ABSTRACT. Faber MJ, Bosscher RJ, Chin A Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil 2006;87:885-96. Objectives:To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects.Design: A 20-week, multicenter randomized controlled trial, with 52-week follow-up.Setting: Fifteen homes for the elderly. Participants: Two hundred seventy-eight men and women (mean age Ϯ standard deviation, 85Ϯ6y).Interventions: Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks.Main Outcome Measures: Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability).Results: Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the IB (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR]ϭ2.95; 95% confidence interval [CI], 1.64Ϫ5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased; this effect became significant after 11 weeks of training (HRϭ.39; 95% CI, .18Ϫ.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores.Conclusions: Fall-preventive moderate intensity groupexercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.

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To increase the level of physical activity and to reduce the risk of musculoskeletal disorders, we support implementation of worksite physical activity programs. For the other outcome measures, scientific evidence of the effectiveness of such a program is still limited or inconclusive, which is mainly the result of the small number of high-quality trials. Therefore, we recommend performing more randomized, controlled trials of high methodological quality, taking into account criteria such as randomization, blinding, and compliance.

Background and Purpose. The Performance-Oriented Mobility Assessment (POMA) is a widely used instrument that provides an evaluation of balance and gait. It is used clinically to determine the mobility status of older adults or to evaluate changes over time. To support the use of the POMA for these purposes, the clinimetric properties (in particular, responsiveness) were determined. Subjects. Participants (78% female; mean age=84.9 years) were living in either self-care or nursing-care residences. Concurrent and discriminant validity were assessed with the total group (N=245), whereas reliability and responsiveness were determined with a subsample (n=30). Fall-related predictive validity was assessed with a subsample of 72 participants. Methods. In addition to the POMA, several reference performance tests were administered. The POMA was assessed on 2 consecutive days by 2 raters (observers). The analyses included the calculation of Spearman rank correlation coefficients (R), limits of agreement (LOA) with Bland-Altman plots, minimal detectable changes at the 95% confidence level (MDC95), and sensitivity and specificity with regard to predicting falls. When possible, findings for the total scale (POMA-T) were complemented by findings for its balance subscale (POMA-B) and its gait subscale (POMA-G). Results. The interrater and test-retest reliability for the POMA-T and the POMA-B were good (R=.74–.93), whereas for the POMA-G, the reliability values, although high as well, were systematically slightly lower (R=.72–.89). The Spearman correlations with the reference performance tests (R=|.64|–|.68|) indicated satisfactory concurrent validity for the POMA-T and the POMA-B, but the corresponding findings for the POMA-G (R=|.52|–|.56|) were less convincing. The discriminant validity values of the 3 scales were about the same. The LOA for the POMA-T were on the order of –4.0 to 4.0 for test-retest agreement and –3.0 to 3.0 for interrater agreement. On the basis of the MDC95 values, it was concluded that changes in POMA-T scores at the individual level should be at least 5 points and that those at the group level (n=30) should be at least 0.8 point to be considered reliable. Even when optimal cutoff points were used, sensitivity and specificity values (varying between 62.5% and 66.1%) for the POMA-T as well as for its 2 subscales indicated poor accuracy in predicting falls. Discussion and Conclusion. The POMA-T and its subscale POMA-B have adequate reliability and validity for assessing mobility in older adults. The POMA-T is useful for demonstrating intervention effects at the group level. Changes within subjects, however, should be at least 5 points before being interpreted as reliable changes. The accuracy of the POMA-T in predicting falls is poor.

Physical activity, and especially a regularly active lifestyle, may slow the decline in mobility performance. A beneficial effect was observed for sports and nonsports activities, independent of the presence of chronic disease.