Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults

Abstract

IMPORTANCE Long-term exercise benefits on prevalent adverse events in older populations, such as falls, fractures, or hospitalizations, are not yet established or known. OBJECTIVE To systematically review and investigate the association of long-term exercise interventions (Ն1 year) with the risk of falls, injurious falls, multiple falls, fractures, hospitalization, and mortality in older adults. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, SportDiscus, PsychInfo, and Ageline were searched through March 2018. STUDY SELECTION Exercise randomized clinical trials (RCTs) with intervention length of 1 year or longer, performed among participants 60 years or older. DATA EXTRACTION AND SYNTHESIS Two raters independently screened articles, abstracted the data, and assessed the risk of bias. Data were combined with risk ratios (RRs) using DerSimonian and Laird's random-effects model (Mantel-Haenszel method). MAIN OUTCOMES AND MEASURES Six binary outcomes for the risk of falls, injurious falls, multiple falls (Ն2 falls), fractures, hospitalization, and mortality. RESULTS Forty-six studies (22 709 participants) were included in the review and 40 (21 868 participants) in the meta-analyses (mean [SD] age, 73.1 [7.1] years; 15 054 [66.3%] of participants were women). The most used exercise was a multicomponent training (eg, aerobic plus strength plus balance); mean frequency was 3 times per week, about 50 minutes per session, at a moderate intensity. Comparator groups were often active controls. Exercise significantly decreased the risk of falls (n = 20 RCTs; 4420 participants; RR, 0.88; 95% CI, 0.79-0.98) and injurious falls (9 RTCs; 4481 participants; RR, 0.74; 95% CI, 0.62-0.88), and tended to reduce the risk of fractures (19 RTCs; 8410 participants; RR, 0.84; 95% CI, 0.71-1.00; P = .05). Exercise did not significantly diminish the risk of multiple falls (13 RTCs; 3060 participants), hospitalization (12 RTCs; 5639 participants), and mortality (29 RTCs; 11 441 participants). Sensitivity analyses provided similar findings, except the fixed-effect meta-analysis for the risk of fracture, which showed a significant effect favoring exercisers (RR, 0.84; 95% CI, 0.70-1.00; P = .047). Meta-regressions on mortality and falls suggest that 2 to 3 times per week would be the optimal exercise frequency. CONCLUSIONS AND RELEVANCE Long-term exercise is associated with a reduction in falls, injurious falls, and probably fractures in older adults, including people with cardiometabolic and neurological diseases.

Effects of a 12-Month Supervised, Community-Based, Multimodal Exercise Program Followed by a 6-Month Research-to-Practice Transition on Bone Mineral Density, Trabecular Microarchitecture, and Physical Function in Older Adults: A Randomized Controlled Trial

“…Exercise is the only strategy that can improve multiple modifiable musculoskeletal fracture risk factors, but appropriate prescription and adherence is critical. Meta‐analyses and systematic reviews of exercise intervention trials have reported that well‐controlled, supervised, and structured programs involving multicomponent exercise training, incorporating moderate‐ to high‐intensity progressive resistance training (PRT) with short bouts of varied or diverse loading weight‐bearing impact activities and challenging balance and mobility exercises, can improve or maintain BMD and multiple fall‐related risk factors in older adults . However, several real‐world, translational studies examining the effects of exercise programs delivered to older people and those with osteoporosis in community settings have reported mixed findings on bone and muscle outcomes .…”

“…Meta-analyses and systematic reviews of exercise intervention trials have reported that well-controlled, supervised, and structured programs involving multicomponent exercise training, incorporating moderate-to high-intensity progressive resistance training (PRT) with short bouts of varied or diverse loading weight-bearing impact activities and challenging balance and mobility exercises, can improve or maintain BMD and multiple fall-related risk factors in older adults. (4)(5)(6) However, several realworld, translational studies examining the effects of exercise programs delivered to older people and those with osteoporosis in community settings have reported mixed findings on bone and muscle outcomes. (7,8) Thus, there remains a need for safe, effective, accessible, evidence-based exercise programs that can be widely adopted, implemented, and maintained in the community for people with or at increased risk for fractures.…”

Perspectives of inpatient neurological rehabilitation in elderly patients

“…-Physical therapy: Physical activity is beneficial for reducing overall morbidity and mortality in older adults (36). Exercise tended to decrease mortality risk in clinical populations (mostly people with cognitive decline or cardiac disease), which reinforces the role of exercise as a core therapeutic element for treating prevalent diseases in older people (37). Tolerance of cardiac muscle to effortinduced ischemia could be increased by using antioxidant and cardio-protective agents (38).…”

“…Dynamic balance training can involve slow movements in single stance, simple tai chi movements, tandem walking, turns while walking, walking backwards, walking over a virtual object (eg, a 15-cm stripe on the floor), slow forward lunges, and slow dance movements. Multicomponent balance training is probably most effective in improving balance (40) The best exercise regimen in older people would be moderate-intensity, multicomponent training comprising balance exercises (eg, balance, strength training for the lower limbs, and aerobic exercisewalking), performed 2 to 3 times per week, with 30 to 60 minutes (37).…”

Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis

“…However, recently there was a review and meta-analysis that showed exercise had a beneficial effect on reduction of fall-related fractures, with pooled estimates of RR 0.604, alongside improvements in leg strength 11 . Interestingly, one recent review of long term exercise (≥1 year) in older people has also found a significant reduction in fracture 12 . Bone mineral density (BMD) is weakly associated with fracture risk 13 , but combined with a history of falls, becomes important in terms of fracture prevention.…”