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파일첨부 (2018)Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged care.pdf
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(Hur)Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged

Background: Falls prevention is an international priority, and residents of long-term aged care fall
approximately 3 times more often than community dwellers. There is a relative scarcity of published trials in this setting.


Objectives:
Our objective was to undertake a randomized controlled trial to test the effect of published
best practice exercise in long-term residential aged care. The trial was designed to determine if combined
high level balance and moderate intensity progressive resistance training (the Sunbeam Program) is
effective in reducing the rate of falls in residents of aged care facilities.

 



Method:
A cluster randomized controlled trial of 16 residential aged care facilities and 221 participants
was conducted. The broad inclusion criterion was permanent residents of aged care. Exclusions were
diagnosed terminal illness, no medical clearance, permanent bed- or wheelchair-bound status, advanced
Parkinson
s disease, or insuffi
cient cognition to participate in group exercise. Assessments were taken at
baseline, after intervention, and at 12 months. Randomization was performed by computer-generated
sequence to receive either the Sunbeam program or usual care. A cluster refers to an aged care facility.
Intervention:
The program consisted of individually prescribed progressive resistance training plus

balance exercise performed in a group setting for 50 hours over a 25-week period, followed by a maintenance period for 6 months.

Outcome Measures: The primaryoutcomemeasurewas the rateoffalls (numberoffalls and days followedup).
Secondary outcomes included physical performance (Short Physical Performance Battery), quality of life (36-
item Short-Form Health Survey), functional mobility (University of Alabama Life Space Assessment), fear of
falling (Falls Ef
ficacy Scale International), and cognition (Addenbrookes Cognitive Evaluatione
revised).

Results: The rate of falls was reduced by 55% in the exercise group (incidence rate ratio ¼ 0.45, 95%
con
fidence interval 0.17-0.74); an improvement was also seen in physical performance (P ¼
.02). There
were no serious adverse events.

Conclusion: The Sunbeam Program significantly reduced the rate of falls and improved physical performance in residents of aged care. This finding is important as prior work in this setting has returned
inconsistent outcomes, resulting in best practice guidelines being cautious about recommending exercise
in this setting. This work provides an opportunity to improve clinical practice and health outcomes for
long-term care residents.

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