Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease: A Secondary Analysis of the FINALEX Study
No study has investigated how exercise modifies the effect of fall-related drugs (FRDs) on falls among people with Alzheimer’s disease (AD).
The aim of this study was to investigate how exercise intervention and FRDs interact with fall risk among patients with AD.
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.
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].
Exercise has the potential to decrease the risk for falls among people with AD using antihypertensives and psychotropics.
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
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.
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 was obtained for all patients in the original FINALEX study. Spouses provided informed consent when patients had reduced judgment capacity.
- 1.Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57.CrossRefGoogle Scholar
- 22.Pitkala KH, Raivio MM, Laakkonen ML, Tilvis RS, Kautiainen H, Strandberg TE. Exercise rehabilitation on home-dwelling patients with Alzheimer’s disease–a randomized, controlled trial. Study Protocol. 2010;11:92.Google Scholar
- 30.WHO. WHO Collaborating Centre for Drug Statistics Methodology. 2017. Available at: https://www.whocc.no/atc_ddd_index/. Accessed 1 Apr 2018.