title: Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011.
abstract: BACKGROUND
  Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care.
  
  
  METHODS
  A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes.
  
  
  RESULTS
  In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63-0.88) and intermittent (HR, 0.87; 95% CI, 0.8-0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90-0.97).
  
  
  CONCLUSIONS
  Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk.
authors.affiliation: University of North Carolina, Radiology, 130 Mason Farm Road, Room 3126, Chapel Hill, NC 27514. Email: mikgreen@umail.iu.edu. At the time of this study, Ms Greenwood-Hickman was affiliated with the University of Washington, Seattle, Washington, and Group Health Research Institute, Seattle, Washington.
authors.forename: Mikael Anne
authors.initials: MA
authors.lastname: Greenwood-Hickman
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Dori E
authors.initials: DE
authors.lastname: Rosenberg
authors.affiliation: Department of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, Washington.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phelan
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D057286:Electronic Health Records; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005260:Female; D020446:Fitness Centers / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006123:Group Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data* / Q000639:trends; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D014481:United States; D014861:Washington / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology / Q000628:therapy