Original article
Effects of Exercise Programs on Falls and Mobility in Frail and Pre-Frail Older Adults: A Multicenter Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2006.04.005Get rights and content

Abstract

Faber MJ, Bosscher RJ, Chin A Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial.

Objectives

To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects.

Design

A 20-week, multicenter randomized controlled trial, with 52-week follow-up.

Setting

Fifteen homes for the elderly.

Participants

Two hundred seventy-eight men and women (mean age ± standard deviation, 85±6y).

Interventions

Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks.

Main Outcome Measures

Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability).

Results

Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the IB (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR]=2.95; 95% confidence interval [CI], 1.64−5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased; this effect became significant after 11 weeks of training (HR=.39; 95% CI, .18−.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores.

Conclusions

Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.

Section snippets

Design

The study was carried out in 15 long-term care centers in Amsterdam, the Netherlands, and its vicinity. In these centers, people live in self-care and in nursing care residences. In self-care residences, people live independently but have access to on-site nursing care, dining, and recreational facilities. In nursing care residences, people live less independently, with care up to full nursing care. We designed the study as a multicenter, randomized, single-blind, controlled trial, with 2

Participants

The mean age of the participants who entered the trial was 84.9 years (range, 63–98y); 188 (79.0%) were women. On average 64 minutes a day were spent on habitual physical activity, mainly in the form of light household work that accounted for 47 minutes of activity per day. The number of persons active in some form of sports-like activity was 150 (63.3%) and on average this accounted for 13 minutes of physical activity per day. Examples of frequently reported activities were walking,

Discussion

The FW and IB exercise programs were effective in reducing fall risk and improving the scores on the POMA and the physical performance score in the subgroup of pre-frail elderly. In this subgroup small, but significant, beneficial effects were found for the physical performance measures, whereas the effect on fall risk reduction was more pronounced. Fall risk was not reduced immediately after the start of the intervention, but positive effects became apparent after 11 weeks of exercise. In the

Conclusions

Elderly people can reduce their risk of falling by participating in moderate intensity group-exercise programs. However, this beneficial effect is limited to those who are not yet frail. For frail elderly, the currently evaluated exercise programs may even increase the risk of falling. We therefore recommend including group-exercise programs as part of a fall-preventive intervention for nonfrail and pre-frail elderly only. For frail elderly, safety-enhancing interventions such as the use of hip

Acknowledgments

We thank Anna Paauw and Lyda ter Hofstede for their efforts in collecting the data and Ton Duijvestijn and Aschwin Kolman for their contribution in developing the exercise programs. We also thank Klaas Faber for his critical reading of the manuscript.

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