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.

Final Research Report

This project's final research report is expected to be available by March 2024.

Engagement Resources

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. 

Conflict of Interest Disclosures

Project Information

Christopher Sciamanna, MD, MPH
Pennsylvania State University Hershey Medical Center
Integrating Patient-Centered Exercise Coaching into Primary Care to Reduce Fragility Fracture

Key Dates

April 2015
January 2023

Study Registration Information


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Last updated: October 27, 2023