A 2-Year Follow-Up After a 2-Year RCT with Vitamin D and Exercise: Effects on Falls, Injurious Falls and Physical Functioning Among Older Women

Abstract

BackgroundBoth exercise and vitamin D are recommended means to prevent falls among older adults, but their combined effects on fall-induced injuries are scarcely studied.MethodsA 2-year follow-up of a previous 2-year randomized controlled trial with vitamin D and exercise (Ex) of 409 older home-dwelling women using a factorial 2 × 2 design (D−Ex−, D+Ex−, D−Ex+, D+Ex+). Besides monthly fall diaries, femoral neck bone mineral density (fn-BMD), and physical functioning were assessed at 1 and 2 years after the intervention.ResultsAfter the intervention, S-25OHD concentrations declined to baseline levels in both supplement groups. The groups did not differ for change in fn-BMD or physical functioning, except for leg extensor muscle strength, which remained about 10% greater in the exercise groups compared with the reference group (D−Ex−). There were no between-group differences in the rate of all falls, but medically attended injurious falls reduced in D+Ex− and D−Ex+ groups compared with D−Ex−. However, all former treatment groups had less medically attended injured fallers, HRs (95% CI) being 0.62 (0.39–1.00) for D+Ex−, 0.46 (0.28–0.76) for D−Ex+, and 0.55 (0.34–0.88) for D+Ex+, compared with D−Ex−.ConclusionsExercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training. Although there was no difference in the rate of all falls, former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after the intervention. Vitamin D without exercise was associated with less injurious falls with no difference in physical functioning.

Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis

“…The present systematic review included in total 31 interventions (participants in total n = 4739), and their characteristics are summarized in Table 2 . Twenty-four interventions reported both the fall rate and fall risk while three interventions investigated the fall risk only [ 50 , 84 , 85 ] and four interventions reported only the fall rate [ 83 , 86 , 87 ]. The mean age of the included participants was 74.1 ± 4.3 years.…”

“… Trombetti et al [ 88 ] Yes Yes Yes Yes Yes Unclear The control group was a delayed intervention control group that started the same implemented intervention during the 6 months of follow-up. Uusi-Rasi et al [ 87 ] Yes Unclear Yes Yes Unclear Unclear Weerdesteyn et al [ 100 ] Yes Unclear Unclear Yes Yes Unclear Half of the intervention group was not randomly assigned. The follow-up started from the point of group assignment.…”

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

“…If a vitamin D deficiency or osteoporosis is diagnosed, supplementation with vitamin D and calcium should be considered. The relevance of vitamin D supplementation in fall and injury prevention is currently the subject of controversy in the scientific community, but the benefit of (moderate) vitamin D supplementation has been demonstrated in several recently published, randomized, controlled trials …”

“…The relevance of vitamin D supplementation in fall and injury prevention is currently the subject of controversy in the scientific community, but the benefit of (moderate) vitamin D supplementation has been demonstrated in several recently published, randomized, controlled trials. 24,25 Recent studies in which the effectiveness of fall prevention programs was assessed, revealed that interventions that cover multiple components are the most promising for preventing falls. 26 This is not surprising, as falls are a geriatric syndrome, and the causes for these are mostly multifactorial.…”

Does long-term recreational gymnastics prevent injurious falls in older women? A prospective 20-year follow-up

“…We have shown previously that exercise training can reduce the severity of falls [ 22]. This benefit was partly maintained after cessation of the exercise intervention, despite the fact that physical activity had returned to baseline and did not differ from the non-training counterparts anymore [23][24][25]. However, all exercise trials do not support a reduction in falls incidence [ 26,27].…”