Abstract

A 25-week randomized controlled trial was conducted to determine if strength and agility training could reduce the risk of falls in a group of elderly women with low bone mass. Participants exercised twice weekly and had their fall risk measured before, during and after the study period. Significant reductions of fall risk were seen in the resistance and agility training groups. These interventions can be implemented in the community to target high fall risk groups to prevent the devastating occurrence of falls. Background: Falls occurring in the elderly population can be a serious event, particularly those leading to hip fractures. A fall can lead to loss of independence, inability to complete important activities of daily living, and earlier institutionalization. Furthermore, mortality rates in the elderly are significantly higher after a hip fracture. Older women with osteoporosis have a higher risk of falling compared to women without osteoporosis because of decreased strength and balance. Research has shown that exercise might be an effective method to reduce the risk of falls in the elderly. This article describes a randomized controlled trial that compares two different methods of exercise versus a control group with the goal of reducing fall risk in a group of community-dwelling elderly women with low bone mass.

Methods: A group of community-dwelling women aged 75-85 with osteoporosis, osteopenia or low bone density mass were randomly assigned to three groups: 1) Resistance training (n = 34), 2) agility training (n = 36), and 3) control exercise group (n = 34). Resistance training involved the use of free weights to increase muscle strength. While agility training used exercises such as ball games, relay races, and dance moves to help improve hand-eye coordination and balance. The control exercise group participated in stretching routines, which have not been shown to reduce fall risk. Attendance of all classes was approximately 80% in all three groups. However, two participants in each group did withdraw from the study prior to mid-point assessment. Exercise sessions were held twice a week at a community centre and led by a certified fitness instructor. Fall risk was measured using a validated tool with a 75% predictive accuracy for falls. This tool generated a standardized score based on the measurement of postural sway, quadriceps strength, hand reaction time, proprioception (sensing of position and motion of the body), and edge contrast sensitivity (a test of vision). The fall risk score of each participant was measured at the beginning of the study, the mid-point and the conclusion of the study.

Findings: The mean age of the participants was 79.2 years old. Baseline characteristics such as age, height, weight, number of medications, mental status, physical activity, and bone mass were not different between the study groups. Physical activity outside of the twice-weekly exercise sessions increased equally in all three groups. Adverse events (AEs) in the resistance training group included musculoskeletal pain (sore back, neck, bursitis, etc.). All pain resolved within three weeks. AEs in the agility training group included shortness of breath which resolved after 5 minutes of rest, several missteps and falls. None of the AEs required a physician's attention. The fall risk scores were significantly reduced in the resistance and agility training groups as compared with the stretching group. This risk was reduced by 57.3% and 47.5% in the resistance and agility groups, respectively, but only 20.2% in the stretching group.

Conclusions: Agility and strength training are effective methods to reduce the risk of falls in elderly women with low bone mass. The largest reduction in fall risk was seen in the agility training group. However, this study has also demonstrated that some participants will experience adverse events such as soreness and falls during the exercise sessions. Agility training participants had the highest potential risk of falling. Greater staff supervision and more advanced planning were also required compared to the resistance training method. This study is useful because these exercise techniques can be conducted at local community centres by certified fitness instructors. These classes can be targeted towards elderly groups with increased fall risk to prevent the occurrence of a fall and the potentially devastating consequences.

Reference: Liu-Ambrose T., Khan K.M., Eng J.J., Janssen P.A., Lord S.R., and McKay H. "Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: A 6-month randomized, controlled trial'. Journal of the American Geriatric Society. 2004; 52:657-665.