步速改变居家锻炼对既往有跌倒史的老年人预防跌倒的效果：一项随机对照试验的二次分析

Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial.

作者信息

Rice Jordyn, Falck Ryan S, Davis Jennifer C, Hsu Chun L, Dian Larry, Madden Kenneth, Parmar Naaz, Cook Wendy L, Khan Karim M, Liu-Ambrose Teresa

机构信息

Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada.

Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.

出版信息

Phys Ther. 2025 Mar 3;105(3). doi: 10.1093/ptj/pzaf008.

DOI:10.1093/ptj/pzaf008

PMID:39879229

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11921415/

Abstract

OBJECTIVE

Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults.

METHODS

This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling.

RESULTS

At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI [confidence interval] = 0.33-0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38-1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed "Up & Go" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81-4.21).

CONCLUSION

Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.

IMPACT

Older adults with slow gait speed may be a target population for exercise-based fall prevention.

摘要

目的

运动是一种基于证据的预防跌倒策略。然而，其效果可能因个体特征（如步态速度）而异。本研究探讨了基线步态速度是否会改变居家运动对老年人后续跌倒的影响。

方法

这是一项对12个月的随机对照试验的二次分析，该试验对象为年龄≥70岁且在过去12个月内有过跌倒经历的社区居住成年人。参与者被随机分为接受12个月居家运动组（n = 172）或标准护理组（n = 172）。本研究使用负二项回归分析了按基线步态速度（慢[<0.80 m/s]或正常[≥0.80 m/s]）分层的6个月和12个月时干预对跌倒发生率的影响。使用线性混合模型将基线步态速度作为干预对运动能力和认知功能影响的潜在调节因素进行研究。

结果

在基线时，134名参与者步态速度慢（运动组 = 70；标准护理组 = 64），210名参与者步态速度正常（运动组 = 102；标准护理组 = 108）。对于步态速度慢的参与者，与标准护理相比，运动在6个月时使跌倒发生率降低了44%（发生率比 = 0.56；95%置信区间[CI] = 0.33 - 0.95），但在12个月时未降低（发生率比 = 0.63；95% CI = 0.38 - 1.03）；对于步态速度正常的参与者，运动在6个月或12个月时对跌倒发生率没有显著影响。步态速度改变了干预效果；在运动组中，步态速度慢的参与者在6个月时的定时起立行走测试中有显著改善（估计平均差异 = -4.05；95% CI = -6.82至 -1.27），在12个月时的数字符号替换测试中有显著改善（估计平均差异 = 2.51；95% CI = 0.81 - 4.21）。