【学术2005-077】运动和维生素D预防老年妇女跌倒研究
【学术2005-077】运动和维生素D预防老年妇女跌倒研究
2015-03-29长城国际心脏病学会议长城国际心脏病学会议
长城国际心脏病学会议
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(英文原文)Exercise and Vitamin D in Fall Prevention Among Older Women
Importance While vitamin D supplementation and exercise arerecommended for prevention of falls for older people, results regarding these 2factors are contradictory.
Objective To determine the effectiveness of targeted exercisetraining and vitamin D supplementation in reducing falls and injurious fallsamong older women.
Design,Setting, and Participants A 2-yearrandomized, double-blind, placebo-controlled vitamin D and open exercise trialconducted between April 2010 and March 2013 in Tampere, Finland. Participantswere 409 home-dwelling women 70 to 80 years old. The main inclusion criteriawere at least 1 fall during the previous year, no use of vitamin D supplements,and no contraindication to exercise.
Interventions Four study groups, including placebo without exercise, vitaminD (800 IU/d) without exercise, placebo and exercise, and vitamin D (800 IU/d)and exercise.
MainOutcomes and Measures The primaryoutcome was monthly reported falls. Injurious falls and the number of fallersand injured fallers were reported as secondary outcomes. In addition, bonedensity, physical functioning (muscle strength, balance, and mobility), andvitamin D metabolism were assessed.
Results Intent-to-treat analyses showed that neither vitamin D norexercise reduced falls. Fall rates per 100 person-years were 118.2, 132.1,120.7, and 113.1 in the placebo without exercise, vitamin D without exercise,placebo and exercise, and vitamin D and exercise study groups, respectively;however, injurious fall rates were 13.2, 12.9, 6.5, and 5.0, respectively.Hazard ratios for injured fallers were significantly lower among exercisers withvitamin D (0.38; 95% CI, 0.17-0.83) and without vitamin D (0.47; 95% CI,0.23-0.99). Vitamin D maintained femoral neck bone mineral density andincreased tibial trabecular density slightly. However, only exercise improvedmuscle strength and balance. Vitamin D did not enhance exercise effects onphysical functioning.
Conclusionsand Relevance The rate of injuriousfalls and injured fallers more than halved with strength and balance trainingin home-dwelling older women, while neither exercise nor vitamin D affected therate of falls. Exercise improved physical functioning. Future research isneeded to determine the role of vitamin D in the enhancement of strength,balance, and mobility.
来源: ACC News Story(March 23,2015)
运动和维生素D预防老年妇女跌倒研究(中文摘要)
近日芬兰一项研究结果显示,在家接受力量和平衡训练的老年妇女,损伤性跌倒和受伤跌倒者的比率下降超过一半,而运动或维生素D均不影响跌倒率。运动可改善机体功能。但人们仍需要进一步研究来明确维生素D在增强力量、平衡感和行动力方面的作用。
补充维生素D和加强锻炼被建议用来预防老年人跌倒,但有关这两种因素的研究结果仍相互矛盾。这项为期2年的随机、双盲、安慰剂对照试验旨在明确运动训练和补充维生素D对减少老年妇女跌倒和损伤性跌倒的有效性。研究纳入409名居家的70~80岁妇女。主要纳入标准为:在过去的1年中至少跌倒1次、未服用维生素D补充剂、无运动禁忌证。受试者被分为4组:无运动安慰剂组、无运动维生素D组(800 IU/d)、安慰剂和运动组、维生素D(800 IU/d)和运动组。主要转归是每月报告的跌倒数;次要转归是损伤性跌倒以及跌倒者和受伤跌倒者人数。此外,研究还评估受试者的骨密度、机体功能(肌肉力量、平衡感和行动力)以及维生素D代谢情况。
意向性分析显示,维生素D或运动都未能减少跌倒。无运动安慰剂组、无运动维生素D组、安慰剂和运动组以及维生素D和运动组的跌倒率分别为118.2例/100人-年、132.1例/100人-年、120.7例/100人-年和113.1例/100人-年。然而,4组的损伤性跌倒率分别为13.2例/100人-年、12.9例/100人-年、6.5例/100人-年和5.0例/100人-年。补充维生素D(HR:0.38)和未补充维生素D(HR:0.47)运动者中的受伤跌倒风险比显著较低。维生素D维持股骨颈的骨密度并略增加胫骨小梁的密度。然而,单纯运动只能提高肌肉力量和平衡感。维生素D未能增强运动对机体功能的作用。