title: Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls.
abstract: OBJECTIVE
  To determine the safety and efficacy of an exercise protocol designed to improve strength, mobility, and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls.
  
  
  METHODS
  A randomized controlled 3-month intervention trial, with an additional 3-month follow-up.
  
  
  METHODS
  Out-patient geriatric rehabilitation unit.
  
  
  METHODS
  Fifty-seven female geriatric patients (mean age 82 +/- 4.8 years; range 75-90) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture.
  
  
  METHODS
  Ambulatory training of strength, functional performance, and balance 3 times per week for 3 months. Patients of the control group attended a placebo group 3 times a week for 3 months. Both groups received an identical physiotherapeutic treatment 2 times a week, in which strengthening and balance training were excluded.
  
  
  METHODS
  Strength, functional ability, motor function, psychological parameters, and fall rates were assessed by standardized protocols at the beginning (T1) and the end (T2) of intervention. Patients were followed up for 3 months after the intervention (T3).
  
  
  RESULTS
  No training-related medical problems occurred in the study group. Forty-five patients (79%) completed all assessments after the intervention and follow-up period. Adherence was excellent in both groups (intervention 85.4 +/- 27.8% vs control 84.2 +/- 29.3%). The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses. For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455-1.245).
  
  
  CONCLUSIONS
  Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail, high-risk geriatric patients with a history of injurious falls.
authors.affiliation: Bethanien Krankenhaus am Klinikum der Universität Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hauer
authors.forename: B
authors.initials: B
authors.lastname: Rost
authors.forename: K
authors.initials: K
authors.lastname: Rütschle
authors.forename: H
authors.initials: H
authors.lastname: Opitz
authors.forename: N
authors.initials: N
authors.lastname: Specht
authors.forename: P
authors.initials: P
authors.lastname: Bärtsch
authors.forename: P
authors.initials: P
authors.lastname: Oster
authors.forename: G
authors.initials: G
authors.lastname: Schlierf
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation*; D005684:Gait; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology; D005082:Physical Exertion; D004856:Postural Balance; D013997:Time Factors; D016138:Walking; D014947:Wounds and Injuries / Q000534:rehabilitation*