December 31, 2018
A program of moderate-intensity exercise for 1 year or longer was associated with a "modest but significant" decrease in the risk for falls and falls leading to injury among elderly people, a review and meta-analysis found. Such programs were also associated with a potential decrease in fracture risk, the authors write.
The findings corroborate those of other meta-analyses showing a beneficial effect of exercise interventions of any length on fall-related outcomes in the elderly, they add. However, this study is the first to focus on long-term exercise, which may produce benefits that are similarly long term.
The benefits appeared to extend to patients with neurologic or cardiometabolic disorders and were not associated with any increased risk for mortality or hospitalization.
The study, which was conducted by Philipe de Souto Barreto, PhD, from the Institute of Aging, Toulouse University Hospital, France, and colleagues, was published online December 28 in JAMA Internal Medicine.
On the basis of these findings, "the best exercise regimen for protecting older people against diverse adverse events would be moderate-intensity, multicomponent training comprising balance exercises, performed 2 to 3 times per week; a session duration of 30 to 60 minutes (average of 50 minutes, according to studies on injurious falls analysis) should be safe and effective," the researchers explain.
Reduced Risk for Falls, Injuries
The investigators conducted a systematic review of 46 long-term randomized clinical trials (RCTs) with 22,709 participants. Of those studies, 40, with 21,868 people, were included in the meta-analysis. The studies lasted for at least 48 weeks and compared the effects of at least one exercise intervention against a comparator group consisting of no intervention or an attention or active control. Studies were restricted to those in which participants were at least 60 years old at baseline or that had a study population whose mean age was 60 years or more.
The exercise interventions were associated with a 12% reduction in the risk of falling (20 RCTs; 4420 participants; risk ratio [RR], 0.88; 95% confidence interval [CI], 0.80 - 0.98; P = .02). Similarly, the exercise interventions were associated with a 26% reduction in the risk for an injurious fall (nine RCTs; 4481 participants; RR, 0.74; 95% CI, 0.62 - 0.88; P = .001).
However, the authors add, "exercise was not effective in reducing the number of fractures (P = .054)." They also found no significant association between long-term exercise and risk for mortality, hospitalization, or experiencing multiple falls, which "may mean that mortality and hospitalizations are difficult-to-change outcomes, probably because they are determined by multidimensional parameters that may be beyond the scope of exercise-induced benefits."
Evidence Is 'Robust' and 'Consistent'
With this study, "we have sufficient, robust, and consistent evidence that exercise interventions prevent adverse events in older people, including falls, injurious falls, fractures, and mobility disability," Ryan R. Kraemer, MD, and C. Seth Landefeld, MD, from the Department of Medicine, University of Alabama at Birmingham, write in an invited commentary.
The findings also answer some questions raised by the Lifestyle Interventions and Independence for Elders study, which suggested that regular exercise helped older adults maintain mobility but also showed an association, albeit statistically nonsignificant, between exercise and an increased risk for hospitalization and mortality. This analysis helps put those concerns to rest.
"When it comes to long-term exercise for older adults," Kraemer and Landefeld conclude, "less is not always more: moderate intensity exercise 2 or 3 times weekly should be what the doctor orders."
The mean age of the study participants was 73.1 years; 66.3% were women. The mean intervention length was 17 months; the median was 12 months. Sixteen trials were restricted to patients who had received a specific clinical diagnosis, such as cardiovascular disease or dementia.
Most studies used exercise regimens with multiple components, such as aerobics plus strength or balance training. Most regimens were conducted in thrice-weekly sessions of approximately 50 minutes each, at moderate intensity. "Average compliance was about 65%," the authors write. "Comparator groups were often active controls, ranging from attention controls to more intensive interventions (eg, stent angioplasty)."
Review limitations include lack of information on exercise adherence in some of the studies; the arbitrary use of 1 year as the definition of "long-term" exercise; the risk for a type 1 error due to the use of several types of statistical analyses; and high heterogeneity among the groups of participants in the studies under review.
The original article lists the study authors' relevant financial relationships. Dr Kraemer and Dr Landefeld have disclosed no relevant financial relationships.
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SOURCE: Medscape, December 31, 2018. JAMA Intern Med. Published online December 28, 2018.