Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial

Abstract

Importance: Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.

Objective: To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall.

Design, setting, and participants: A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.

Interventions: Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months.

Main outcomes and measures: The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention.

Results: Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.

Conclusions and relevance: Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.

Trial registration: ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596.

Figure 1.. Participant Flow in a Trial of a Home-Based Exercise Program vs Usual Care for Secondary Fall Prevention

PPA indicates Physiological Profile Assessment; TUG, Timed Up and Go; SPPB, Short Physical Performance Battery.

Figure 2.. Accumulation of Falls and Cumulative Hazards of First and Second Falls by Treatment Group

A, Numbers below x-axis indicate participants who provided fall data. Overall, 10.5% of fall calendars (471/4472) were not returned. A total of 11 participants (3% of total randomized sample; 7 randomized to exercise and 4 randomized to usual care) did not provide any data related to falls after randomization. These participants dropped out within the first 2 months of the study. The estimated incidence rate of falls per person-year was 1.4 (95% CI, 0.1-2.0) in the exercise group and 2.1 (95% CI, 0.1-3.2) in the usual care group. The median total exposure was 365 (interquartile range [IQR], 365-365) days for both exercise and usual care. B, The median observation period from baseline to first fall was 173.5 (IQR, 58-365) days for the exercise group and 180.5 (IQR, 47.75-365) days for the usual care group. C, The median observation period after the first fall was 188 (IQR, 67-365) days for the exercise group and 161.5 (IQR, 52.5-365) days for the usual care group. In panels B and C, vertical lines on the curves indicate censored events.