Exercise in Older Women May Improve BMD and Reduce Fall Risk

From Medscape Medical News
Laurie Barclay, MD

February 4, 2010 — An exercise program vs a general wellness intervention in older women may improve bone mineral density (BMD) and reduce fall risk, but not cardiovascular disease risk, according to the results of a randomized, single-blinded, controlled trial reported in the January 25 issue of Archives of Internal Medicine.

"Physical exercise affects many risk factors and diseases and therefore can play a vital role in general disease prevention and treatment of elderly individuals and may reduce costs, write Wolfgang Kemmler, PhD, from Freidrich-Alexander University of Erlangen-Nuremberg in Erlangen, Germany, and colleagues from the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study.
"We sought to determine whether a single exercise program affects fracture risk (bone mineral density [BMD] and falls), coronary heart disease (CHD) risk factors, and health care costs in community dwelling elderly women."

From May 1, 2005, through July 31, 2008, a total of 246 women 65 years or older who were living independently in the area of Erlangen-Nuremberg, Germany, were recruited and randomly assigned 1:1 to an 18-month exercise program (exercise group) or to a wellness program (control group).
The exercise intervention consisted of a multipurpose exercise program emphasizing exercise intensity, whereas the control intervention emphasized well-being with a low-intensity, low-frequency program. Study endpoints included BMD, the number of falls, Framingham-based 10-year CHD risk, and direct healthcare costs.

Among 227 women who completed the 18-month study, there were significant effects of exercise for BMD of the lumbar spine (mean percentage of change in BMD from baseline to follow-up for the exercise group: 1.77% (95% confidence interval [CI], 1.26% - 2.28% vs control subjects: 0.33%; 95% CI, −0.24% to 0.91%; P < .001), femoral neck (exercise group: 1.01%; 95% CI, 0.37% - 1.65% vs control subjects: −1.05%; 95% CI, −1.70% to −0.40%; P < .001), and fall rate per person for 18 months (exercise group: 1.00; 95% CI, 0.76 - 1.24 vs control subjects: 1.66; 95% CI, 1.33 - 1.99; P = .002).

In both subgroups, there was a significantly effect on 10-year CHD risk, but this was not significantly different between the groups (absolute change for the exercise group: −1.96%; 95% CI, −2.69% to −1.23% vs control subjects: −1.15%; 95% CI, −1.69% to −0.62%; P = .22). During the 18-month intervention, direct healthcare costs per participant were not significantly different between the groups (exercise group: €2255; 95% CI, €1791 - €2718; vs control subjects : €2780; 95% CI, €2187 - €3372; P = .20).

"Compared with a general wellness program, our 18-month exercise program significantly improved BMD and fall risk, but not predicted CHD risk, in elderly women," the study authors write. "This benefit occurred at no increase in direct costs."

Limitations of this study include exercise in both groups, which may have prevented significant group differences for 10-year CHD risk; and possible crossover and inadequate blinding.

"This contribution extends the existing data in that a single multipurpose exercise program that is based on a low-volume, high-intensity philosophy and is designed for the elderly improves overall fitness, maintains bone health, and reduces fall risk," the study authors conclude. "Because this training regimen can be easily adopted by other institutions and health care providers, a broad implementation of this program is feasible."

The Siemens Betriebs Krankenkasse, Behinderten-undRehabilitations-Sportverband Bayern, Netzwerk Knochengesundheit e.V.,Opfermann Arzneimittel GmbH, Thera-Band, Institute of Sport Science, and Institute of Medical Physics supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:179-185. Abstract