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Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a FallA Randomized Clinical Trial

Educational Objective
To learn whether an exercise strength and balance retraining program for older adults who have experienced a fall can prevent subsequent falls.
1 Credit CME
Key Points

Question  Does a home-based exercise program reduce falls among community-dwelling older adults who present to a fall prevention clinic after a fall?

Findings  In this randomized clinical trial that included 344 older adults receiving geriatrician-led care at a fall prevention clinic, a home-based strength and balance retraining exercise program significantly reduced subsequent falls compared with usual care only (1.4 vs 2.1 falls per person-year).

Meaning  These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.

Abstract

Importance  Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.

Objective  To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall.

Design, Setting, and Participants  A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.

Interventions  Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months.

Main Outcomes and Measures  The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention.

Results  Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.

Conclusions and Relevance  Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.

Trial Registration  ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Teresa Liu-Ambrose, PT, PhD, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada (teresa.ambrose@ubc.ca).

Correction: This article was corrected on July 9, 2019, for omitted conflict of interest disclosures.

Author Contributions: Dr Liu-Ambrose had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Liu-Ambrose, Davis, Dian, Cook, Khan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Liu-Ambrose, Davis, Best, Khan.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Davis, Best.

Obtained funding: Liu-Ambrose, Davis, Cook, Khan.

Administrative, technical, or material support: Liu-Ambrose, Davis, Dian, Madden, Cook, Hsu, Khan.

Supervision: Liu-Ambrose, Davis.

Conflict of Interest Disclosures: Dr Liu-Ambrose reported receiving research funding from the Canadian Institutes of Health Research, Alzheimer’s Society of Canada Research Program, Heart and Stroke Foundation of Canada, Michael Smith Foundation for Health Research, Jack Brown and Family Alzheimer Research Foundation Society Funding, Vancouver Foundation, Vancouver Coastal Health Research Institute, Canada Foundation for Innovation, BC Knowledge Development Fund, and Rosetta Stone Canada; being a cofounder of Synaptitude Brain Health Inc; and serving on the board of directors for the BC Brain Wellness Foundation Inc and the executive team of Synaptitude Brain Health Inc (she does not receive personal fees for these roles). Dr Davis reported receiving research funding from the Canadian Institutes of Health Research (British Columbia Support Unit: Health Economics and Simulation Methods Cluster) and Michael Smith Foundation for Health Research. Dr Madden reported receiving funding from the Canadian Institutes of Health Research, Canadian Diabetes Society, Heart and Stroke Foundation of Canada, Vancouver Coastal Health Research Foundation, Jack Bell Foundation, and Allan M. McGavin Foundation. Dr Khan reported receiving research funding from the Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, Canada Foundation for Innovation, and BC Knowledge Development Fund; serving as a consultant to the Vancouver Coastal Health Authority from 2006 to 2008; receiving book royalties from McGraw-Hill; and serving as scientific director of the Canadian Institutes of Health Research Institute of Musculoskeletal Health and editor in chief of the British Journal of Sports Medicine. No other disclosures were reported.

Funding/Support: This study was funded by the Canadian Institutes for Health Research (MOP-110954 and MAT-92025). Dr Liu-Ambrose is a Canada Research Chair (Tier 2) in Physical Activity, Mobility, and Cognitive Neuroscience, Department of Physical Therapy, University of British Columbia. Dr Madden is the Allan M. McGavin Chair in Geriatric Medicine, Department of Medicine, University of British Columbia.

Role of the Funder/Sponsor: The study funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Meeting Presentations: Findings of this clinical trial were reported as an oral presentation at the 2018 Canadian Association of Geriatrics meeting, Vancouver, British Columbia, on October 20, 2018, and as a poster presentation at the 2018 Alzheimer’s Association International Conference, San Francisco, California, on July 23, 2018.

Additional Contributions: We thank Meghan G. Donaldson, PhD, University of British Columbia, for her contribution to study concept and design. Dr Donaldson did not receive compensation for her role in the study. We thank the participants for their participation in this study.

Data Sharing Statement: See Supplement 3.

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