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BMJ. 2016 Feb 3;352:i245. doi: 10.1136/bmj.i245.

Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study).

Collaborators (148)

Pahor M, Guralnik JM, Leeuwenburgh C, Caudle C, Crump L, Holmes L, Lee J, Lu CJ, Miller ME, Espeland MA, Ambrosius WT, Applegate W, Beavers DP, Byington RP, Cook D, Furberg CD, Harvin LN, Henkin L, Hepler J, Hsu FC, Lovato L, Roberson W, Rushing J, Rushing S, Stowe CL, Walkup MP, Hire D, Rejeski W, Katula JA, Brubaker PH, Mihalko SL, Jennings JM, Hadley EC, Romashkan S, Patel KV, Bonds D, McDermott MM, Spring B, Hauser J, Kerwin D, Domanchuk K, Graff R, Rego A, Church TS, Blair SN, Myers VH, Monce R, Britt NE, Harris MN, McGucken AP, Rodarte R, Millet HK, Tudor-Locke C, Butitta BP, Donatto SG, Cocreham SH, King AC, Castro CM, Haskell WL, Stafford RS, Pruitt LA, Berra K, Yank V, Fielding RA, Nelson ME, Folta SC, Phillips EM, Liu CK, McDavitt EC, Reid KF, Kim WS, Beard VE, Manini TM, Pahor M, Anton SD, Nayfield S, Buford TW, Marsiske M, Sandesara BD, Knaggs JD, Lorow MS, Marena WC, Korytov I, Morris HL, Fitch M, Singletary FF, Causer J, Radcliff KA, Newman AB, Studenski SA, Goodpaster BH, Glynn NW, Lopez O, Nadkarni NK, Williams K, Newman MA, Grove G, Bonk JT, Rush J, Kost P, Ives DG, Kritchevsky SB, Marsh AP, Brinkley TE, Demons JS, Sink KM, Kennedy K, Shertzer-Skinner R, Wrights A, Fries R, Barr D, Gill TM, Axtell RS, Kashaf SS, de Rekeneire N, McGloin JM, Wu KC, Shepard DM, Fennelly B, Iannone LP, Mautner R, Barnett TS, Halpin SN, Brennan MJ, Bugaj JA, Zenoni MA, Mignosa BM, Williamson J, Sink KM, Hendrie HC, Rapp SR, Verghese J, Woolard N, Espeland M, Jennings J, Pepine CJ, Ariet M, Handberg E, Deluca D, Hill J, Szady A, Chupp GL, Flynn GM, Gill TM, Hankinson JL, Fragoso CA, Groessl EJ, Kaplan RM.

Author information

1
Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT 06510, USA thomas.gill@yale.edu.
2
Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
3
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
4
Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
5
Departments of Health Research & Policy and Medicine, Stanford School of Medicine, Stanford, CA, USA.
6
Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA.
7
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
8
Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
9
Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT 06510, USA.
10
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Abstract

OBJECTIVE:

To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations.

DESIGN:

Multicenter, single blinded randomized trial (Lifestyle Interventions and Independence for Elders (LIFE) study).

SETTING:

Eight centers across the United States, February 2010 to December 2011.

PARTICIPANTS:

1635 sedentary adults aged 70-89 years with functional limitations, defined as a short physical performance battery score ≤ 9, but who were able to walk 400 m.

INTERVENTIONS:

A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises.

MAIN OUTCOME MEASURES:

Serious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis.

RESULTS:

Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction).

CONCLUSIONS:

In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men.Trial registration ClinicalsTrials.gov NCT01072500.

PMID:
26842425
PMCID:
PMC4772786
DOI:
10.1136/bmj.i245
[Indexed for MEDLINE]
Free PMC Article

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