Abstract
Background
Falls prevention is an international priority, and residents of long-term aged care
fall approximately 3 times more often than community dwellers. There is a relative
scarcity of published trials in this setting.
Objectives
Our objective was to undertake a randomized controlled trial to test the effect of
published best practice exercise in long-term residential aged care. The trial was
designed to determine if combined high level balance and moderate intensity progressive
resistance training (the Sunbeam Program) is effective in reducing the rate of falls
in residents of aged care facilities.
Method
A cluster randomized controlled trial of 16 residential aged care facilities and 221
participants was conducted. The broad inclusion criterion was permanent residents
of aged care. Exclusions were diagnosed terminal illness, no medical clearance, permanent
bed- or wheelchair-bound status, advanced Parkinson's disease, or insufficient cognition
to participate in group exercise. Assessments were taken at baseline, after intervention,
and at 12 months. Randomization was performed by computer-generated sequence to receive
either the Sunbeam program or usual care. A cluster refers to an aged care facility.
Intervention
The program consisted of individually prescribed progressive resistance training plus
balance exercise performed in a group setting for 50 hours over a 25-week period,
followed by a maintenance period for 6 months.
Outcome Measures
The primary outcome measure was the rate of falls (number of falls and days followed
up). Secondary outcomes included physical performance (Short Physical Performance
Battery), quality of life (36-item Short-Form Health Survey), functional mobility
(University of Alabama Life Space Assessment), fear of falling (Falls Efficacy Scale
International), and cognition (Addenbrooke's Cognitive Evaluation–revised).
Results
The rate of falls was reduced by 55% in the exercise group (incidence rate ratio = 0.45,
95% confidence interval 0.17-0.74); an improvement was also seen in physical performance
(P = .02). There were no serious adverse events.
Conclusion
The Sunbeam Program significantly reduced the rate of falls and improved physical
performance in residents of aged care. This finding is important as prior work in
this setting has returned inconsistent outcomes, resulting in best practice guidelines
being cautious about recommending exercise in this setting. This work provides an
opportunity to improve clinical practice and health outcomes for long-term care residents.
Keywords
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Article info
Publication history
Published online: February 02, 2018
Footnotes
HUR Health and Fitness equipment provided in kind support with the use of the resistance training equipment for this trial and contributed funds toward some travel expenses for research assistants. Feros Care and Domain Principal Group donated funds to support masked assessors. It was agreed a priori that none of these supporters would have any influence over the study design, the decision to submit the results of the research for publication, or the preparation of this manuscript.
The authors declare no conflicts of interest.
Identification
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
