Strength, balance training halves fall injuries in older women with previous falls

Strength and balance training exercises reduced by more than half the rate of injuries from falls in home-dwelling older women, while neither exercise nor vitamin D affected the rate of falls, a study found.

Researchers designed a 2-year randomized, double-blind, placebo-controlled trial of vitamin D and exercise between April 2010 and March 2013 in Finland. It enrolled 409 home-dwelling women ages 70 to 80 who had fallen at least once during the previous year. The women did not already use vitamin D supplements and had no contraindication to exercise. They were randomized to 4 study groups: placebo without exercise, vitamin D (800 IU/d) without exercise, placebo and exercise, and vitamin D (800 IU/d) and exercise.

Results appeared online March 23 at JAMA Internal Medicine.

Neither vitamin D nor exercise significantly reduced falls, the study reported. Fall rates per 100 person-years were 118.2 for placebo without exercise, 132.1 for vitamin D without exercise, 120.7 for placebo and exercise, and 113.1 for vitamin D and exercise.

Injurious fall rates per 100 person-years were 13.2 for placebo without exercise, 12.9 for vitamin without exercise, 6.5 for placebo and exercise, and 5.0 for vitamin D and exercise. Hazard ratios for injuries from falling were significantly lower among exercisers with vitamin D (HR, 0.38; 95% CI, 0.17 to 0.83) and without vitamin D (HR, 0.47; 95% CI, 0.23 to 0.99) compared to the nonexercise groups. Compared with the placebo without exercise group, normal walking speed was maintained in the placebo and exercise group (P=0.007). Backward walking improved significantly among exercisers.

The researchers noted that the exercise training was primarily intended to improve balance, muscle strength, and mobility rather than bone density, because limited physical capacity or comorbidities of participants were likely to restrict the intensity or type of loading needed to strengthen bone. During the intervention, femoral neck bone mass density declined in all groups, but the mean decline was greatest in the placebo without exercise group. The researchers noted that although the interventions (alone or in combination) could not increase femoral neck bone mass density, both reduced bone loss at this clinically relevant site.

The study was limited because milk in Finland is fortified with vitamin D and the study population was vitamin D replete. Although the exercise program was planned to be suitable and safe for women with musculoskeletal problems, it was challenging to reach and recruit the frailest women, and results cannot be generalized to frail and institutionalized women or men, the study authors noted.

“Given the fact that fall risk is multifactorial, exercise may be the most effective and feasible strategy for preventing injurious falls in community-dwelling older adults replete with vitamin D,” they concluded.