The Effect of Group Exercise on Physical Functioning and Falls
The Effect of Group Exercise on Physical Functioning and Falls
Objectives: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people.
Design: Cluster randomized, controlled trial of 12 months duration.
Setting: Retirement villages in Sydney and Wollongong, Australia.
Participants: Five hundred fifty-one people aged 62 to 95 (mean±standard deviation=79.5±6.4) who were living in self- and intermediate-care retirement villages.
Measurements: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength.
Results: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4±28.7 for the GE subjects and 31.5±25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance.
Conclusion: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.
For several years now, it has been clear that exercise can modify key falls risk factors such as decreased muscle strength, reduced speed, and poor balance in older people, and there is now good evidence that exercise can reduce the incidence of falls themselves. Interestingly, the interventions shown to be effective have involved disparate exercise regimes, including tai chi, supervised strength and endurance training, and home exercise prescribed by a physiotherapist or specially trained nurse. Further evidence for exercise being an effective intervention comes from the Yale Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) study, which included a home exercise program as one of its multifaceted interventions. These interventions resulted in significantly lower falling rates in the intervention subjects and improvements in intermediate measures such as balance and transfer abilities.
However, not all exercise interventions have been found to be effective in preventing falls. For example, the meta-analysis of the seven FICSIT trials that involved exercise found that interventions that contained a balance component reduced falls significantly by about 17%. In contrast, programs classified as resistance, endurance, or flexibility training were not effective in reducing fall rates.
It has also been suggested that that some interventions have failed to be effective because the subjects were at too high or too low a risk of falling for the interventions implemented. The findings of the recent successful trials that have targeted their interventions carefully to those most likely to benefit (those with mild strength and balance deficits, women aged 80 and over, and those aged 70 and older with one or more falls risk factors) have supported this claim.
Previous studies have shown that a 12-month exercise program resulted in improved strength, coordination, standing and leaning balance, and walking speed in older community-dwelling women. The exercise program consisted of group activities that were designed to maximize enjoyment and social interaction, with the aim of facilitating long-term compliance. In spite of improvements in physical functioning, falling rates in the exercise group were similar to those observed in the control group. This may have been due to the untargeted nature of the program, in that the subjects who took part in the trial had relatively high physical performance levels and low falling rates.
This study builds on this work by assessing whether group exercises designed to improve the ability of subjects to undertake activities for daily living (ADLs) can prevent falls in a large sample of older people who are living in retirement villages a population group with high levels of functional impairments and risk of falling. It was hypothesized that a weight-bearing group exercise program would be more effective in reducing falls than a control program primarily of seated flexibility and relaxation activity or no exercise at all.
Objectives: To determine whether a 12-month program of group exercise can improve physical functioning and reduce the rate of falling in frail older people.
Design: Cluster randomized, controlled trial of 12 months duration.
Setting: Retirement villages in Sydney and Wollongong, Australia.
Participants: Five hundred fifty-one people aged 62 to 95 (mean±standard deviation=79.5±6.4) who were living in self- and intermediate-care retirement villages.
Measurements: Accidental falls, choice stepping reaction time, 6-minute walk distance postural sway, leaning balance, simple reaction time, and lower-limb muscle strength.
Results: Two hundred eighty subjects were randomized to the weight-bearing group exercise (GE) intervention that was designed to improve the ability of subjects to undertake activities for daily living. Subjects randomized to the control arm (n=271) attended flexibility and relaxation (FR) classes (n=90) or did not participate in a group activity (n=181). In spite of the reduced precision of cluster randomization, there were few differences in the baseline characteristics of the GE and combined control (CC) subjects, although the mean age of the GE group was higher than that of the CC group, and there were fewer men in the GE group. The mean number of classes attended was 39.4±28.7 for the GE subjects and 31.5±25.2 for the FR subjects. After adjusting for age and sex, there were 22% fewer falls during the trial in the GE group than in the CC group (incident rate ratio=0.78, 95% confidence interval (CI)=0.62-0.99), and 31% fewer falls in the 173 subjects who had fallen in the past year (incident rate ratio=0.69, 95% CI=0.48-0.99). At 6-month retest, the GE group performed significantly better than the CC group in tests of choice stepping reaction time, 6-minute walking distance, and simple reaction time requiring a hand press. The groups did not differ at retest in tests of strength, sway, or leaning balance.
Conclusion: These findings show that group exercise can prevent falls and maintain physical functioning in frail older people.
For several years now, it has been clear that exercise can modify key falls risk factors such as decreased muscle strength, reduced speed, and poor balance in older people, and there is now good evidence that exercise can reduce the incidence of falls themselves. Interestingly, the interventions shown to be effective have involved disparate exercise regimes, including tai chi, supervised strength and endurance training, and home exercise prescribed by a physiotherapist or specially trained nurse. Further evidence for exercise being an effective intervention comes from the Yale Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) study, which included a home exercise program as one of its multifaceted interventions. These interventions resulted in significantly lower falling rates in the intervention subjects and improvements in intermediate measures such as balance and transfer abilities.
However, not all exercise interventions have been found to be effective in preventing falls. For example, the meta-analysis of the seven FICSIT trials that involved exercise found that interventions that contained a balance component reduced falls significantly by about 17%. In contrast, programs classified as resistance, endurance, or flexibility training were not effective in reducing fall rates.
It has also been suggested that that some interventions have failed to be effective because the subjects were at too high or too low a risk of falling for the interventions implemented. The findings of the recent successful trials that have targeted their interventions carefully to those most likely to benefit (those with mild strength and balance deficits, women aged 80 and over, and those aged 70 and older with one or more falls risk factors) have supported this claim.
Previous studies have shown that a 12-month exercise program resulted in improved strength, coordination, standing and leaning balance, and walking speed in older community-dwelling women. The exercise program consisted of group activities that were designed to maximize enjoyment and social interaction, with the aim of facilitating long-term compliance. In spite of improvements in physical functioning, falling rates in the exercise group were similar to those observed in the control group. This may have been due to the untargeted nature of the program, in that the subjects who took part in the trial had relatively high physical performance levels and low falling rates.
This study builds on this work by assessing whether group exercises designed to improve the ability of subjects to undertake activities for daily living (ADLs) can prevent falls in a large sample of older people who are living in retirement villages a population group with high levels of functional impairments and risk of falling. It was hypothesized that a weight-bearing group exercise program would be more effective in reducing falls than a control program primarily of seated flexibility and relaxation activity or no exercise at all.
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