After the Fall, Exercise Training Improves Quality of Life for Older Patients

TAIPEI, Taiwan, July 6 -- Older patients prone to falling can have significantly better lives if they undergo a structured exercise programs, found investigators here.

In a randomized study of patients who had recently fallen, exercise training with a focus on stretching, muscle strengthening, and balance training was better than either home modification or patient education at improving patient quality of life, reported Mau-Roung Lin, Ph.D., of Taipei Medical University, and colleagues.

Exercise training also improved objective measures such as functional reach and balance better than either of the other two types of interventions, but did not have a statistically significant effect on the occurrence rate of falls, the authors noted in the April issue of the Journal of the American Geriatrics Society.

They chose to focus on quality-of-life measures rather than harder endpoints in their study because of the effect that falls can have on the psyches of older patients, the investigators said.

"Because quality of life is a broad, multidimensional construct that includes at least such domains as physical, psychological, and social functioning, and because a fall-prevention program often affects fall risks as well as many other aspects of health in older patients, quality-of-life measures can provide a comprehensive health profile resulting from such programs," they wrote.

They conducted a four-month randomized trial comparing the three interventions among community-dwelling adults age 65 and older who had fallen at least once.

The education program consisted of 30- to- 40-minute home visits every two weeks, during which patients were given pamphlets on fall prevention, including stretching and strengthening exercises for the lower extremities, use of walking aids, and home improvements to reduce hazards.

The home assessment and modification program involved 30- to 40-minute home visits in which patients and families were instructed about fall risks, such as stair lighting, remediation of loose wires or carpeting, use of handrails, stable furniture, etc.

The exercise-training program consisted of individualized training with physical therapists, who helped patients with exercises aimed at improving the stability of muscles of the extremities and improve balance and functional reach.

Quality of life, the primary outcome, was as measured by the brief version of the World Health Organization Quality of Life instrument. Secondary outcomes included functional balance and gait according to functional reach, activities of daily living scores as assessed by the Older Americans Resources and Services questionnaire, fear of falling according to a visual analog scale, and depression level according to the Geriatric Depression Scale.

The authors found that patients in the exercise-training group had a score change of 2.1 patients greater than that of patients in the educational intervention group on the physical domain of the WHO quality of life instrument (95% confidence interval -1.2 to 5.3).

Exercise patients also had a 3.8 point greater change on the psychological domain of the WHO instrument (95% CI, 0.7 to 7.0), 3.4 points greater for the social domain (95% CI, 0.7 to 6.1) and 3.2 points greater on the environmental domain (95% CI, 0.6 to 5.7) compared with the education group.

Patients in the home assessment group had higher score changes on each of the WHO domains compared with the education group, but these differences were not statistically significant.

The exercise-training patients also had larger improvement in functional reach, balance and gait, and reported a greater decrease in their fear of falling than patients in the other groups.

There were no significant differences in the incidence of falls, however. The incidence over six months was 2.4 per 1,000 person-years in the education group, 1.1 in the home-assessment group, and 1.6 in the exercise training group.

"The quality-of-life outcome supported the superiority of exercise training over the other two interventions in older fallers and paralleled those more-objective functional measures," the authors concluded.

They noted that the study results may not be applicable to frail elderly patients who tended not to participate in the study, and that there may be cultural differences between Taiwanese patients and those from other cultures that may affect outcomes. In addition, the sample size was relatively small, and there were differences in response rates between the home assessment and education groups that may have resulted in overestimation of differences.