Jensen Jane, Nyberg Lars, Rosendahl Erik, Gustafson Yngve, Lundin-Olsson Lillemor
Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Sweden.
Aging Clin Exp Res. 2004 Aug;16(4):283-92. doi: 10.1007/BF03324553.
Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling.
187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering.
At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. No association was found between improved mobility and reduced risk of falling.
Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling.
行动能力受损是老年人跌倒的最强预测因素之一。我们假设，作为预防跌倒计划一部分的运动，对于居住在养老院、有不同认知水平且跌倒风险高的老年人的步态、平衡和力量，会在短期和长期都产生积极影响。第二个假设是，这些影响将与跌倒风险降低相关。
9家机构中年龄≥65岁且跌倒风险高的187名居民参与研究。这些机构被整群随机分为跌倒干预组或常规护理组。干预计划包括：教育、环境改善、个性化设计的运动、药物审查、跌倒后评估、辅助器具和髋部保护器。数据针对基线表现和聚类进行了调整。
在11周时，发现干预对独立行走能力（功能性活动分类，FAC，p=0.026）、最大步态速度（p=0.002）和步高（≥10厘米，p<0.001）有积极影响，但对伯格平衡量表无显著影响。在9个月（长期结果）时，3名干预组居民和15名对照组居民失去了行走能力（p=0.001）。干预组的独立行走能力和最大步态速度得以维持，而对照组则恶化（p=0.001）。认知水平较高和较低的居民在大多数结果指标上均受益。未发现行动能力改善与跌倒风险降低之间存在关联。
作为预防跌倒计划的一部分，运动似乎能保持行走能力、维持步态速度、实现独立行走并提高步高。认知障碍程度较低和较高的居民均从中受益，但未发现其与跌倒风险降低相关。
