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Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease: A Secondary Analysis of the FINALEX Study

  • Niko M. Perttila
  • Hanna Öhman
  • Timo E. Strandberg
  • Hannu Kautiainen
  • Minna Raivio
  • Marja-Liisa Laakkonen
  • Niina Savikko
  • Reijo S. Tilvis
  • Kaisu H. Pitkälä
Original Research Article

Abstract

Introduction

No study has investigated how exercise modifies the effect of fall-related drugs (FRDs) on falls among people with Alzheimer’s disease (AD).

Objective

The aim of this study was to investigate how exercise intervention and FRDs interact with fall risk among patients with AD.

Methods

In the FINALEX trial, community-dwelling persons with AD received either home-based or group-based exercise twice weekly for 1 year (n =129); the control group received normal care (n =65). The number of falls was based on spouses’ fall diaries. We examined the incidence rate ratios (IRRs) for falls among both non-users and users of various FRDs (antihypertensives, psychotropics, drugs with anticholinergic properties [DAPs]) in both control and combined intervention groups.

Results

Between the intervention and control groups, there was no difference in the number of falls among those without antihypertensives or psychotropics. In the intervention group taking antihypertensives, the IRR was 0.5 falls/person-year (95% confidence interval [CI] 0.4–0.6), while in the control group, the IRR was 1.5 falls/person-year (95% CI 1.2–1.8) [p < 0.001 for group, p = 0.067 for medication, p < 0.001 for interaction]. Among patients using psychotropics, the intervention group had an IRR of 0.7 falls/person-year (95% CI 0.6–0.9), while the control group had an IRR of 2.0 falls/person-year (95% CI 1.6–2.5) [p < 0.001 for group, p = 0.071 for medication, p < 0.001 for interaction]. There was a significant difference in falls between the intervention and control groups not using DAPs (0.6, 95% CI 0.5–0.7; 1.2, 95% CI 1.0–1.4), and between the intervention and control groups using DAPs (1.1, 95% CI 0.8–1.3; 1.5, 95% CI 1.0–2.1) [p < 0.001 for group, p = 0.014 for medication, p  = 0.97 for interaction].

Conclusion

Exercise has the potential to decrease the risk for falls among people with AD using antihypertensives and psychotropics.

Trial Registration

ACTRN12608000037303.

Notes

Acknowledgements

This study was supported by the Social Insurance Institution of Finland, Central Union for the Welfare of the Aged, Päivikki and Sakari Sohlberg Foundation, King Gustaf V and Queen Victoria Foundation, Avohoidon Tutkimussäätiö (Finnish Foundation), Finnish Association for General Practice, Finnish Medical Foundation, Paulo Foundation, Finnish Alzheimer’s Disease Research Society, Orion Research Foundation sr, Juho Vainio Foundation, and the Uulo Arhio Foundation.

Compliance with Ethical Standards

Funding

This study was supported by the Social Insurance Institution of Finland, Central Union for the Welfare of the Aged, Päivikki and Sakari Sohlberg Foundation, and the King Gustaf V and Queen Victoria Foundation. The sponsors had no role in the study design, data analysis or interpretation of the results, writing of the report, or in the decision to submit the manuscript for publication.

Conflicts of interest

Niko Perttila, Hanna Öhman, Timo Strandberg, Hannu Kautiainen, Minna Raivio, Marja-Liisa Laakkonen, Niina Savikko, Reijo Tilvis and Kaisu Pitkälä declare that they have no conflicts of interest relevant to the content of this review. The authors are independent researchers who have no association with the sponsors.

Ethical approval

All procedures performed in the original FINALEX study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The original FINALEX study and this subgroup analysis of that study were approved by the Ethics Committee of the Helsinki University Hospital.

Informed consent

Informed consent was obtained for all patients in the original FINALEX study. Spouses provided informed consent when patients had reduced judgment capacity.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Niko M. Perttila
    • 1
  • Hanna Öhman
    • 1
    • 2
  • Timo E. Strandberg
    • 3
    • 4
  • Hannu Kautiainen
    • 1
  • Minna Raivio
    • 1
  • Marja-Liisa Laakkonen
    • 1
    • 2
  • Niina Savikko
    • 3
    • 5
  • Reijo S. Tilvis
    • 3
  • Kaisu H. Pitkälä
    • 1
  1. 1.Department of General Practice, Unit of Primary Health CareUniversity of Helsinki, Helsinki University HospitalHelsinkiFinland
  2. 2.Hospital, Rehabilitation and Care ServicesHelsinkiFinland
  3. 3.University of Helsinki, Helsinki University HospitalHelsinkiFinland
  4. 4.Center for Life Course Health ResearchUniversity of OuluOuluFinland
  5. 5.Home CareEspooFinland

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