domingo, 12 de julio de 2015

Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011

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Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011

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Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005-2011

Mikael Anne Greenwood-Hickman, MPH; Dori E. Rosenberg, PhD, MPH; Elizabeth A. Phelan, MD, MS; Annette L. Fitzpatrick, PhD, MA

Suggested citation for this article: Greenwood-Hickman MA, Rosenberg DE, Phelan EA, Fitzpatrick AL. Participation in Older Adult Physical Activity Programs and Risk for Falls Requiring Medical Care, Washington State, 2005–2011. Prev Chronic Dis 2015;12:140574. DOI:


Physical activity is known to prevent falls; however, use of widely available exercise programs for older adults, including EnhanceFitness and Silver Sneakers, has not been examined in relation to effects on falls among program participants. We aimed to determine whether participation in EnhanceFitness or Silver Sneakers is associated with a reduced risk of falls resulting in medical care.
A retrospective cohort study examined a demographically representative sample from a Washington State integrated health system. Health plan members aged 65 or older, including 2,095 EnhanceFitness users, 13,576 Silver Sneakers users, and 55,127 nonusers from 2005 through 2011, were classified as consistent users (used a program ≥2 times in all years they were enrolled in the health plan during the study period); intermittent users (used a program ≥2 times in 1 or more years enrolled but not all years), or nonusers of EnhanceFitness or Silver Sneakers. The main outcome was measured as time-to-first-fall requiring inpatient or out-of-hospital medical treatment based on the International Classification of Diseases, 9th Revision, Clinical Modification, Sixth Edition and E-codes.
In fully adjusted Cox proportional hazards models, consistent (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63–0.88) and intermittent (HR, 0.87; 95% CI, 0.8–0.94) EnhanceFitness participation were both associated with a reduced risk of falls resulting in medical care. Intermittent Silver Sneakers participation showed a reduced risk (HR, 0.93; 95% CI, 0.90–0.97).
Participation in widely available community-based exercise programs geared toward older adults (but not specific to fall prevention) reduced the risk of medical falls. Structured programs that include balance and strength exercise, as EnhanceFitness does, may be effective in reducing fall risk.


Falls affect 30% to 40% of community-living adults over age 65 every year. Half of falls result in some type of injury, and falls may contribute to declining function, loss of independence, illness, and death (1). Fall-related health care costs the United States nearly $30 billion annually (2). For many older adults, fear of falls and their physical and psychological aftermath are a serious concern, often leading to self-imposed restrictions on activity (3,4).
Fall prevention research has found that regular physical activity incorporating strength and balance exercise can reduce falls, fall-related injuries, and falls resulting in medical care (5–7). Community-based programs intended to enhance older adults’ access to age-appropriate exercise may be beneficial in preventing falls. In a large integrated health system in Washington State, Group Health Cooperative (GHC), Medicare-qualifying adult members aged 65 or older are eligible to participate in 2 nationally disseminated exercise programs at no additional cost. EnhanceFitness (EF), an evidence-based intervention funded by the Centers for Disease Control and Prevention, offers community-based group exercise classes led by qualified instructors. Another program, Silver Sneakers (SS), provides full membership to participating fitness centers nationwide in more than 10,000 locations (8,9). Previous investigations have suggested that specific fall prevention exercise programs can be effective in preventing falls among community-dwelling older adults (10,11). However, these programs targeted fall prevention and were not as widely disseminated as EF and SS are. Although general exercise programs for older adults reach a much wider audience, their impact on fall prevention has not been studied. Although EF participation has been shown to improve physical function (12,13), no previous studies have examined associations between participation in either EF or SS and fall-related outcomes (14). Preventing falls and the costs and system burden they create is a relevant outcome from both the societal and health plan perspectives.
Our objective was to examine the relationship between participation in EF or SS and risk for a fall requiring medical treatment (termed “medical fall” hereafter), in a sample of GHC Medicare plan enrollees. On the basis of existing evidence that physical activity plays an important role in fall prevention, we hypothesized that consistent users of either program would have lower risks of a medical fall compared with nonusers.


There was no financial support available for this work. Analyses were performed on an existing data set within the Group Health Research Institute.

Author Information

Corresponding Author: Mikael Anne Greenwood-Hickman, University of North Carolina, Radiology, 130 Mason Farm Road, Room 3126, Chapel Hill, NC 27514. Telephone: 765-586-3323.
Author Affiliations: Dori E. Rosenberg, Group Health Research Institute, Seattle, Washington; Elizabeth A. Phelan, Department of Medicine, School of Public Health and Community Medicine, University of Washington, Seattle, Washington; Annette L. Fitzpatrick, University of Washington, Seattle, Washington. At the time of this study, Ms Greenwood-Hickman was affiliated with the University of Washington, Seattle, Washington, and Group Health Research Institute, Seattle, Washington.


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