THE EFFECTS OF EXERCISE ON FALLS IN ELDERLY PATIENTS - A PREPLANNED METAANALYSIS OF THE FICSIT TRIALS

Objective.-To determine if short-term exercise reduces falls and fall- related injuries in the elderly. Design.-A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention T echniques (FICSIT)-independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 week s. Fall and injury follow-up was obtained for up to 2 to 4 years. Sett ing.-Two nursing home and five community-dwelling (three health mainte nance organizations) sites. Six were group and center based; one was c onducted at home. Participants.-Numbers of participants ranged from 10 0 to 1323 per study. Subjects were mostly ambulatory and cognitively i ntact, with minimum ages of 60 to 75 years, although some studies requ ired additional deficits, such as functionally dependent in two or mor e activities of daily living, balance deficits or lower extremity weak ness, or high risk of falling. Interventions.-Exercise components vari ed across studies in character, duration, frequency, and intensity. Tr aining was performed in one area or more of endurance, flexibility, ba lance platform, Tai Chi (dynamic balance), and resistance. Several tre atment arms included additional nonexercise components, such as behavi oral components, medication changes, education, functional activity, o r nutritional supplements. Main Outcome Measures.-Time to each fall (f all-related injury) by self-report and/or medical records. Results.-Us ing the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treat ment arms including general exercise was 0.90 (95% confidence limits [ CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.7 0, 0.98). No exercise component was significant for injurious falls, b ut power was low to detect this outcome. Conclusions.-Treatments inclu ding exercise for elderly adults reduce the risk of falls.