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BACKGROUND\ud Community screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.\ud \ud METHODS\ud In a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.\ud \ud RESULTS\ud We randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.\ud \ud CONCLUSIONS\ud Advice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650. opens in new tab.) more...

Background The aim was to estimate the prevalence of frailty and relative contribution of physical/balance, nutritive, cognitive and sensory frailty to important adverse health states (falls, physical activity levels, outdoor mobility, problems in self-care or usual activities, and lack of energy or accomplishment) in an English cohort by age and sex. Methods Analysis of baseline data from a cohort of 9803 community-dwelling participants in a clinical trial. The sample was drawn from a random selection of all people aged 70 or more registered with 63 general practices across England. Data were collected by postal questionnaire. Frailty was measured with the Strawbridge questionnaire. We used cross sectional, multivariate logistic regression to estimate the association between frailty domains and known correlates and adjusted for age. Some models were stratified by sex. Results Mean age of participants was 78 years (sd 5.7), range 70 to 101 and 47.5% (4653/9803) were men. The prevalence of overall frailty was 20.7% (2005/9671) and there was no difference in prevalence by sex (Odds Ratio 0.98; 95% Confidence Interval 0.89 to 1.08). Sensory frailty was the most common and this was reported by more men (1823/4586) than women (1469/5056; Odds Ratio for sensory frailty 0.62, 95% Confidence Interval 0.57 to 0.68). Men were less likely than women to have physical or nutritive frailty. Physical frailty had the strongest independent associations with adverse health states. However, sensory frailty was independently associated with falls, less frequent walking, problems in self-care and usual activities, lack of energy and accomplishment. Conclusions Physical frailty was more strongly associated with adverse health states, but sensory frailty was much more common. The health gain from intervention for sensory frailty in England is likely to be substantial, particularly for older men. Sensory frailty should be explored further as an important target of intervention to improve health outcomes for older people both at clinical and population level. Trial registration ISRCTN71002650. more...

Objectives: To identify the components, and assess the reporting quality, of exercise training interventions for people living with pulmonary hypertension.\ud \ud Design: Systematic review with analysis of intervention reporting quality using the Consensus on Exercise Reporting Template (CERT).\ud \ud Data sources: Eligible studies in the Cochrane Systematic Review of exercise-based rehabilitation for pulmonary hypertension, updated with a new search of relevant databases from 1 August 2016 to 15 January 2018.\ud \ud Eligibility criteria: Peer-reviewed journal articles of randomised and non-randomised controlled trials, and non-controlled prospective observational studies, investigating dynamic exercise training interventions in adult humans with diagnosed pulmonary hypertension, reporting on at least one physiological and/or psychosocial outcome.\ud \ud Results: Interventions typically involved cycle ergometry and walking. They were delivered as 3-week inpatient, or outpatient and/or home-based programmes, lasting for 4–15 weeks. Components relating specifically to exercise prescription were described satisfactorily and in more detail than motivational/behavioural change strategies, adherence and fidelity. Mean CERT score was 13.1 (range 8–17) out of a possible maximum score of 19. No studies fully reported every aspect of an exercise intervention to the standard recommended by CERT.\ud \ud Summary/conclusion: Considerable variability was evident in the components and reporting quality of interventions for exercise rehabilitation studies in pulmonary hypertension. Interventional studies using exercise training should pay greater attention to describing motivational/behavioural change strategies, adherence and fidelity. Detailed description of these parameters is essential for the safe and effective replication of exercise rehabilitation interventions for pulmonary hypertension in clinical practice. more...

The TIDieR (Template for Intervention Description and Replication) Checklist. (DOCX 28Â kb)

Background: Exercise programmes addressing problems of gait, balance and lower limb strength, are effective in reducing rate and risk of falls in community-dwelling older people. There is a lack of evidence regarding the long-term effects of falls prevention exercises.\ud \ud Aim: To investigate whether a falls prevention exercise intervention had any long-term effects on health-related outcomes compared to advice only, in older adults who have participated in a falls prevention clinical trial. Methods: This study used mixed methods. A cohort study followed-up a subset of 4891/9803 (50%) older people recruited to a larger RCT; The Prevention of Fall Injury Trial (PreFIT). Data on falls, health-related quality of life, frailty, cognition and general health were collected from participants allocated to advice only and advice plus exercise, up to six-years after randomisation. Interviews were undertaken with 23 participants randomised to the exercise intervention to explore their experiences of the trial.\ud \ud Results: 2980/4891 (61%) participants responded to a postal survey (advice: n=1507; exercise: n=1473). At six years, there were no long-term effects of exercise on falls or other health outcomes. There were no differences by treatment arm or by adherence to exercise. Overall health of the whole cohort gradually declined over time, in multiple domains. Analysis of interviews identified five themes: happy to help; exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and loss. Participants were no longer undertaking the strength and balance exercises prescribed during their intervention. They preferred walking as their main form of exercise, and no-one reported preventing falls as a motivator to continuing to exercise.\ud \ud Conclusions: There were no long-term effects of falls prevention exercises in this cohort of older people. This may be because older people stop their specific strength and balance exercises when their supervised intervention comes to an end. more...