Abstract
Objectives
Frailty increases the risks of hospitalization, institutionalization, and death. Our
objective was to study the effects of home-based physical exercise on the number of
days spent at home among pre-frail and frail persons, versus usual care. In addition,
utilization and costs of health care and social services, cost-effectiveness, and
health-related quality-of-life (HRQoL) were explored.
Design
Randomized controlled trial, with year-long supervised exercise for 60 minutes twice
a week versus usual care. Follow-up for 24 months after randomization.
Setting and Participants
A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria:
≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State
Examination score ≥17.
Methods
Primary outcome, days spent at home over 24 months, was calculated deducting days
in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D
questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved
from medical records.
Results
The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and
39% frail. After 24 months, there was no difference between groups in days spent at
home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98–1.09]. After 12 months,
the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23–1.98),
and after 24 months, 1.23-fold (95% CI 0.95–1.50) versus usual care. Over 12 months,
the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline
15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004).
Conclusions and Implications
Physical exercise did not increase the number of days spent at home. Exercise prevented
deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated
with decreased utilization of other health care and social services over 24 months.
Keywords
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Article info
Publication history
Published online: July 18, 2020
Footnotes
The authors declare no conflicts of interest.
This work was supported by South Karelia Social and Health Care District (Eksote, grant register number 1236/00.01.05.01/2013); the Social Insurance Institution of Finland (SII, register number 94/331/2013); and State Research Funding for Academic Health Research (Ministry of Social Affairs and Health, Finland). The funders had no role in the design, or in collection, analysis, and interpretation of the data, or in writing the manuscript.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
