Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial.
OBJECTIVE
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.


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


METHODS
Fifteen homes for the elderly.


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


METHODS
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.


METHODS
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.
Faber
Marjan J
MJ
Faculty of Human Movement Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands.
Bosscher
Ruud J
RJ
Chin A Paw
Marijke J
MJ
van Wieringen
Piet C
PC
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D026302:Tai Ji; D016896:Treatment Outcome