Results Summary
What was the research about?
After older adults fall and fracture a bone, regular exercise can decrease the risk of falls and help prevent another bone fracture.
In this study, the research team compared two ways of reducing bone fractures from falls in adults ages 65 and older who had fallen and fractured a bone in the past:
- Exercise with coaching. Patients went to exercise classes for strength, balance, and walking. A trained volunteer led in-person group classes. Patients could also request to do classes at home with an exercise DVD. During the COVID-19 pandemic, in-person classes moved to a virtual format. A coach met with patients in person or by phone and encouraged them to exercise. Every six months, doctors received reports on the patients’ progress.
- Usual care plus information. Patients received a list of exercises and information about how to prevent falls.
What were the results?
After three years, patients who received exercise with coaching and patients who received usual care didn’t differ in:
- The risk of serious injury or bone fractures due to a fall
- Depression, loneliness, and anxiety
- Physical function
- Belief that they had a lower risk of falling
- Minutes of physical activity per week
Patients who received exercise with coaching reported more minutes of strength training per week than patients who received usual care (64 minutes versus 36 minutes).
Who was in the study?
The study included 1,139 older patients with a previous fall injury. All received care from one of three health systems in Pennsylvania. Among patients, 91 percent were White, and 9 percent were a race other than White. Also, 64 percent were between the ages of 65 and 75, and 84 percent were women.
What did the research team do?
The research team assigned patients by chance to receive exercise with coaching or usual care plus information.
Every four months for three years, the research team called patients to ask about falls. When a fall led to a healthcare visit, the team requested health records to confirm the severity of the fall. At the start of the study and every year, the team asked patients about depression, loneliness, anxiety, their risk of falling, and physical function.
Patients with a history of fall injuries, agencies on aging, and clinicians provided input throughout the study.
What were the limits of the study?
Trained peer volunteers led the exercise classes. Patients took part in fewer exercise classes toward the end of the study. Results may have differed if paid staff with a background in health or exercise led the classes or if patients took part in more classes.
Future research could look at other ways to encourage exercise among older adults who have fallen and fractured a bone in the past.
How can people use the results?
Organizations that serve older adults can use the results when considering ways to encourage exercise among older adults who have fallen and fractured a bone in the past.
Professional Abstract
Objective
To compare the effectiveness of exercise with coaching versus enhanced usual care in reducing serious fall-related injuries, including fragility fractures, among older adults with a prior fragility fracture
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 1,139 patients ages 65 and older with a history of a fragility fracture in the last 10 years |
| Interventions/ Comparators |
|
| Outcomes | Primary: serious fall-related injuries, including fragility fractures Secondary: depression, loneliness, anxiety, physical function, perceived risk of falls, weekly minutes of strength training, and weekly minutes of physical activity |
| Timeframe | 3-year follow-up for study outcomes |
This randomized controlled trial compared the effectiveness of exercise with coaching versus enhanced usual care in reducing the risk of serious fall-related injuries among older adults.
Researchers randomized patients to receive either exercise with coaching or enhanced usual care. In the exercise with coaching group, patients participated in sessions led by a trained peer volunteer that included exercises for strength, balance, and walking. Patients could participate in the exercise sessions in person or at home with an exercise DVD. The exercise sessions shifted to a virtual format for the latter half of the study due to the COVID-19 pandemic. Patients also received in-person or phone support from a coach who encouraged patients to exercise. Every six months, patients’ primary care providers received reports on the patients’ progress.
In the enhanced usual care group, patients received a list of recommended exercises and pamphlets with information about how to prevent falls.
The study included data from 1,139 older patients with a history of a fragility fracture from a fall. All received care from one of three health systems in Pennsylvania. Among patients, 91% were White, and 9% were a race other than White. Also, 64% were between the ages of 65 and 75, and 84% were female.
Researchers called patients every four months for three years to ask about falls. When patients reported a fall that led to a visit with a healthcare provider, researchers requested medical records to confirm the severity of the fall-related injury. At baseline and annually, phone calls also included surveys to ask about secondary outcomes.
Patients with a history of a fragility facture, agencies on aging, and clinicians provided input throughout the study.
Results
After three years, patients who received exercise with coaching and patients who received enhanced usual care did not differ significantly in the risk of serious fall-related injuries.
Patients who received exercise with coaching reported more minutes of strength training per week than patients who received enhanced usual care (64 minutes versus 36 minutes; p<0.001). Patients in the two groups did not differ significantly in other secondary outcomes.
Limitations
Trained peer volunteers led the exercise sessions. Patients participated in fewer exercise sessions toward the end of the study than at the beginning. Results may have differed if paid staff with a background in health or exercise led the sessions, or if patients continued to participate in exercise sessions throughout the study.
Conclusions and Relevance
In this study, compared with enhanced usual care, exercise with coaching did not significantly reduce serious fall-related injuries or fragility fractures among older adults.
Future Research Needs
Future research could examine other ways to encourage adherence to virtual and in-person exercise programs among older adults with a prior fragility fracture.
Final Research Report
View this project's final research report.
Engagement Resources
Journal Citations
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers noted that the report accentuated the importance of subgroup analyses over the main study outcomes. The researchers revised their study conclusions by focusing on the lack of significant differences between groups related to the primary outcome: serious fall-related injuries. They still reported the secondary outcome that participants in the intervention reported significantly more time spent in strength training than participants in the control condition; however, this did not translate into fewer fractures.
- The reviewers requested more information about how the stakeholders in the study influenced the study design and interpretation. The researchers explained that they could not easily identify these aspects because some stakeholders participated in every team meeting at every level, so their comments were not recorded separately. In addition, in annual meetings the study’s stakeholders were asked to provide feedback on specific issues that differed each year.
- The reviewers suggested that the researchers expand their study limitations section in the report discussion by moving limitations mentioned throughout the report to one section. The researchers expanded their study limitations to summarize limitations mentioned throughout the report.
- The reviewers asked the researchers to explain how this study fits into the larger literature on fragility fractures. The researchers added text to their introduction to the study by noting that there have been few large-scale studies of whether physical activity plus coaching could reduce serious fall injuries.