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

Abstract

ABSTRACTinterventiOns 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 MeasuresSerious 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). COnClusiOnsIn 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.

Relating factors to severe injury from outdoor falls in older people

“…Gait, muscle strength, coordination and reaction velocity can be different depending on the degree of physical activity. Although the harmony of these elements can affect injury severity, we did not investigate these factors . Furthermore, some previous studies have shown that underlying disease and medicine are associated with the prognosis of fall injury .…”

Influência Do Hábito De Exercício Na Infância E Adolescência Na Flexibilidade De Adultos Sedentários

“…Valores muitos elevados, expressos por uma hipermobilidade, podem estar associados a uma maior predisposição a lesões musculares, tendíneas e articulares e a algumas outras doenças específicas do tecido conjuntivo ou a determinadas enfermidades clínicas 29 . Por outro lado, quando presente em valores reduzidos pode representar um risco maior de quedas nos idosos 14 , diminuindo assim a qualidade de vida dos mesmos e prejudicando a execução de atividades rotineiras, tal como sentar e levantar do solo 30 . Dessa forma, os resultados deste estudo sugerem que, em relação à flexibilidade corporal de adultos, parece ser conveniente a inclusão desse tipo de exercício nos programas de exercício físico para que possa ser otimizado esse componente não-aeróbico da aptidão física, aparentemente, independente do histórico de sua prática na juventude.…”

“…A flexibilidade corporal, um dos componentes não-aeróbicos da aptidão física, pode ser definida como a amplitude máxima passiva fisiológica de um dado movimento articular 9 e tende a diminuir com a idade em indivíduos dos dois sexos 10,11 . Diversos estudos têm indicado que uma baixa flexibilidade está associada à uma menor qualidade de vida 12 e a um risco mais alto de quedas em indivíduos mais velhos 13,14 . Embora seja plausível supor que o sedentarismo possa ser acompanhado de níveis menores de flexibilidade corporal é desconhecido se ter sido fisicamente ativo nos primeiros anos de vida poderia contribuir, minimizar ou eliminar essa tendência à redução com o envelhecimento.…”

Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial)

“…45 In subgroup analyses the authors observed that the hazard ratio for time to first serious fall injury did not differ significantly according to sex (interaction p = 0.14); however, a clinically meaningful qualitative difference was observed with a hazard ratio of 0.62 (95% CI 0.34 to 1.12) in men and of 1.05 (95% CI 0.72 to 1.52) in women. In an analysis that was not prespecified, we repeated the primary analysis in the subgroups of males and females and found similar treatment effects in each (men: IRR 0.87, 95% CI 0.64 to 1.17; women: 0.86, 95% CI 0.68 to 1.09).…”