grip strength, pinch strength, and box and blocks test scored significantly better for the participants with regular PA. Muscle strength, flexibility, and three items of functional ability of participants with regular PA were significantly better in the DC group. An active lifestyle contributes to a good old-age life. The effective amount of PA and the reduction of sedentary time should be advocated to prevent frailty and disability in older adults.
... One NZ study, in 12 villages, specifically mentioned agreement and involvement of managers in participant recruitment. 20 Others were able to randomly sample a large number of residents, or contact all residents in a specific geographical location, 21 though the full methodology employed in these studies is unclear. One large Australian study mailed all members of the Retirement Village Residents Association of Victoria 22 though this does not guarantee representativeness. ...
Article
Objectives: Retirement villages are semi-closed communities, access usually being gained via village managers. This paper explores issues recruiting a representative resident cohort, as background to a study of residents, to acquire sociodemographic, health and disability data and trial an intervention designed to improve outcomes. Methods: We planned approaching all Auckland/Waitematā District villages and, via managers, contacting residents ('letter-drop'; 'door-knocks'). In 'small' villages (n ≤ 60 units), we planned contacting all residents, randomly selecting in 'larger' villages. We excluded those with doubtful or absent legal capacity. Results: We approached managers of 53 of 65 villages. Thirty-four permitted recruitment. Some prohibited 'letter-drops' and/or 'door-knocks'. Hence, we recruited volunteers (23 villages) via meetings, posters, newsletters and word-of-mouth, that is representative sampling obtained from 11/34 villages. We recruited 578 residents (median age = 82 years; 420 = female; 217:361 sampled:volunteers), finding differences in baseline parameters of sampled vs. volunteers. Conclusion: Due to organisational/managers' policy, and national legislation restrictions, our sample does not represent our intended population well. Researchers should investigate alternative data sources, for example electoral rolls and censuses.
... One of the strategies for preventing and managing these factors is to motivate older people to participate in regular physical activity programmes (Gerez et al., 2010). Maintenance or recovery of physical functionality in the elderly through certain exercise programmes (Carter et al., 2002;Herala et al., 2002;Jones & Rikli, 2000;Liu-Ambrose et al., 2005;Lord et al., 2003;Westerterp & Meijer, 2001), besides decreasing fall rate and its consequences (Boyle et al., 2007;Fuzhong et al., 2005;Mancini et al., 2005;Nelson et al., 2007), contributes to improving their quality of life (Rejeski & Mihalko, 2001). ...
Article
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Background: Fear of falling (FOF) is reportedly associated with reduced physical activity (PA) and quality of life (QoL), and may be more pervasive among older adults with mobility dysfunction, necessitating the use of assistive mobility devices (AMDs). Purpose: This study examined the level of FOF, QoL and PA in a sample of Nigerian community-dwelling older adults (aged 65 years and above) either using or not using AMDs. Methodology: This was a cross-sectional survey of 80 conveniently sampled older adults (46 males, 34 females; mean age =71.58±6.00 years) from Ngor-Okpala Local Government Area in Imo State. Participants comprised 34 participants (20 males, 14 females) with any AMD type (WAMDs) and 46 participants (23 males, 20 females) without any (WOAMDs). The Physical Activity Scale for the Elderly (PASE), the Modified Fall Efficacy Scale (MFES) and the Short form Health Survey (SF-36) Questionnaire were used for assessing PA, FOF, and QoL respectively. Data was analyzed using frequency counts and percentages, mean and standard deviation, chi-square and independent t-test at 0.05 level of significance. Results: FOF was significantly more common among WAMDs than WOAMDs (X² = 80.00, p<0.0001). The WOAMDs had significantly higher scores overall and in practically all PASE domains than the WAMDs except for job and outdoor gardening domains where the two groups had similar scores. The WAMDs had significantly lower scores overall and in all QoL domains compared to WOAMDs. (p< 0.05). Conclusion: This study found FOF to be associated with the use of AMDs as all WAMDs and none of WOAMDs had FOF. Older adults not using AMDs also have significantly better physical activity level and QoL than those using assistive mobility devices. Interventions targeted at remedying FOF among WAMDs may help increase their PA participation and QoL.
... Sample size calculations used a simulation approach in Stata 13 and coefficients from previous studies: alpha (a measure of over-dispersion in the negative binomial regression model) was assumed to be 0.65. 29 We assumed a control group rate of falls of 0.75 falls/person year over the 12-month follow-up as this was the fall rate in a large trial with similar recruitment methods. 30 The 0.70 value for IRR was chosen, as this was the size of effect on the fall rate from Tai Chi in a similar population. ...
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Introduction: Falls significantly reduce independence and quality of life in older age. Balance-specific exercise prevents falls in people aged 60+ years. Yoga is growing in popularity and can provide a high challenge to balance; however, the effect of yoga on falls has not been evaluated. This trial aims to establish the effect on falls of a yoga exercise programme compared with a yoga relaxation programme in community-dwellers aged 60+ years. Method and analysis: This randomised controlled trial will involve 560 community-dwelling people aged 60+ years. Participants will be randomised to either: (1) the Successful AGEing (SAGE) yoga exercise programme or (2) a yoga relaxation programme. Primary outcome is rate of falls in the 12 months post randomisation. Secondary outcomes include mental well-being, physical activity, health-related quality of life, balance self-confidence, physical function, pain, goal attainment and sleep quality at 12 months after randomisation. The number of falls per person-year will be analysed using negative binomial regression models to estimate between-group difference in fall rates. Generalised linear models will assess the effect of group allocation on the continuously scored secondary outcomes, adjusting for baseline scores. An economic analysis will compare the cost-effectiveness and cost-utility of the two yoga programmes. Ethics and dissemination: Protocol was approved by the Human Research Ethics Committee at The University of Sydney, Australia (approval 2019/604). Trial results will be disseminated via peer-reviewed articles, conference presentations, lay summaries. Trial registration number: The protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).
... A total of 30 clusters per group with 10 individuals in each cluster (ie, 600 participants) will provide 80% power to detect as significant, at the 5% two-sided level, a 33% lower rate of falls in intervention group participants than control participants (IRR=0.67). For this calculation, we used the PASS negative binomial package and coefficients from previous studies: overdispersion in the negative binomial regression model was assumed to be 0.65 based on a previous trial, 38 and the effect size from a meta-analysis of the Otago Exercise Programme. 39 We assumed: a control group rate of falls of 0.06 per person month over the follow-up period; a design effect of 1.09 with an ICC of 0.01; and withdrawal of 6 clusters. ...
Article
Introduction: Older Aboriginal people have a strong leadership role in their community including passing on knowledge and teachings around culture and connections to Country. Falls significantly affect older people and are a growing concern for older Aboriginal people and their families. Regular participation in balance and strength exercise has been shown to be efficacious in reducing falls. A pilot study developed in partnership with Aboriginal communities, the Ironbark: Standing Strong and Tall programme, demonstrated high community acceptability and feasibility, and gains in balance and strength in Aboriginal participants. This cluster randomised controlled trial will assess the effectiveness of the programme in reducing the rate of falls in older Aboriginal people. Methods: We will examine the effectiveness and cost-effectiveness of the Ironbark group-based fall prevention programme compared with a group-based social programme, with Aboriginal people aged 45 years and older in three Australian states. The primary outcome is fall rates over 12 months, measured using weekly self-reported data. Secondary outcomes measured at baseline and after 12 months include quality of life, psychological distress, activities of daily living, physical activity, functional mobility and central obesity. Differences between study groups in the primary and secondary outcomes at 12 months will be estimated. Conclusion: This is the first trial to investigate the effectiveness and cost-effectiveness of a fall prevention programme for Aboriginal peoples aged ≥45 years. The study has strong cultural and community governance, including Aboriginal investigators and staff, and is guided by a steering committee that includes representatives of Aboriginal community-controlled services. Trial registration number: ACTRN12619000349145.
... [3] Düşme oranı erkeklerde (yılda kişi başına 2,8 düş-me) kadınlardan (yılda kişi başına 1,5 düşme) daha yüksektir. [12] Potansiyel olarak düşmeye neden olan 400'ün üzerinde risk etmeni vardır. Çeşitli kaynaklarda risk etmenlerinin farklı sınıflandırmaları olmasına karşın genelde içsel ve dışsal nedenler olarak iki grupta toplanırlar. ...
... (Fowkes, Rudan, Rudan, Aboyans, Denenberg, McDermott, & Criqui, 2013;Wilkinson, & Ahern, 2011;Suominen, Uurto, Saarinen, Venermo, & Salenius, 2010 (Steggal, 1966;Gisolf, 2005). Muscle pump adalah suatu tehnik atau cara pompa muscular untuk menggerakan darah dan pembuluh darah pada serangkaian tempat darah mengalir (tuba) sehingga aliran darah ke jantung dan seluruh tubuh menjadi lancar (Lord, Castell, Corcoran, Dayhew, Matters, Shan, & Williams, 2003;Ballaz, Fusco, Crétual, Langella, & Brissot, 2007;Takahashi, Hayano, Okada, Saitoh, & Kamiya, 2005). Perubahan gravitasi mempengaruhi distribusi cairan dalam tubuh. ...
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Effectiveness of Buerger Allen Exercise on lower limb circulation among patients with diabetes mellitusBackground: Buerger Allen Exercise is a specific exercise intended to improve circulation to the feet and leg using gravitational changes to influence the distribution of body fluids to alternately help emptying and fulfilling the blood columns, and by using muscle contraction through active movement of the ankle to improve circulation of peripheral blood vessel by driving blood and blood vessel. Ankle Brachial Index (ABI) is one of the indicators to assess changes in peripheral vascularization.Purpose: To know the effectiveness of Buerger Allen Exercise on lower limb circulation among patients with diabetes mellitusMethod: A quasi-experimental by pre- and post-test with controlled group, involving 28 participants divided by two group; interventional group and controlled group. The sampling technique is a non-probability sampling.Results: Shows by t-test and GLM-RM finds out that there are significant differences in the improvements of ABI average scores between interventional and controlled groups after Buerger Allen Exercise is conducted to the right leg with (p-value= 0.001; α = 0.05 ) and to the left leg with (p-value= 0.002; α = 0.05). While, GLM-RM in the research is still not able to determine the optimal point of time in practicing Buerger Allen Exercise.Conclusion: The effectiveness of Buerger Allen Exercise on lower limb circulation and suggestion that Buerger Allen Exercise can be applied as one of the nurse self-intervention to improve peripheral vascularization to patients with diabetes mellitusKeywords : Buerger Allen Exercise; Lower limb circulation; patients; diabetes mellitusPendahuluan: Buerger Allen Exercise adalah latihan khusus yang ditujukan untuk meningkatkan sirkulasi ke kaki dengan menggunakan perubahan gravitasi mempengaruhi distribusi cairan dalam tubuh dengan membantu secara bergantian untuk mengosongkan dan mengisi kolom darah, dan menggunakan kontraksi otot melalui gerakan aktif dari pergelangan kaki untuk meningkatkan sirkulasi pembuluh darah perifer dengan menggerakan darah dan pembuluh darah. Ankle Brachial Index (ABI) merupakan salah satu indikator untuk menilai perubahan vaskularisasi perifer.Tujuan: Untuk mengetahui pengaruh Buerger Allen Exercise terhadap sirkulasi ekstremitas bawah bagi penyandang diabetes melitusMetode : Menggunakan desain kuasi eksperimen pre post tes dengan kelompok kontrol, melibatkan 28 partisipan yang dibagi dalam dua kelompok; kelompok intervensi dan kelompok kontrol. Tehnik pengambilan sampel dengan non probability sampling. Penelitian ini menggunakan t-tes dan GLM-RM.Hasil : Uji t-tes didapatkan perbedaan yang signifikan rata-rata skor peningkatan ABI antara kelompok intervensi dan kontrol setelah dilakukan Buerger Allen Exercise pada kaki kanan dengan (p-value= 0,001; α = 0,05 ) dan pada kaki kiri dengan (p-value= 0,002; α = 0,05 ). Sedangkan dengan GLM-RM pada penelitian ini belum dapat menentukan titik optimum waktu pelaksanaan Buerger Allen Exercise.Simpulan: Adanya pengaruh Buerger Allen Exercise terhadap sirkulasi ekstremitas bawah dan disarankan agar Buerger Allen Exercise dapat diterapkan sebagai salah satu intervensi mandiri perawat dalam meningkatkan vaskularisasi perifer bagi penyandang diabetes melitus
... Randomized controlled exercise interventions to reduce falls and the risk factors for falling have been successful in improving the balance of aged people with high risk for falling (Barnett et al., 2003;Brouwer et al., 2003;Song et al., 2003;Nitz and Low Choy, 2004), while others have not (Rubenstein et al., 2000;Latham et al., 2003;Lord et al., 2003;Steadman et al., 2003). Only a few randomized controlled multifactorial fall prevention studies including assessment of the effects of the intervention on postural control have been conducted among the community-dwelling aged. ...
Thesis
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Intervención con ejercicio físico multicomponente sobre el adulto mayor frágil en la vida real (Real-Life intervention) Tesis Doctoral presentada por:
Article
Background: Slips, trips, and falls are the second leading cause of non-fatal injuries in workplace in the United States. A stage combat landing strategy is used in the theatre arts to reduce the risk of fall-induced injury, and may be a viable approach among some working populations. Objective: The goal of this study was to compare fall impact characteristics between experts in stage combat landing strategy and naïve participants after four training sessions of stage combat landing strategy training. Methods: Forward and backward falls from standing were induced by releasing participants from static leans. Participants fell onto a foam mat, and impact force was measured using force platforms under the mat. A statistical equivalence test was used to determine if impact characteristics between groups were similar. Results: Results indicated equivalence between groups in peak impact force during backward but not forward falls. Equivalence between groups in impact time suggested a mechanism by which equivalence in peak impact force as achieve. Conclusions: Four training sessions was sufficient for naïve participants to exhibit fall impact characteristics similar to experts in an anecdotally-effective landing strategy, and support further study. To our knowledge, this was the first study to investigate training for a landing strategy involving stepping after losses of balance from standing.
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Le vieillissement entraîne un déclin des capacités cognitives, motrices, et à réaliser deux tâches simultanément (doubles tâches). Ces altérations peuvent augmenter les risques de chutes, la perte d’autonomie, voire la dégradation de la qualité de vie. Dans ce contexte, nous savons que les entraînements en doubles tâches sont efficaces pour maintenir ces fonctions. Le passage par le jeu dans les programmes d’entraînement (exergames) permet de motiver les participants et de maintenir leur engagement. L’objectif de notre travail était de concevoir, développer et évaluer l’efficacité d’un exergame personnalisé reposant sur le concept de l’interférence cognitivo-motrice auprès de séniors. Après avoir mesuré l’intensité de la sollicitation physique de cet exergame, nous avons évalué son efficacité à court et moyen terme pour l’amélioration des capacités cognitives, motrices et de doubles tâches chez des personnes âgées. Nous avons également mesuré l’impact de cet entraînement sur le niveau d’activité physique, la motivation, la peur de tomber et la qualité de vie des participants. Enfin, nous avons étudié le niveau de sécurité et d’adhérence de ce jeu. Nous avons ainsi montré que notre exergame était fonctionnel, utilisable comme support d’entraînement, sûr et apprécié par tous ses utilisateurs (participants comme animateurs). Nous avons également montré que cet exergame d’intensité modérée entrainait une amélioration des fonctions cognitives et un maintien des fonctions motrices des séniors. Ce projet répond aux enjeux actuels de meilleure compréhension de l’efficacité des exergames personnalisés et ouvre de nouvelles perspectives sur cette thématique.
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Background Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. Methods We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2. Results Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented. Conclusion Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.
Article
Background: Frailty is common in older people and is characterised by decline across multiple body systems, causing decreased physiological reserve and increased vulnerability to adverse health outcomes. It is estimated that 21% of the community-dwelling population over 65 years are frail. Frailty is independently predictive of falls, worsening mobility, deteriorating functioning, impaired activities of daily living, and death. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) defines mobility as: changing and maintaining a body position, walking, and moving. Common interventions used to increase mobility include functional exercises, such as sit-to-stand, walking, or stepping practice. Objectives: To summarise the evidence for the benefits and safety of mobility training on overall functioning and mobility in frail older people living in the community. Search methods: We searched CENTRAL, MEDLINE, Embase, AMED, PEDro, US National Institutes of Health Ongoing Trials Register, and the World Health Organization International Clinical Trials Registry Platform (June 2021). Selection criteria: We included randomised controlled trials (RCTs) evaluating the effects of mobility training on mobility and function in frail people aged 65+ years living in the community. We defined community as those residing either at home or in places that do not provide rehabilitative services or residential health-related care, for example, retirement villages, sheltered housing, or hostels. DATA COLLECTION AND ANALYSIS: We undertook an 'umbrella' comparison of all types of mobility training versus control. Main results: This review included 12 RCTs, with 1317 participants, carried out in 9 countries. The median number of participants in the trials was 97. The mean age of the included participants was 82 years. The majority of trials had unclear or high risk of bias for one or more items. All trials compared mobility training with a control intervention (defined as one that is not thought to improve mobility, such as general health education, social visits, very gentle exercise, or "sham" exercise not expected to impact on mobility). High-certainty evidence showed that mobility training improves the level of mobility upon completion of the intervention period. The mean mobility score was 4.69 in the control group, and with mobility training, this score improved by 1.00 point (95% confidence interval (CI) 0.51 to 1.51) on the Short Physical Performance Battery (on a scale of 0 to 12; higher scores indicate better mobility levels) (12 studies, 1151 participants). This is a clinically significant change (minimum clinically important difference: 0.5 points; absolute improvement of 8% (4% higher to 13% higher); number needed to treat for an additional beneficial outcome (NNTB) 5 (95% CI 3.00 to 9.00)). This benefit was maintained at six months post-intervention. Moderate-certainty evidence (downgraded for inconsistency) showed that mobility training likely improves the level of functioning upon completion of the intervention. The mean function score was 86.1 in the control group, and with mobility training, this score improved by 8.58 points (95% CI 3.00 to 14.30) on the Barthel Index (on a scale of 0 to 100; higher scores indicate better functioning levels) (9 studies, 916 participants) (absolute improvement of 9% (3% higher to 14% higher)). This result did not reach clinical significance (9.8 points). This benefit did not appear to be maintained six months after the intervention. We are uncertain of the effect of mobility training on adverse events as we assessed the certainty of the evidence as very low (downgraded one level for imprecision and two levels for bias). The number of events was 771 per 1000 in the control group and 562 per 1000 in the group with mobility training (risk ratio (RR) 0.74, 95% CI 0.63 to 0.88; 2 studies, 225 participants) (absolute difference of 19% fewer (9% fewer to 26% fewer)). Mobility training may result in little to no difference in the number of people who are admitted to nursing care facilities at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased number of admissions to nursing care facilities (low-certainty evidence, downgraded for imprecision and bias). The number of events was 248 per 1000 in the control group and 208 per 1000 in the group with mobility training (RR 0.84, 95% CI 0.53 to 1.34; 1 study, 241 participants) (absolute difference of 4% fewer (8% more to 12% fewer)). Mobility training may result in little to no difference in the number of people who fall as the 95% confidence interval includes the possibility of both a reduced and increased number of fallers (low-certainty evidence, downgraded for imprecision and study design limitations). The number of events was 573 per 1000 in the control group and 584 per 1000 in the group with mobility training (RR 1.02, 95% CI 0.87 to 1.20; 2 studies, 425 participants) (absolute improvement of 1% (12% more to 7% fewer)). Mobility training probably results in little to no difference in the death rate at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased death rate (moderate-certainty evidence, downgraded for bias). The number of events was 51 per 1000 in the control group and 59 per 1000 in the group with mobility training (RR 1.16, 95% CI 0.64 to 2.10; 6 studies, 747 participants) (absolute improvement of 1% (6% more to 2% fewer)). Authors' conclusions: The data in the review supports the use of mobility training for improving mobility in a frail community-dwelling older population. High-certainty evidence shows that compared to control, mobility training improves the level of mobility, and moderate-certainty evidence shows it may improve the level of functioning in frail community-dwelling older people. There is moderate-certainty evidence that the improvement in mobility continues six months post-intervention. Mobility training may make little to no difference to the number of people who fall or are admitted to nursing care facilities, or to the death rate. We are unsure of the effect on adverse events as the certainty of evidence was very low.
Chapter
This chapter provides a rationale for using exercise and physical activity for health promotion and disease prevention and treatment in older adults. Physical inactivity is a key factor contributing to the onset of muscle mass and function decline, which in turn appears to be a vital contributant to frailty. The chapter discusses the exercise in terms of the specific modalities and doses that have been studied in randomised controlled trials for their role in the physiological changes of ageing, disease prevention, and treatment of older people with chronic disease and disability. It focuses on changes in functional capacity, physical fitness and body composition, quality of life, and disease burden, rather than on changes in longevity itself. There is a growing body of observational data and experimental evidence that physical activity can significantly influence a wide range of cognitive functions. The chapter offers recommendations to address gaps in knowledge and clinical implementation needs in this field.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Article
Objective: To determine the prevalence rates of frail, prefrail, robust and mobility disabled older adults living in retirement villages within regional Victoria, Australia. Methods: This cross-sectional, observational study invited residents of retirement villages to complete the self-report questionnaires Fried Frailty Phenotype and Frail Non-Disabled screening tool to classify respondents as frail, prefrail, robust and/or mobility disabled. Results: From 212 respondents, prevalence rates of frail and prefrail status were 34% and 35%, respectively. A fifth (20%) of residents were mobility disabled. The prevalence of residents classified as frail or prefrail (ie, not robust) was higher in women (74%) than in men (58%). Classification as not robust increased with increasing age. Conclusions: This study is the first to estimate prevalence rates of frailty and mobility disability in retirement village residents in regional Australia. Findings from this study have potential to inform the development of facilities and programs to support people living in this setting.
Article
Zusammenfassung Durch den demografischen Wandel wird die Anzahl von Pflegeheimbewohnern in der Zukunft weiter ansteigen. Die Heimbewohner weisen eine extrem niedrige körperliche Leistungsfähigkeit auf, welche durch gezielte bewegungstherapeutische Maßnahmen adressiert werden kann. Insbesondere die konditionellen Fähigkeiten sind auch bei Hochbetagten gut trainierbar. Für die Zukunft müssen die Pflegeheime dringend auf körperliches Training und Bewegungsförderungsmaßnahmen zurückgreifen.
Article
PURPOSE Frailty is a geriatric syndrome that impairs the health and quality of life of older adults. While unintended weight loss is known to be a primary risk factor for frailty, obesity has also been closely associated with frailty. Combined exercise is thought to be an effective way of resolving obesity and frailty, but studies demonstrating the effect of combined exercise on obese frailty are lacking. In this review, we seek to understand the relevant mechanisms by exploring prior studies on obese frailty, and provide the implications of appropriate combined exercise interventions for obese frailty. METHODS To collect data for this study, we used academic search systems such as Scopus, Google Scholar, PubMed, and Web of Science. The keywords used for the search were a combination of words such as ’obesity’, ‘frailty’, ‘combined or multicomponent exercise’, and ‘older or elderly adults’. RESULTS The results from the 16 selected articles confirmed that combined exercise reduces body weight, percentage of body fat, and risk of falls. Moreover, it improves muscle strength, balance, and walking function of the obese frail population. CONCLUSIONS As we have confirmed the positive outcomes on the combined exercise for obese frail older adults, an optimal exercise program needs to be presented. Older adults with obesity are recommended to exercise at least 2-3 times a week during the initial period. Further, they should begin with low-intensity walking, full-body exercise, balance, and flexibility exercises, then gradually increase the exercise volume. Moreover, to facilitate the positive outcomes of physical training and to encourage autonomy and enjoyment of exercise among obese frail older adults, a novel method and an individualized scientific exercise program need to be developed.
Article
Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65 years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.
Article
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Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality. The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication. There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
Article
Aim: To evaluate the effects of a single session of non-invasive brain stimulation (NIBS) on postural balance. Introduction: The NIBS has been used widely in improving balance. However, the effect of a single session of NIBS on balance in healthy individuals has not been systemically reviewed. Methods: A systematic literature review and best evidence synthesis were conducted, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, to determine the effects of different NIBS techniques on balance function in healthy individuals. The methodological quality of included articles was assessed by the risk of bias, and the Downs and Black tool. Data were analyzed by using the best evidence synthesis. Thirty-five articles were included that used the following NIBS techniques: anodal transcranial direct current stimulation (a-tDCS), cathodal transcranial direct current stimulation (c-tDCS), continuous theta burst stimulation (cTBS), and repetitive transcranial magnetic stimulation (rTMS) on primary motor cortex (M1), supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC), and cerebellum on balance. Results: Strong evidence showed that a-tDCS of M1, SMA improve balance in healthy participants, and the a-tDCS of DLPFC induces improvement only in dual task balance indices. Also, the findings indicate that cerebellar a-tDCS might significantly improve balance, if at least 10 min cerebellar a-tDCS with an intensity of ≥1 mA, over or maximum 1.5 cm below the inion, is used. Strong evidence showed that c-tDCS, cTBS, and rTMS are not effective on the balance. Conclusion: According to the results, the a-tDCS may be a useful technique to improve balance in healthy adults.
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Introduction : Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training (PBBT), a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule (i.e., contextual interference) on reactive balance function and its transfer to proactive balance function (i.e., voluntary step execution test and Berg balance test). Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior to the improvements following random PBBT. Methods and Analysis : This is a double-blind randomized controlled trial. Fifty community-dwelling older adults (over 70 years) will be recruited and randomly allocated to a random PBBT group ( n = 25) or a block PBBT group ( n = 25). The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups (random PBBT and block PBBT) will receive a similar perturbation intensity during training (which will be customized to participant’s abilities), the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance (ANCOVA) to allow for nonparametric analysis. Discussion : This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults (random PBBT vs. block PBBT) over 1 month. The research will address key issues concerning balance retraining: older adults’ neuromotor capacities to optimize training responses and their applicability to real-life challenges. Clinical Trial Registration : Helsinki research ethics approval has been received (Soroka Medical Center approval #0396-16-SOR; MOH_2018-07-22_003536; www.ClinicalTrials.gov , NCT04455607).
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To address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed. Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.
Chapter
Falls pose a major threat to the well-being and quality of life of older people. Over 90% of hip fractures result from a fall, and falls are the leading cause of injury-related hospitalization and death in people aged over 65 years. There is now robust evidence on fall risk factors and effective targeted intervention strategies to prevent falls in older people in a range of settings. This chapter provides a summary of fall risk assessment and fall prevention strategies for older people in community, hospital, and residential aged care facilities. Validated fall risk assessment tools can give a strong indication of a person’s risk of falling and can be incorporated into clinical practice. Effective interventions for reducing falls include exercise, multifactorial interventions, enhanced podiatry intervention, home safety occupational therapy interventions, medication review, expedited cataract extraction and daily or weekly vitamin D supplementation in people with low levels of vitamin D.
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This study evaluated the effect of PROMUFRA program on physical frailty, kinanthropometric, muscle function and functional performance variables in pre-frail, community-dwelling older people. Participants (n = 50, 75 ± 7 years) were randomly assigned to two groups: intervention group (IG), and control group (CG). The IG performed multi-component exercise program, focused on high-intensity resistance training (HIRT) combined with self-massage for myofascial release (SMMR) for 12 weeks (2 d.wk−1). Two measurements were performed, at baseline and post-3 months. Participants (n = 43) were analyzed and significant differences were found in group-time interaction for muscle mass (p = 0.017), fat mass (p = 0.003), skeletal muscle mass index (p = 0.011), maximum isometric knee extension (p = 0.042), maximum dynamic knee extension (p = 0.001), maximum leg press (p < 0.001), Barthel Index (p = 0.039) and EuroQol 5-dimensions-3-levels (p = 0.012). We conclude that PROMUFRA program is an effective training method to achieve healthy improvements for the pre-frail community.
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Objectives: ADVANTAGE Joint Action is a large collaborative project co-founded by the European Commission and its Member States to build a common understanding of frailty for Member States on which to base a common management approach for older people who are frail or at risk of developing frailty. One of the key objectives of the project is presented in this paper; how to manage frailty at the individual level. Methods: A systematic review of the literature was conducted, including grey literature and good practices when possible. Results: The management of frailty should be directed towards comprehensive and holistic treatment in multiple and related fields. Prevention requires a multifaceted approach addressing factors that have resonance across the individual's life course. Comprehensive geriatric assessment to diagnose the condition and plan a personalized multidomain treatment increases better outcomes. Multicomponent exercise programmes, adequate protein and vitamin D intake, when insufficient, and reduction in polypharmacy and inadequate prescription, are the most effective strategies found in the literature to manage frailty effectively. Conclusion: Frailty can be effectively prevented and managed with a multidomain intervention strategy based on comprehensive geriatric assessment.
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Frailty and falls are closely associated with each other as well as with disability, hospitalization, and death. Exercise can reduce these risks in both robust and frail older people. This before-after, non-randomized intervention study assessed a one-year proprioception training program with individual daily home exercises in 564 community-dwelling people aged 70 years and over, with different frailty phenotypes. After the exercise program, we observed a moderate reduction in the mean number of falls, fear of falls, body mass index and body fat percentage in frail and pre-frail participants. These results suggest that a home proprioception program may be a viable alternative to complex multicomponent exercise programs in settings where these are not feasible, since home proprioception can reach a larger population at a lower cost, and it affords clear benefits.
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Recreation and leisure are important at all stages of life. For many people, retirement provides greater free time as well as the ability to relocate to places known for their recreational opportunities. Moreover, advances in health care and changing cultural norms have removed many of the barriers that might otherwise limit the recreational choices of disabled or less active seniors. Although many retirees simply continue to participate in the leisure activities they are already familiar with, others modify their behavior in response to life course events. For example, retirement often brings greater opportunities for leisure, a new social role with new behavioral expectations, and changes in economic status that can either expand or limit the range of recreational options available. Retirement can also increase seniors' exposure to new kinds of leisure activities through changes in living arrangements, geographic mobility (especially in the case of migration to retirement communities), and participation in social networks that are based on age rather than occupational, economic, or cultural background. Another life course event, the onset of declining health or disability, can also influence leisure activity in a variety of ways. Many seniors take up new forms of exercise in order to maintain fitness or to lessen the impact of health problems, while others limit their activities in response to real, perceived, or expected declines in their physical capabilities (Marsiske et aI., 1997). Still others adjust their leisure activities in response to the death of a spouse (Patterson, 1996). The life course transitions associated with retirement and aging therefore pose both obstacles and opportunities where recreation and leisure are concerned.
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Background Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old). Objective To analyze the safety and effectiveness of long-term exercise interventions in older adults. Methods We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). Results Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95–1.17) or mortality (RR = 0.93, 95% CI 0.83–1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48–0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants’ baseline characteristics (age, physical function, and cognitive status) and exercise frequency. Conclusions Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.
Chapter
The prevention of osteoporotic fracture by exercise intervention requires a two-pronged approach, that is, the maximization of bone strength and the minimization of falls. Intense animal and human research activity over the last 30 years has generated a wealth of evidence that has led to a recommended exercise prescription for optimizing bone health. The incorporation of exercise as a fracture prevention strategy should commence before peak bone mass has been attained and continue throughout life, and can be enhanced by adequate calcium consumption. Osteogenic exercise follows certain training principles, including site specificity, requirement for overload, reversibility, and greatest efficacy in the weakest bones. The minimally effective exercise regime would consist of twice-weekly, high-intensity, weight-bearing impact loading, and resistance training; however, a precise optimum dose remains to be determined. Falls present a formidable risk to an osteoporotic skeleton; therefore, neuromuscular strength training and balance training strategies should be incorporated in exercise programs to minimize fracture risk, particularly in old age. Although trials with fractures as an outcome have been limited, there is a growing body of indirect evidence that supports exercise as a powerful strategy to reduce the incidence of osteoporotic fracture. While exercise appears to be a safe and effective fracture prevention approach, future work must identify strategies that promote the adoption and uptake of osteogenic exercise across the life span.
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Introduction There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults. Methods MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018. Results 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias. Conclusions The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.
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Cycle and treadmill exercise tests are unsuitable for elderly, frail and severely limited patients with heart failure and may not reflect capacity to undertake day-to-day activities. Walking tests have proved useful as measures of outcome for patients with chronic lung disease. To investigate the potential value of the 6-minute walk as an objective measure of exercise capacity in patients with chronic heart failure, the test was administered six times over 12 weeks to 18 patients with chronic heart failure and 25 with chronic lung disease. The subjects also underwent cycle ergometer testing, and their functional status was evaluated by means of conventional measures. The walking test proved highly acceptable to the patients, and stable, reproducible results were achieved after the first two walks. The results correlated with the conventional measures of functional status and exercise capacity. The authors conclude that the 6-minute walk is a useful measure of functional exercise capacity and a suitable measure of outcome for clinical trials in patients with chronic heart failure.
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To determine if short-term exercise reduces falls and fall-related injuries in the elderly. A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years. Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home. Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling. Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements. Time to each fall (fall-related injury) by self-report and/or medical records. Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome. Treatments including exercise for elderly adults reduce the risk of falls.
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Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors. We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.
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This study was undertaken to determine (a) whether a program of regular exercise can improve gait patterns in older women, and (b) whether any such improvement in gait is mediated by increased lower limb muscle strength. A 22-week randomized controlled trial of exercise was conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia. Subjects were 160 women aged 60-83 years (Mean age 71.1, SD = 5.2) who were randomly recruited from the community. Exercise and control subjects were tested prior to and at the end of the trial. At initial testing, exercisers and controls performed similarly in the strength and gait parameters. They were well matched in terms of age and a number of health and life-style characteristics. At the end of the trial, the exercise subjects showed improved strength in five lower limb muscle groups, increased walking speed, cadence, stride length, and shorter stride times as indicated by both reduced swing and stance duration. There were no significant improvements in any of the strength or gait parameters in the controls. Within the exercise group, increased cadence was associated with improved ankle dorsiflexion strength, and increased stride length was associated with improved hip extension strength. Exercise subjects with initial slow walking speed showed greater changes in velocity, stride length, cadence, and stance duration than those with initial fast walking speed. These findings show that exercise can increase gait velocity and related parameters in older persons, and that part of this increase may be mediated by improved lower limb muscle strength.
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The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults. The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization. The intervention was supervised exercise (1-h sessions, three per week, for 24-26 weeks), followed by self-supervised exercise. Exercise groups included strength training using weight machines (n = 25), endurance training using bicycles (n = 25), and strength and endurance training (n = 25). Study outcomes included gait tests, balance tests, physical health status measures, self-reported falls (up to 25 months of follow-up), and inpatient and outpatient use and costs. There were no effects of exercise on gait, balance, or physical health status. Exercise had a protective effect on risk of falling (relative hazard = .53, 95% CI = .30-.91). Between 7 and 18 months after randomization, control subjects had more outpatient clinic visits (p < .06) and were more likely to sustain hospital costs over $5000 (p < .05). Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults. In community-living adults with mainly mild impairments in gait, balance, and physical health status, short-term exercise may not have a restorative effect on these impairments.
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To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing falls and injuries in elderly women. Randomised controlled trial of an individually tailored programme of physical therapy in the home (exercise group, n = 116) compared with the usual care and an equal number of social visits (control group, n = 117). 17 general practices in Dunedin, New Zealand. Women aged 80 years and older living in the community and registered with a general practice in Dunedin. Number of falls and injuries related to falls and time between falls during one year of follow up; changes in muscle strength and balance measures after six months. After one year there were 152 falls in the control group and 88 falls in the exercise group. The mean (SD) rate of falls was lower in the exercise than the control group (0.87 (1.29) v 1.34 (1.93) falls per year respectively; difference 0.47; 95% confidence interval 0.04 to 0.90). The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 (0.52 to 0.90). The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 (0.39 to 0.97). After six months, balance had improved in the exercise group (difference between groups in change in balance score 0.43 (0.21 to 0.65). An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing falls and injuries in women 80 years and older.
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after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial. we aimed to assess the effectiveness of the programme over 2 years. women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. falls and compliance to the exercise programme were monitored for 2 years. 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49-0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42-0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group. falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period.
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To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme. Randomised controlled trial with one year's follow up. Community health service at a New Zealand hospital. 240 women and men aged 75 years and older. 121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial. Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls. Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (523 pound sterling) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered. A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.
Article
This guideline was developed and written under the auspices of the American Geritrics Society (AGS) Panel of Falls in Older Persons and approved by the AGS Board of Directors on April 5, 2001.
Article
OBJECTIVE: To determine if short-term exercise reduces falls and fall-related injuries in the elderly. DESIGN: A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years. SETTING: Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home. PARTICIPANTS: Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling. INTERVENTIONS: Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements. MAIN OUTCOME MEASURES: Time to each fall (fall-related injury) by self-report and/or medical records. RESULTS: Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome. CONCLUSIONS: Treatments including exercise for elderly adults reduce the risk of falls. Language: en
Article
Background: after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial. Objective: we aimed to assess the effectiveness of the programme over 2 years. Setting: 17 general practices in Dunedin, New Zealand. Subjects: women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. Methods: falls and compliance to the exercise programme were monitored for 2 years. Results: 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49‐0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42‐0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group. Conclusions: falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period.
Article
OBJECTIVE: To evaluate the effects of two exercise approaches, Tai Chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrence of falls).DESIGN: The Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques), a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education [ED]). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4-month follow-up. Falls were monitored continuously throughout the study.SETTING: Persons aged 70 and older living in the community.PARTICIPANTS: A total of 200 participants, 162 women and 38 men; mean age was 76.2.MEASUREMENTS: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional (IADL), and psychosocial well-being (CES-D scale, fear of falling questionnaire, self-perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables.RESULTS: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12-minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P = .046 and P = .058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%.CONCLUSIONS: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. Tai Chi warrants further study as an exercise treatment to improve the health of older people.
Article
Objectives: To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme. Design: Randomised controlled trial with one year's follow up. Setting: Community health service at a New Zealand hospital. Participants: 240 women and men aged 75 years and older. Intervention: 121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial. Main outcome measures: Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls. Results: Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (£523) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered. Conclusion: A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.
Article
General practice p 994 Older people frequently fall. This is a serious public health problem, with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different settings, with the aim of reducing the rate of falls and injurious falls in people over 65 (see boxes 2 3). Summary points Multifaceted interventions reduce falls in older people (those over 65) Home assessment of older people at risk of falls without referral or direct intervention is not recommended Assessment of high risk residents in nursing homes with relevant referral is effective Evidence from well designed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective Methods We updated two previous systematic reviews to include any new evidence up to March 1998. 4 5 We electronically searched Medline for all randomised controlled trials and systematic reviews by using the terms fall(s), accidental falls, fracture, elderly, aged, older, and senior. We followed up relevant references in papers, and we contacted researchers in prevention of falls for information about other trial evidence and about studies from journals not catalogued by the National Library of Medicine. For inclusion, studies had to be randomised controlled trials of interventions designed to minimise or prevent exposure to the risk factors for falling (or fracture) in people aged 65 years or over living in either community or residential care. Outcomes had to include the number of people who had fallen or the number of falls or fractures. We excluded drug or dietary treatments for the prevention of fractures. Trials that fulfilled the inclusion criteria were reviewed and summarised …
Article
This review has focused on a specific part of the relationship of exercise to health. The overall evidence supporting the health benefits of exercise is substantial and has been critically reviewed recently (18, 94). Thus, the United States Preventive Services Task Force recommends that all adults exercise regularly (94). The conclusions summarized below regarding older adults do not affect this basic recommendation. There is solid evidence that exercise can improve measures of fitness in older adults, particularly strength and aerobic capacity. These exercise effects occur in chronically ill adults, as well as in healthy adults. Because physical fitness is a determinant of functional status, it is logical to ask whether exercise can prevent or improve impairments in functional status in older adults. The evidence that exercise improves functional status is promising, but inconclusive. Problems with existing studies include a lack of randomized controlled trials, a lack of evidence that effects of exercise can be sustained over long periods of time, inadequate statistical power, and failure to target physically unfit individuals. Existing studies suggest that exercise may produce improvements in gait and balance. Arthritis patients may experience long-term functional status benefits from exercise, including improved mobility and decreased pain symptoms. Nonrandomized trials suggest exercise promotes bone mineral density and thereby decreases fracture risk. Recent studies have generally concluded that short-term exercise does not improve cognitive function. Yet the limited statistical power of these studies does not preclude what may be a modest, but functionally meaningful, effect of exercise on cognition. Future research, beyond correcting methodologic deficiencies in existing studies, should systematically study how functional status effects of exercise vary with the type, intensity, and duration of exercise. It should address issues in recruiting functionally impaired older adults into exercise studies, issues in promoting long-term adherence to exercise, and whether the currently low rate of exercise-related injuries in supervised classes can be sustained in more cost-effective interventions that require less supervision.
Article
To determine whether a 12-month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women. A randomized, controlled trial of 12 months duration. Conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia. One hundred ninety-seven women aged 60 to 85 years (mean age 71.6, SD = 5.4) who were randomly recruited from the community. Accidental falls, postural sway, reaction time, neuromuscular control, and lower limb muscle strength. Exercise and control subjects were tested before, midway through, and at the end of the trial. At initial testing, exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors. The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 (range 26-82). At the end of the trial, the exercise subjects showed improved performance in all five strength measures, in reaction time, neuromuscular control, body sway on a firm surface with the eyes open, and body sway on a compliant surface with the eyes open and closed. In contrast, there were no significant improvements in any of the test measures in the controls. In one test measure, hip flexion strength, the exercisers showed continued improvement throughout the study year. There was no significant difference in the proportion of fallers between the exercise and control subjects. Interesting trends were evident, however, between falls frequency and adherence to the exercise program. These findings show that exercise can produce long-term benefits with regard to improving sensorimotor function in older persons. The findings also suggest that high compliance to an exercise program may reduce falls frequency, although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls.
Article
Regular exercise has been recommended to improve balance, strength, and coordination in older persons. In this study, 44 persons, aged 50 to 75 years (mean 62.4 yrs) underwent assessments of quadriceps strength, reaction time, neuromuscular control, and body sway on two occasions before beginning a 10-week exercise program. The subjects were retested for the same measures at the end of the program. The mean number of classes attended for the 40 subjects who were retested was 16.2 (range 11 to 19). On completion of the program, the subjects showed improved performance in the tests of quadriceps strength, reaction time, body sway on a firm surface with the eyes closed, and a compliant surface with the eyes open and closed. In contrast, a group of nonexercisers showed no improvements in any of the test measures. These results suggest that exercise may play a role in improving a number of sensorimotor systems that contribute to stability in older persons.
Article
To determine whether a 12-month program of regular exercise can improve dynamic postural stability in older women. Randomized controlled trial of 12 months' duration. Conducted as part of the Randwick Falls and Fractures Study, in Sydney, Australia. One hundred and twelve community-dwelling women aged 60 to 85 years (mean age 71.2, SD = 5.4). Quantitative measures of dynamic postural stability: maximal balance range and coordinated stability. Exercise and control subjects were tested before, midway through, and at the end of the trial. The stability measures had good test-retest reliability, and test performances were significantly associated with measures of lower limb muscle strength, reaction time, neuromuscular control, and body sway. At initial testing, exercisers and controls performed similarly in the two stability measures. The mean number of classes attended for the 48 exercise subjects who completed the program was 58.4 (range 26-77). At the end of the trial, the exercise subjects showed significantly improved performance in both the maximal balance range and coordinated stability tests, with no improvement evident in the controls. Improvements in coordinated stability were associated with corresponding improvements in ankle dorsiflexion, hip extension, and hip flexion strength. These findings show that exercise can significantly improve dynamic postural stability in older persons and elucidate some possible mechanisms by which such improvements may be mediated.
Article
Recurrent events are common in medical research, yet the best ways to measure their occurrence remain controversial. Moreover, the correct statistical techniques to compare the occurrence of such events across populations or treatment groups are not widely known. In both observational studies and randomised clinical trials one natural and intuitive measure of occurrence is the event rate, defined as the number of events (possibly including multiple events per person) divided by the total person-years of experience. This is often a more relevant and clinically interpretable measure of disease burden in a population than considering only the first event that occurs. Appropriate statistical tests to compare such event rates among treatment groups or populations require the recognition that some individuals may be especially likely to experience recurrent events. Straightforward approaches are available to account for this tendency in crude and stratified analyses. Recently developed regression models can appropriately examine the association of several variables with rates of recurrent events.
Article
Falls in elderly people are a common presenting complaint to accident and emergency departments. Current practice commonly focuses on the injury, with little systematic assessment of the underlying cause, functional consequences, and possibilities for future prevention. We undertook a randomised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls. Eligible patients were aged 65 years and older, lived in the community, and presented to an accident and emergency department with a fall. Patients assigned to the intervention group (n=184) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated; those assigned to the control group (n=213) received usual care only. The analyses were by intention to treat. Follow-up data were collected every 4 months for 1 year. At 12-month follow-up, 77% of both groups remained in the study. The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group (p=0.0002). The risk of falling was significantly reduced in the intervention group (odds ratio 0.39 [95% CI 0.23-0.66]) as was the risk of recurrent falls (0.33 [0.16-0.68]). In addition, the odds of admission to hospital were lower in the intervention group (0.61 [0.35-1.05]) whereas the decline in Barthel score with time was greater in the control group (p<0.00001). The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment.
Article
To assess the methodological quality of intention to treat analysis as reported in randomised controlled trials in four large medical journals. Survey of all reports of randomised controlled trials published in 1997 in the BMJ, Lancet, JAMA, and New England Journal of Medicine. Methods of dealing with deviations from random allocation and missing data. 119 (48%) of the reports mentioned intention to treat analysis. Of these, 12 excluded any patients who did not start the allocated intervention and three did not analyse all randomised subjects as allocated. Five reports explicitly stated that there were no deviations from random allocation. The remaining 99 reports seemed to analyse according to random allocation, but only 34 of these explicitly stated this. 89 (75%) trials had some missing data on the primary outcome variable. The methods used to deal with this were generally inadequate, potentially leading to a biased treatment effect. 29 (24%) trials had more than 10% of responses missing for the primary outcome, the methods of handling the missing responses were similar in this subset. The intention to treat approach is often inadequately described and inadequately applied. Authors should explicitly describe the handling of deviations from randomised allocation and missing responses and discuss the potential effect of any missing response. Readers should critically assess the validity of reported intention to treat analyses.
Article
To determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls. A randomized controlled trial. Private dwellings in the community in Sydney, Australia. A total of 530 subjects (mean age 77 years), recruited primarily before discharge from selected hospital wards. A home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications. The primary study outcome was falls, ascertained over a 12-month follow-up period using a monthly falls calendar. Thirty six percent of subjects in the intervention group had at least one fall during follow-up, compared with 45% of controls (P = .050). The intervention was effective only among subjects (n = 206) who reported having had one or more falls during the year before recruitment into the study; in this group, the relative risk of at least one fall during follow-up was 0.64 (95% confidence interval, 0.50-0.83). Similar results were obtained when falls data were analyzed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a 12-month follow-up visit. Home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by occupational therapists may also lead to changes in behavior that enable older people to live more safely in both the home and the external environment.
Article
Fractures in the elderly often result from a simple fall. To assess the effects of programmes designed to reduce the incidence of falls in community dwelling, institutionalised, or hospitalised elderly people. We searched MEDLINE, EMBASE, CINAHL, PsycLIT, Social Science Citation Index, Dissertation Abstracts, Index to UK Theses, the Cochrane Register of Controlled Trials, and bibliographies of identified studies. We contacted known workers in the field. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: May 1997. Randomised trials of interventions designed to minimise the effect of, or prevent exposure to, any putative risk factor for falling in elderly individuals living in the community, in institutional care, or in hospital. The main outcomes of interest were number of fallers or falls, or the number sustaining a fall resulting in injury. Trials that focused on intermediate outcomes such as improved balance or did not report fall outcomes, were excluded. Two reviewers selected trials for inclusion. For each included trial, quality assessment and data extraction was carried out independently by two reviewers. Results of trials of similar design were pooled. Eighteen trials and one pre-planned meta-analysis were included. The analysis of four trials which studied the effect of exercise alone did not establish protection against falling (Peto odds ratio 1.05; 95% confidence interval 0.74 to 1.48). Based on one trial, there was no evidence to support exercise in conjunction with health education classes (Peto odds ratio 1.72; 95% confidence interval 0.78 to 3.75), or of health education classes alone (Peto odds ratio 1.25; 95% confidence interval 0.51 to 3.03) for the prevention of falls. However, significant protection against falling was apparent from interventions which targeted multiple, identified, risk factors in individual patients (Peto odds ratio 0.77; 95% confidence interval 0. 64 to 0.91), and from interventions which focused on behavioural interventions targeting environmental hazards plus other risk factors (Peto odds ratio 0.81; 95% confidence interval 0.71 to 0.93). Health care purchasers and providers contemplating fall prevention programmes should consider health screening of at risk elderly people, followed by interventions which are targeted at both intrinsic and environmental risk factors of individual patients. There is inadequate evidence for the effectiveness of single interventions such as exercise alone or health education classes for the prevention of falls.
Article
This study investigated the neuropsychological, sensorimotor, speed, and balance contributions to a new test of choice stepping reaction time (CSRT) and determined whether this new test is an important predictor of falls in older people. A total of 477 retirement-village residents aged 62 to 95 years (mean +/- SD, 79.2 +/- 6.2 years) took the CSRT test, which required them to step onto one of four panels that were illuminated in a random order. The subjects also took tests that measured neuropsychological, sensorimotor, speed, and balance function. Multiple regression analysis revealed that poor performance in Part B of the Trail Making Test (a neuropsychological test) and impaired quadriceps strength, simple reaction time, sway with eyes open on a compliant surface, and maximal balance range were the best predictors of increased CSRTs (multiple r(2) =.45). Subjects with a history of falls had significantly increased CSRTs compared with nonfallers (1322 +/- 331 milliseconds and 1168 +/- 203 milliseconds, respectively). Impaired CSRT was a significant and independent predictor of falls, as were two complementary sensory measures (visual contrast sensitivity and lower limb proprioception). Of these measures, CSRT was the most important in predicting falls. Furthermore, the inclusion of CSRT in the model excluded measures of strength, central processing speed, and balance, because these could not provide nonredundant information for the prediction of falls. This study identifies a new test that provides a composite measure of falls risk in older people and elucidates the relative importance of specific physiological and neuropsychological systems in the initiation of fast and appropriate step responses.
Article
To determine the extent to which physiologic, psychologic, and health-related factors predict 6-minute walk distance (6MWD) in older people. Cross-sectional study. Retirement villages. A total of 515 people between the ages of 62 and 95 years (mean +/- standard deviation, 79.5+/-6.4y) residing in retirement villages in Australia. Not applicable. Quantitative tests of vision, strength, peripheral sensation, reaction time, and balance and short Mini-Mental State Examination, Geriatric Depression Scale, Positive and Negative Affect Schedule (PANAS), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and 6MWD. All physiologic, psychologic, and health scores were significantly associated with 6MWD. Multiple regression analysis revealed that 10 factors (visual contrast sensitivity, lower-limb strength, simple reaction time, postural sway, maximal balance range, PANAS positive scale score, SF-36 pain score, number of medications used, SF-36 general health subscale score, age) were significant and independent predictors of 6MWD performance. Of these measures, strength, maximal balance range, medication use, and age explained the largest proportions of the variance in 6MWD. The final regression model explained over half (52.5%) of the variance in 6MWD (multiple r=.72). In older people, 6MWD depends on multiple physiologic, psychologic, and health factors. Thus, 6MWD appears to provide a measure of overall mobility and physical functioning in this population group rather than a specific measure of cardiovascular fitness.
Performance in the six-minute walk test depends on multiple physiological, psychological and health factors in older people
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Interventions for preventing falls in elderly people (Cochrane Review) In: The Cochrane Library
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Gillespie LD, Gillespie WJ, Robertson MC et al. Interventions for preventing falls in elderly people (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.
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