Kemmler Wolfgang, von Stengel Simon, Engelke Klaus, Häberle Lothar, Kalender Willi A
Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nuremberg, Henkestrasse 91, 91052 Erlangen, Germany.
Arch Intern Med. 2010 Jan 25;170(2):179-85. doi: 10.1001/archinternmed.2009.499.
Physical exercise affects many risk factors and diseases and therefore can play a vital role in general disease prevention and treatment of elderly individuals and may reduce costs. We sought to determine whether a single exercise program affects fracture risk (bone mineral density [BMD] and falls), coronary heart disease (CHD) risk factors, and health care costs in community-dwelling elderly women.
We conducted a randomized, single-blinded, controlled trial from May 1, 2005, through July 31, 2008, recruiting women 65 years or older who were living independently in the area of Erlangen-Nuremberg, Germany. In all, 246 women were randomly assigned to an 18-month exercise program (exercise group) or a wellness program (control group). The exercise group (n = 123) performed a multipurpose exercise program with special emphasis on exercise intensity; the controls (n = 123) focused on well-being with a low-intensity, low-frequency program. The main outcome measures were BMD, the number of falls, the Framingham-based 10-year CHD risk, and direct health care costs.
For the 227 women who completed the 18-month study, significant exercise effects were observed for BMD of the lumbar spine (mean [95% confidence interval (CI)] percentage of change in BMD [baseline to follow-up] for the exercise group: 1.77% [1.26% to 2.28%] vs controls: 0.33% [-0.24% to 0.91%]; P < .001), femoral neck (exercise group: 1.01% [0.37% to 1.65%] vs controls: -1.05% [-1.70% to -0.40%]; P < .001), and fall rate per person during 18 months (exercise group: 1.00 [0.76 to 1.24] vs controls: 1.66 [1.33 to 1.99]; P = .002). The 10-year CHD risk was significantly affected in both subgroups (absolute change for the exercise group: -1.96% [95% CI, -2.69% to -1.23%] vs controls: -1.15% [-1.69% to -0.62%]; P = .22), with no significant difference between the groups. The direct health care costs per participant during the 18-month intervention showed nonsignificant differences between the groups (exercise group: 2255 euros[95% CI, 1791 euros-2718 euros] vs controls: 2780 euros [2187 euros-3372 euros]; P = .20).
Compared with a general wellness program, our 18-month exercise program significantly improved BMD and fall risk, but not predicted CHD risk, in elderly women. This benefit occurred at no increase in direct costs.
clinicaltrials.gov Identifier: NCT00267839.
体育锻炼会影响多种风险因素和疾病，因此在老年人的总体疾病预防和治疗中可发挥重要作用，且可能降低成本。我们试图确定单一的锻炼计划是否会影响社区居住老年女性的骨折风险（骨密度[BMD]和跌倒情况）、冠心病（CHD）风险因素以及医疗保健成本。
我们于2005年5月1日至2008年7月31日进行了一项随机、单盲、对照试验，招募年龄在65岁及以上、独立生活在德国埃尔朗根 - 纽伦堡地区的女性。共有246名女性被随机分配到一个为期18个月的锻炼计划（锻炼组）或一个健康促进计划（对照组）。锻炼组（n = 123）进行了一个多用途锻炼计划，特别强调锻炼强度；对照组（n = 123）通过低强度、低频计划关注健康状况。主要结局指标为骨密度、跌倒次数、基于弗雷明汉模型的10年冠心病风险以及直接医疗保健成本。
对于完成18个月研究的227名女性，观察到锻炼对腰椎骨密度有显著影响（锻炼组骨密度[从基线到随访]变化的平均[95%置信区间（CI）]百分比：1.77%[1.26%至2.28%]，对照组：0.33%[-0.24%至0.91%]；P <.001），股骨颈（锻炼组：1.01%[0.37%至1.65%]，对照组： - 1.05%[-1.70%至 - 0.40%]；P <.001），以及18个月内每人的跌倒率（锻炼组：1.00[0.76至1.24]，对照组：1.66[1.33至1.99]；P =.002）。两个亚组的10年冠心病风险均受到显著影响（锻炼组的绝对变化： - 1.96%[95%CI， - 2.69%至 - 1.23%]，对照组： - 1.15%[-1.69%至 - 0.62%]；P =.22），两组之间无显著差异。18个月干预期间每位参与者的直接医疗保健成本在两组之间无显著差异（锻炼组：2255欧元[95%CI，1791欧元 - 2718欧元]，对照组：2780欧元[2187欧元 - 3372欧元]；P =.20）。
与一般的健康促进计划相比，我们为期18个月的锻炼计划在老年女性中显著改善了骨密度和跌倒风险，但未预测冠心病风险。这种益处并未伴随着直接成本的增加。
clinicaltrials.gov标识符：NCT00267839。
