Home-based exercise reduces falls in cognitively frail older adults who have previously fallen

Objective: Fragility hip fractures are one of the most serious consequences of falls amongst older adults with osteoporosis. Cognitive frailty, characterized by concurrent physical frailty and mild cognitive impairment, increases fall risk. Exercise is an evidence-based strategy to prevent falls. We examined the effects of home-based exercise on subsequent falls amongst community-dwelling cognitively frail older
adults who have previously fallen.
Methods: A sub-group analysis of a 12-month, single-blind, randomized controlled trial amongst 344 adults C 70 y who had fallen in the past 12 months. Participants were randomized to either 12 months of home-based exercise (EX; n = 172) or usual care (CON; n = 172). In this sub analysis, we included 192 cognitively frail participants
(EX = 93; CON = 99) with Short Physical Performance Battery (SPPB) scores B 9/12 and Montreal Cognitive Assessment (MoCA) scores\26/30. Our primary outcome was falls rate based on self reported falls over 12 months. Secondary outcomes were core components of cognitive frailty (i.e., SPPB and MoCA). We also explored whether adherence moderated the effect of EX on outcomes.
Results: At 12 months, falls rates were 35% lower in EX vs. CON (IRR = 0.65; p = 0.042). The mean monthly adherence was 45.5%. SPPB performance significantly improved amongst EX participants who completed C 45.5% of EX sessions vs. those with completed\45.5% of sessions (estimated mean difference: 0.94;
p = 0.022).
Conclusion: Exercise is a promising strategy for reducing subsequent falls in people with cognitive frailty. Greater exercise adherence improved physical function in this population.