An extensive review of more than 100 randomized controlled trials (RCTs) strongly supports exercise interventions as a way to reduce both the risk of falls among adults 65 and older and the actual number of those who experience a fall. What’s less clear are some of the nuances of that finding—such as the effectiveness of resistance training or walking programs, and the differences between interventions provided by “health professionals” versus “trained providers who were not health professionals.”
The recently published Cochrane systematic review focused on 108 RCTs involving 23,407 community-dwelling adults in 25 countries. Participants were an average age of 76, and 77% were women. The majority of participants lived in the community, and RCTs that focused on participants with conditions that increased the risk of falls—Parkinson disease, stroke, multiple sclerosis, dementia, hip fracture, and severe visual impairment—were excluded.
The Cochrane reviewers analyzed various categories of exercise interventions versus control, which consisted of either no change in usual activities or an intervention not anticipated to reduce falls, such as health education, social visits, “gentle” exercises, or sham exercises. The exercise interventions were categorized as balance and functional; resistance; flexibility training; “3D” exercise including Tai Chi and Qigong; “3D” dance-based exercise; walking programs; endurance; “other”; and exercise interventions that included more than 1 of the studied categories.
Hip fracture is a major public health problem, associated with high morbidity and mortality, and high costs to the healthcare system. With the aging of populations worldwide, the socioeconomic burden of hip fracture is set to rise dramatically.
A new Australian study published in Archives of Osteoporosis, looks at the 12-month mortality of older persons presenting to hospitals in Australia with hip fracture. It is the first large population-based matched cohort study exploring excess mortality risk from hip fracture in the Australian population while accounting for pre-injury comorbid conditions.
The researchers linked hospital and mortality data from four Australian states. 9748 Individuals aged 65 years and older who had a hospital admission with a primary diagnosis of hip fracture in 2009 were matched 1:1 on age, sex, and postcode of residence with a cohort of non-injured individuals selected from the electoral roll. Adjusted mortality rate ratios and attributable risk percent were calculated, and Cox proportional hazard regression was used to examine the effect of risk factors on survival.
A study of nearly 36,000 men over a 24-year span has revealed that walking significantly contributes to prevention of hip fractures to an even greater extent than more strenuous activity. Researchers also found that “contrary to expectation,” sedentary behavior can serve a preventive role too—particularly when accompanied by 2 or more hours of walking per week.
In the study, e-published ahead of print in the American Journal of Public Health, researchers examined data from the Health Professionals Follow-up Study, a project that uses biennial questionnaires to track the health and lifestyle of about 51,000 men. Authors of the hip fracture study focused on reports of 35,996 men aged 50 to 75 from 1986 through 2010.