Home-Based Exercises May Protect High-Risk Elderly Women From Hip Fractures

Laurie Barclay, MD

September 27, 2010

September 27, 2010 —Home-based exercises may protect high-risk elderly women from hip fractures, according to the results of a population-based, randomized controlled exercise trial reported in the September 27 issue of the Archives of Internal Medicine.

"Long-term evidence from randomized trials of the effectiveness of exercise in preventing disability and fall-related fractures in elderly people has been lacking," write Raija Korpelainen, PhD, from University of Oulo in Oulo, Finland, and colleagues. "Fall-related fractures are associated with long-term pain, functional impairment, and increased risks of institutionalization and death in elderly women. Hip fractures place the greatest demands on resources and have the greatest effect on patients because they are associated with high mortality rates and increased morbidity."

From April 1 through April 30, 2001, a total of 160 women aged 70 to 73 years with osteopenia were enrolled in a long-term follow-up extension of an exercise trial. Women in the exercise group had attended supervised balance, leg strength, and impact training sessions once a week for a 6-month period from October to March each year from 1998 to 2001.

Extended follow-up took place from May 1, 2001, through December 31, 2005, with mean total time in observation of 7.1 years. The main study endpoints were femoral neck bone mineral density, postural sway, and leg strength; secondary endpoints were hospital-treated fractures and measures of functional ability. Evaluators blinded to study group measured these endpoints each year.

The exercise group had significantly better outcomes than the control group in postural sway (group x time interaction, P = .005), walking speed (group x time interaction, P < .001), and Frenchay Activities Index score (group x time interaction, P = .001). However, both groups had similar decreases in bone mineral density across time.

During extended follow-up, women in the exercise group had an incidence rate of fractures 0.05 per 1000 person-years vs 0.08 per 1000 person-years among women in the control group (Poisson incidence rate ratio, 0.68; 95% confidence interval [CI], 0.34 - 1.32). None of the women in the exercise group had hip fractures vs 5 in the control group. There was 1 death in the exercise group and 8 deaths in the control group (Poisson incidence rate ratio, 0.11; 95% CI, 0.01 - 0.85).

"Mainly home-based exercises followed by voluntary home training seem to have a long-term effect on balance and gait and may even protect high-risk elderly women from hip fractures," the study authors write.

Limitations of this study include participation rate of approximately three quarters of originally eligible women, lack of generalizability to very ill or institutionalized elderly patients, and incomplete information on falls and physical activity during the postintervention period.

"Life-long physical activity was associated with reduced risk of fractures," the study authors conclude. "Furthermore, mortality was significantly lower in the exercise group than in the control group during the extended follow-up period. Regular daily physical activity should be recommended to elderly women with osteopenia."

The Finnish Ministry of Education, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Miina Sillanpää Foundation, the Research Foundation of Orion Corporation, and the Northern Ostrobothnia District Hospital supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:1548-1556.