@article{ref1,
title="Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial",
journal="JAMA journal of the American Medical Association",
year="2019",
author="Liu-Ambrose, Teresa and Davis, Jennifer C. and Best, John R. and Dian, Larry and Madden, Kenneth and Cook, Wendy and Hsu, Chun Liang and Khan, Karim M.",
volume="321",
number="21",
pages="2092-2100",
abstract="IMPORTANCE: Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. <br><br>OBJECTIVE: To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. <br><br>DESIGN, SETTING, AND PARTICIPANTS: A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic. INTERVENTIONS: Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. <br><br>MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. <br><br>RESULTS: Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported. <br><br>CONCLUSIONS AND RELEVANCE: Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596.<p /> <p>Language: en</p>",
language="en",
issn="0098-7484",
doi="10.1001/jama.2019.5795",
url="http://dx.doi.org/10.1001/jama.2019.5795"
}