Tamminen Anna-Erika, Honkanen Risto, Koivumaa-Honkanen Heli, Sirola Joonas, Sund Reijo, Kröger Heikki, Rikkonen Toni
Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.
Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland.
Sci Rep. 2025 Feb 19;15(1):6009. doi: 10.1038/s41598-025-88205-y.
Polypharmacy has previously been found to increase and exercise interventions to reduce the risk of falls and fall-related injuries. In this study, women who had four or more regular medications benefitted the most from the exercise intervention and had the lowest fall risk compared to the reference group. Fall injuries among older people cause significant health problems with high societal costs. Previously, some exercise interventions have been found to reduce the number of falls and related injuries. We studied how different levels of medication use affect the outcome of an exercise intervention in terms of preventing falls. This exercise RCT involved 914 women born in 1932-1945 and randomly assigned to the intervention (n = 457) and control (n = 457) groups. Both groups participated in functional tests three times during the study. Baseline self-reported prescription drug use was trichotomized: 0-1, 2-3, and ≥ 4 drugs/day (i.e. polypharmacy group). We used Poisson regression for follow-up fall risk and Kaplan-Meier survival analysis for fractures. During follow-up, 1380 falls were reported, 739 (53.6%) resulting in an injury and pain and 63 (4.6%) in a fracture. Women with polypharmacy in the intervention group had the lowest fall risk (IRR 0.713, 95% CI 0.586-0.866, p = 0.001) compared to the reference group that used 0-1 medications and did not receive the intervention. Overall, the number of medications associated with the fall incidence was only seen in the intervention group. However, the number of medications was not associated with fractures in either of the groups. Weaker functional test results were associated with polypharmacy in the control group. The most prominent decrease in fall risk with exercise intervention was seen among women with polypharmacy. Targeting these women might enhance fall prevention efficacy among the aging population.Trial Registration: The study has been registered in ClinicalTrials.gov. Trial registration number NCT02665169. Register date 27/01/2016.
此前发现，多重用药会增加跌倒风险，而运动干预可降低跌倒及跌倒相关损伤的风险。在本研究中，与参照组相比，服用四种或更多常规药物的女性从运动干预中获益最大，且跌倒风险最低。老年人的跌倒损伤会引发严重的健康问题，并带来高昂的社会成本。此前已发现一些运动干预可减少跌倒次数及相关损伤。我们研究了不同用药水平如何影响运动干预在预防跌倒方面的效果。这项运动随机对照试验纳入了914名出生于1932年至1945年的女性，她们被随机分配至干预组（n = 457）和对照组（n = 457）。在研究期间，两组均参加了三次功能测试。基线时自我报告的处方药使用情况被分为三类：每天0 - 1种、2 - 3种以及≥4种药物（即多重用药组）。我们使用泊松回归分析随访期间的跌倒风险，并使用Kaplan - Meier生存分析评估骨折情况。在随访期间，共报告了1380次跌倒，其中739次（53.6%）导致受伤和疼痛，63次（4.6%）导致骨折。与使用0 - 1种药物且未接受干预的参照组相比，干预组中多重用药的女性跌倒风险最低（风险比0.713，95%置信区间0.586 - 0.866，p = 0.001）。总体而言，仅在干预组中观察到用药数量与跌倒发生率相关。然而，两组中用药数量均与骨折无关。对照组中较弱的功能测试结果与多重用药有关。运动干预使多重用药女性的跌倒风险下降最为显著。针对这些女性可能会提高老年人群的跌倒预防效果。试验注册：该研究已在ClinicalTrials.gov注册。试验注册号NCT02665169。注册日期2016年1月27日。
