Two Years Later: a Prospective Long-term Follow-up of a Training Intervention in Geriatric Patients with a History of Severe Falls

Objective: To study the long-term outcome of a physical training regimen of ambulant postward rehabilitation in community-dwelling geriatric patients with a history of injurious falls.

Design: Prospective 2-year follow-up of a randomized placebo-controlled intervention trial.

Setting: Postward rehabilitation in a geriatric hospital in Germany.

Participants: Fifty-seven geriatric patients (mean age, 84.3+/-4.4 y) with a history of severe falls.

Intervention: Ambulatory training of strength, functional performance, and balance 3 times a week for 3 months for 31 patients versus placebo activities for 26 patients.

Main Outcome Measures: Strength, functional performance, fall-related psychologic parameters, and physical activity assessed by standardized protocols 2 years after the training intervention, compared with baseline results.

Results: Motor performance decreased substantially in both groups. As patients in the intervention group declined from significantly improved motor performance levels achieved in the initial training intervention, differences between the groups were still significant in most functional performances 2 years later. Functional decline was greater in persons who were institutionalized or being cared for by family members. Physical activity, which increased during the exercise intervention, returned to low baseline levels.

Conclusions: Improved functional performance in the training group did not lead to an increased level of physical activity after training, which might have preserved the functional improvements. In mobility-restricted, frail, geriatric patients such as our study population, training programs should continue to keep patients active and to prevent the decline in strength and functional performance that precedes loss of autonomy.