Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT

Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.Peer reviewe

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

<p>Abstract</p> <p>Background</p> <p>Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).</p> <p>Methods</p> <p>A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.</p> <p>Results</p> <p>The impact of the use of the ACCG scenario in subgroups (aged 40–80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.</p> <p>Conclusion</p> <p>The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.</p

Effect of 12-month supervised, home-based physical exercise on functioning among persons with signs of frailty : Randomized Controlled Trial

Objectives To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. Design A randomized controlled trial with a 1:1 allocation Setting Home-based Participants Home-dwelling persons aged ≥65 years meeting at least one frailty phenotype criteria (n=300). Intervention 12-month, individually tailored, progressive and physiotherapist-supervised, physical exercise twice a week (n=150) vs. usual care (n=149). Main outcome Measures Functional Independence Measure (FIM), Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed four times at home over 12 months. Results The mean age of the participants was 82.2 (SD 6.3), 75% were women, 61% met 1–2 frailty criteria and 39% ≥3 criteria. FIM deteriorated in both groups over 12 months, -4.1 points (95% CI: -5.6 to -2.5) in the exercise group and -6.9 (-8.4 to -2.3) in the usual care group (group p=0.014, time p<0.001, interaction p=0.56). The mean improvement in SPPB was significantly greater in the exercise group [1.6 (1.3 to 2.0)] than in the usual care group [0.01 (-0.3 to 0.3)] (group p<0.001, time p=0.11, interaction p=0.027). The exercise group reported significantly fewer falls per person-year compared to the usual care group (incidence rate ratio, IRR 0.47 [95% CI 0.40 to 0.55]; p<0.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function or self-reported physical activity. Conclusions One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL or handgrip strength.peerReviewe

Changes in the Severity of Frailty Among Older Adults After 12 Months of Supervised Home-Based Physical Exercise : A Randomized Clinical Trial

Objective To investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses. Design Randomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes. Setting and Participants Home-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria. Methods The severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months. Results Two hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (−0.27, 95% CI –0.47, −0.08) and remained unchanged in the usual care group (0.01, 95% CI –0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P < .001) criteria were lower at 12 months in the exercise group than in the usual care group. Conclusions and Implications The severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.peerReviewe

Effects of home-based physical exercise on days at home, healthcare utilization and functional independence among patients with hip fractures : a randomized controlled trial

Objective To evaluate the effects of a physical exercise program on days lived at home, the use and costs of healthcare and social services mortality and functional independence among patients with hip fractures. Design Randomized controlled trial with parallel two-group design, consisting of a 12-month intervention and 12-month registry follow-up. Setting Home-based intervention. Participants Patients with operated hip fracture, living at home, aged ≥60 years, randomized into physical-exercise (n=61) or usual-care (n=60) groups. Intervention Supervised physical exercise twice a week. Main Outcome Measures The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of healthcare and social services and mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. Results Over 24 months there was no significant difference between the groups in terms of days lived at home (Incidence Rate Ratio [IRR] 1.01 [95% CI 0.90–1.14]) or mortality (Hazard Ratio [HR] 1.01 [95% CI 0.42–2.43]). The mean total costs of healthcare and social services did not differ between the groups: over 12 months the costs per person-year were 1.26-fold (95% CI 0.87–1.86) and over 24 months 1.08-fold (95% CI 0.77–1.70) greater in the physical-exercise than in the usual-care group. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI 0.5–8.5, p=0.029) in favor of the physical-exercise group. Conclusions Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but significantly more in the physical-exercise group than in the usual-care group.peerReviewe

The validity of predicted body fat percentage from body mass index and from impedance in samples of five European populations

Objectives: To test and compare the validity of a body mass index (BMI)-based prediction equation and an impedance-based prediction equation for body fat percentage among various European population groups. Design: Cross-sectional observational study. Settings: The study was performed in five different European centres: Maastricht and Wageningen (The Netherlands), Milan and Rome (Italy) and Tampere (Finland), where body composition studies are routinely performed. Subjects: A total of 234 females and 182 males, aged 18-70 y, BMI 17.0-41.9 kg/m2. Methods: The reference method for body fat percentage (BF%REF) was either dual-energy X-ray absorptiometry (DXA) or densitometry (underwater weighing). Body fat percentage (BF%) was also predicted from BMI, age and sex (BF%BMI) or with a hand-held impedance analyser that uses in addition to arm impedance weight, height, age and sex as predictors (BF%IMP). Results: The overall mean (±s.e.) bias (measured minus predicted) for BF%BMI was 0.2 ± 0.3 (NS) and -0.7 ± 0.3 (NS) in females and males, respectively. The bias of BF%IMP was 0.2 ± 0.2 (NS) and 1.0 ± 0.4 (P < 0.01) for females and males, respectively. There were significant differences in biases among the centres. The biases were correlated with level of BF% and with age. After correction for differences in age and BF% between the centres the bias of BF%BMI was not significantly different from zero in each centre and was not different among the centres anymore. The bias of BF%IMP decreased after correction and was significant from zero and significant from the other centres only in males from Tampere. Generally, individual biases can be high, leading to a considerably misclassification of obesity. The individual misclassification was generally higher with the BMI-based prediction. Conclusions: The prediction formulas give generally good estimates of BF% on a group level in the five population samples, except for the males from Tampere. More comparative studies should be conducted to get better insight in the generalisation of prediction methods and formulas. Individual results and classifications have to be interpreted with caution

Associations of physical activity and sedentary behavior with academic skills--a follow-up study among primary school children.

There are no prospective studies that would have compared the relationships of different types of physical activity (PA) and sedentary behavior (SB) with academic skills among children. We therefore investigated the associations of different types of PA and SB with reading and arithmetic skills in a follow-up study among children.The participants were 186 children (107 boys, 79 girls, 6-8 yr) who were followed-up in Grades 1-3. PA and SB were assessed using a questionnaire in Grade 1. Reading fluency, reading comprehension and arithmetic skills were assessed using standardized tests at the end of Grades 1-3.Among all children more recess PA and more time spent in SB related to academic skills were associated with a better reading fluency across Grades 1-3. In boys, higher levels of total PA, physically active school transportation and more time spent in SB related to academic skills were associated with a better reading fluency across the Grades 1-3. Among girls, higher levels of total PA were related to worse arithmetic skills across Grades 1-3. Moreover, total PA was directly associated with reading fluency and arithmetic skills in Grades 1-3 among girls whose parents had a university degree, whereas these relationships were inverse in girls of less educated parents.Total PA, physically active school transportation and SB related to academic skills may be beneficial for the development of reading skills in boys, whereas factors that are independent of PA or SB may be more important for academic skills in girls.ClinicalTrials.gov: NCT01803776