Wong R M Y, Chong K C, Law S W, Ho W T, Li J, Chui C S, Chow S K H, Cheung W H
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.
J Orthop Translat. 2020 Jun 1;24:58-65. doi: 10.1016/j.jot.2020.05.007. eCollection 2020 Sep.
To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies.
Literature search was conducted in Pubmed and Embase. Keywords used for literature search were "fracture" AND "fall" AND "exercise". Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures.
Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62-0.82; I = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49-0.83; I = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64-0.89; I = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35-0.83; I = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20-0.67; I = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58-1.09; I = 0%, p = 0.15).
Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men.
The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.
分析运动干预对社区居家老年人跌倒及跌倒相关骨折预防的有效性。
在Pubmed和Embase数据库进行文献检索。用于文献检索的关键词为“骨折”“跌倒”和“运动”。纳入以体育锻炼作为干预措施、年龄大于60岁的社区居家老年人的随机对照试验。进行系统评价和荟萃分析。主要结局指标为跌倒和骨折。
纳入12项研究，共4784名参与者，平均年龄75.4岁。最常见的运动干预是力量和平衡训练。11项研究的荟萃分析结果显示，运动干预对预防跌倒有有益作用（风险比RR = 0.71，95%可信区间CI，0.62 - 0.82；异质性I² = 24%，p < 0.0001）。与男性和女性参与者相比，运动干预应用于女性参与者时效果更好（RR = 0.64，95%CI，0.49 - 0.83；I² = 28%，p = 0.00009）（男性和女性参与者RR = 0.75，95%CI，0.64 - 0.89；I² = 24%，p = 0.001）。7项研究的荟萃分析结果显示，体育锻炼对预防骨折有显著作用（RR = 0.54，95%CI，0.35 - 0.83；I² = 25%，p = 0.005）。然而，仅对女性参与者进行运动干预时效果显著（RR = 0.37，95%CI，0.20 - 0.67；I² = 0%，p = 0.001），而对男女两性进行运动干预时效果不显著（RR = 0.80，95%CI，0.58 - 1.09；I² = 0%，p = 0.15）。
运动干预，尤其是力量和平衡训练相结合，对预防跌倒有效。抗阻运动和跳跃运动对社区居家老年人群预防骨折有效。运动干预对预防骨折的有效性对女性影响更显著。需要进一步研究来检验运动干预对男性的有效性。
可将有效运动或包括振动疗法在内的生物物理干预措施纳入骨折联络服务，以预防未来的跌倒和骨折。
