Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial

Objectives: To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects. Design: A 20-week, multicenter randomized controlled trial, with 52-week follow-up. Setting: Fifteen homes for the elderly. Participants: Two hundred seventy-eight men and women (mean age +/- standard deviation, 85 +/- 6y). Interventions: Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with I meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks. Main Outcome Measures: Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability). Results: Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the 113 (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR]=2.95; 95% confidence interval [CI], 1.64-5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased: this effect became significant after 11 weeks of training (HR=.39- 95% CI,.18-.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores. Conclusions: Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.