title: Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults.
abstract: BACKGROUND
  In Japan, older adults are assessed by frailty checklist for care prevention. However, the effect of care prevention programs in community-dwelling frail older adults is still unclear.
  
  
  OBJECTIVE
  The purpose of this study was to investigate whether the care prevention program would reduce care and disability and to measure its cost-effectiveness in frail older adults.
  
  
  METHODS
  This is a prospective study using propensity score matching.
  
  
  METHODS
  A total of 610 community-dwelling older adults were recruited in 2 cities of Japan.
  
  
  METHODS
  Subjects in the exercise group (n = 305) attended physical exercise sessions once a week for 16 consecutive weeks. The exercise sessions were in a standardized format consisting of moderate-intensity aerobic exercise, progressive strength training, flexibility and balance exercises, and cool-down activities. The control group (n = 305) received only screening evaluation.
  
  
  METHODS
  Primary outcome was long term care insurance requirement certification during the 1-year follow-up period. Secondary outcome measurements were changes of frailty checklist, and care and medical cost.
  
  
  RESULTS
  Twenty-five subjects (8.1%) in the exercise group and 55 (18%) in the control group were newly certified for long-term care insurance service requirement in 1 year after the intervention (RR = 2.16, 95% CI = 1.46-3.20). Consequently, the health care cost for the subjects in the exercise group was significantly lower than in the control group (P < .001). Moreover, subjects in the exercise group had significant improvements in total scores of the frailty checklist compared with the control group that worsened after 1 year (exercise group: from 7.41 ± 3.98 to 7.11 ± 4.00, control group: from 7.34 ± 4.27 to 8.02 ± 4.81, F = 12.84, P < .001).
  
  
  CONCLUSIONS
  These results suggested that physical exercise is effective in preventing the progression of frailty and further disability in older adults living in the community. We could save heath care costs by our care prevention program.
authors.affiliation: Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. yamada@hs.med.kyoto-u.ac.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamada
authors.forename: Hidenori
authors.initials: H
authors.lastname: Arai
authors.forename: Takuya
authors.initials: T
authors.lastname: Sonoda
authors.forename: Tomoki
authors.initials: T
authors.lastname: Aoyama
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011322:Primary Prevention; D011446:Prospective Studies; D016896:Treatment Outcome