Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women The Randomized Controlled Senior Fitness and Prevention (SEFIP) Study
Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women The Randomized Controlled Senior Fitness and Prevention (SEFIP) Study
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DOI：
10.1001/archinternmed.2009.499
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发表时间：
2010-01-25
影响因子：
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通讯作者：
Kalender, Willi A.
中科院分区：
文献类型：
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作者：
Kemmler, Wolfgang;von Stengel, Simon;Kalender, Willi A.
背景资料：体育锻炼影响许多危险因素和疾病，因此可以在老年人的一般疾病预防和治疗中发挥重要作用，并可以降低成本。我们试图确定一个单一的运动项目是否会影响骨折风险（骨矿物质密度[BMD]和福尔斯）、冠心病（CHD）危险因素和医疗保健费用。我们从2005年5月1日至2008年7月31日进行了一项随机、单盲、对照试验，招募在德国埃尔朗根-纽伦堡地区独立生活的65岁或以上的妇女。总共有246名女性被随机分配到一个为期18个月的锻炼计划（锻炼组）或一个健康计划（对照组）。运动组（n = 123）进行了一个多用途的运动计划，特别强调运动强度;控制组（n = 123）专注于幸福与低强度，低频率的程序。主要结果指标为BMD、福尔斯次数、基于Framingham的10年CHD风险和直接医疗费用。结果：对于完成18个月研究的227名妇女，观察到腰椎BMD的显著运动效应（运动组[基线至随访] BMD变化的平均[95%置信区间（CI）]百分比：1.77% [1.26%至2.28%] vs对照组：0.33% [-0.24%至0.91%]; P < .001），股骨颈（运动组：1.01% [0.37%至1.65%] vs对照组：-1.05% [-1.70%至-0.40%]; P <0.001），以及18个月期间的每人跌倒率（运动组：1.00 [0.76至1.24] vs对照组：1.66 [1.33至1.99]; P =. 002）。两个亚组的10年冠心病风险均受到显著影响（运动组的绝对变化：-1.96% [95% CI，-2.69%至-1.23%] vs对照组：-1.15% [-1.69%至-0.62%]; P =. 22），组间无显著差异。在18个月的干预期间，每个参与者的直接医疗保健费用在两组之间没有显着差异（运动组：（原文如此）2255 [ 95% CI，（原文如此）1791-（原文如此）2718] vs对照组：（原文如此）2780 [（原文如此）2187-（原文如此）3372]; P = .20）。与一般的健康计划相比，我们18个月的锻炼计划显着改善了老年妇女的BMD和跌倒风险，但不能预测冠心病风险。这一效益是在直接成本没有增加的情况下产生的。
Background: 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. 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.Methods: We conducted a randomized, single-blinded, controlled trial from May 1, 2005, through July 31, 2008, recruiting women 65 years or older who were living independently in the area of Erlangen-Nuremberg, Germany. In all, 246 women were randomly assigned to an 18-month exercise program (exercise group) or a wellness program (control group). The exercise group (n = 123) performed a multipurpose exercise program with special emphasis on exercise intensity; the controls (n = 123) focused on well-being with a low-intensity, low-frequency program. The main outcome measures were BMD, the number of falls, the Framingham-based 10-year CHD risk, and direct health care costs.Results: For the 227 women who completed the 18-month study, significant exercise effects were observed for BMD of the lumbar spine (mean [95% confidence interval (CI)] percentage of change in BMD [baseline to follow-up] for the exercise group: 1.77% [1.26% to 2.28%] vs controls: 0.33% [-0.24% to 0.91%]; P < .001), femoral neck (exercise group: 1.01% [0.37% to 1.65%] vs controls: -1.05% [-1.70% to -0.40%]; P < .001), and fall rate per person during 18 months (exercise group: 1.00 [0.76 to 1.24] vs controls: 1.66 [1.33 to 1.99]; P =. 002). The 10-year CHD risk was significantly affected in both subgroups (absolute change for the exercise group: -1.96% [95% CI, -2.69% to -1.23%] vs controls: -1.15% [-1.69% to -0.62%]; P =. 22), with no significant difference between the groups. The direct health care costs per participant during the 18-month intervention showed nonsignificant differences between the groups (exercise group: (sic)2255 [ 95% CI, (sic)1791-(sic)2718] vs controls: (sic)2780 [(sic)2187- (sic)3372]; P = .20).Conclusion: 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. This benefit occurred at no increase in direct costs.