Province M A, Hadley E C, Hornbrook M C, Lipsitz L A, Miller J P, Mulrow C D, Ory M G, Sattin R W, Tinetti M E, Wolf S L
Division of Biostatistics, Washington University School of Medicine, St Louis, MO 63110, USA.
JAMA. 1995 May 3;273(17):1341-7.
To determine if short-term exercise reduces falls and fall-related injuries in the elderly.
A preplanned meta-analysis of the seven Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT)--independent, randomized, controlled clinical trials that assessed intervention efficacy in reducing falls and frailty in elderly patients. All included an exercise component for 10 to 36 weeks. Fall and injury follow-up was obtained for up to 2 to 4 years.
Two nursing home and five community-dwelling (three health maintenance organizations) sites. Six were group and center based; one was conducted at home.
Numbers of participants ranged from 100 to 1323 per study. Subjects were mostly ambulatory and cognitively intact, with minimum ages of 60 to 75 years, although some studies required additional deficits, such as functionally dependent in two or more activities of daily living, balance deficits or lower extremity weakness, or high risk of falling.
Exercise components varied across studies in character, duration, frequency, and intensity. Training was performed in one area or more of endurance, flexibility, balance platform, Tai Chi (dynamic balance), and resistance. Several treatment arms included additional nonexercise components, such as behavioral components, medication changes, education, functional activity, or nutritional supplements.
Time to each fall (fall-related injury) by self-report and/or medical records.
Using the Andersen-Gill extension of the Cox model that allows multiple fall outcomes per patient, the adjusted fall incidence ratio for treatment arms including general exercise was 0.90 (95% confidence limits [CL], 0.81, 0.99) and for those including balance was 0.83 (95% CL, 0.70, 0.98). No exercise component was significant for injurious falls, but power was low to detect this outcome.
Treatments including exercise for elderly adults reduce the risk of falls.
确定短期运动是否能减少老年人跌倒及与跌倒相关的损伤。
对七项衰弱与损伤：干预技术合作研究（FICSIT）进行预先计划的荟萃分析——这是独立的、随机的、对照临床试验，评估干预措施在减少老年患者跌倒和衰弱方面的疗效。所有试验都包含为期10至36周的运动成分。对跌倒和损伤的随访长达2至4年。
两家养老院和五个社区居住点（三个健康维护组织）。六个基于团体和中心；一个在家中进行。
每项研究的参与者人数从100至1323不等。受试者大多能独立行走且认知功能完好，最低年龄为60至75岁，不过一些研究要求有额外的缺陷，如在两项或更多日常生活活动中功能依赖、平衡缺陷或下肢无力，或跌倒风险高。
各研究的运动成分在性质、持续时间、频率和强度方面各不相同。训练在耐力、柔韧性、平衡平台、太极拳（动态平衡）和阻力等一个或多个领域进行。几个治疗组还包括额外的非运动成分，如行为成分、药物调整、教育、功能活动或营养补充剂。
通过自我报告和/或医疗记录得出每次跌倒（与跌倒相关损伤）的时间。
使用允许每位患者有多个跌倒结局的Cox模型的Andersen - Gill扩展，包括一般运动的治疗组调整后的跌倒发生率比为0.90（95%置信区间[CL]，0.81，0.99），包括平衡训练的治疗组为0.83（95% CL，0.70，0.98）。没有运动成分对有损伤的跌倒有显著影响，但检测该结局的效能较低。
包括运动在内的针对老年人的治疗可降低跌倒风险。
