澳大利亚神经科学研究所Kim Delbaere团队研究了电子健康StandingTall平衡锻炼预防老年人跌倒的效果。2021年4月6日，该研究发表在《英国医学杂志》上。

为了探讨StandingTall（一种基于家庭的电子健康平衡运动项目）能否为社区老年人提供一种有效的、自我管理的跌倒预防方案，研究人员针对在澳大利亚悉尼社区独立生活的老年人进行了一项评估者盲的随机对照试验。共招募了503名年龄在70岁及以上的参与者，他们在日常生活中独立活动，没有认知障碍、进行性神经疾病、或除运动外的任何其他不稳定或急性疾病。

将这些参与者随机分组，其中干预组254名，每周StandingTall 2小时并接受健康教育，对照组249名，仅接受健康教育，为期两年。主要结局是跌倒率（每人每年跌倒的次数）和12个月跌倒的人数比例。次要结局为24个月内跌倒人数和伤害性跌倒人数（造成任何伤害或需要医疗护理）、依从性、情绪、与健康相关的生活质量和活动水平；以及12个月内的平衡和行动能力结局。

两组参与者前12个月的跌倒率无统计学差异，其中干预组为0.60次/年，对照组为0.76次/年。12个月时两组跌倒者的人数比例也无统计学差异，其中干预组为34.6%，对照组为40.2%。然而，与对照组相比，干预组24个月内的跌倒率降低了16%，差异显著。两组在24个月内跌倒者的人数比例相似，但干预组24个月内的伤害性跌倒人数比例比对照组低20%，差异显著。

12个月后，干预组中有68.1%的参与者平均每周锻炼114.0分钟，52.0%的参与者平均每周锻炼120.4分钟。两组的情绪和活动水平相似。干预组6个月时EQ-5D-5L效用评分改善0.03，6个月时站立平衡改善11秒，12个月时为10秒。未发生严重的培训相关不良事件。

研究结果表明，StandingTall平衡训练方案并不能显著降低老年人跌倒和伤害性跌倒的发生率。

附：英文原文

Title: E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

Author: Kim Delbaere, Trinidad Valenzuela, Stephen R Lord, Lindy Clemson, G A Rixt Zijlstra, Jacqueline C T Close, Thomas Lung, Ashley Woodbury, Jessica Chow, Garth McInerney, Lillian Miles, Barbara Toson, Nancy Briggs, Kimberley S van Schooten

Issue&Volume: 2021/04/06

Abstract:

Objective To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people.

Design Assessor blinded, randomised controlled trial.

Setting Older people living independently in the community in Sydney, Australia.

Participants 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise.

Interventions Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years.

Main outcome measures The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number who had an injurious fall (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months.

Results The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.84, 95% confidence interval 0.62 to 1.13, P=0.071). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.67 to 1.20, P=0.461). However, the intervention group had a 16% lower rate of falls over 24 months compared with the control group (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.68 to 1.10, P=0.239), but the proportion of people who had an injurious fall over 24 months was 20% lower in the intervention group compared with the control group (relative risk 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred.

Conclusions The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and the number of injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies.

DOI: 10.1136/bmj.n740

Source: https://www.bmj.com/content/373/bmj.n740