A 2-year randomized, controlled trial with 2-year follow-up to investigate if exercise and vitamin D supplementation could improve the performance of the neuromuscular system (muscle strength and balance) among the elderly and reduce falls and fall-related injuries.
Falls are the leading cause of unintentional injuries and fractures in older adults. Although less than one in ten falls results in a fracture, about 20 % of falls lead to injury needing medical attention. Therefore, falls prevention is widely considered the most essential element in injury and fracture prevention programs in elderly populations. While vitamin D supplementation and exercise are recommended for prevention of falls for older people, results regarding these two factors are contradictory.
In this 2-year double-blind placebo-controlled vitamin D and open exercise intervention trial with four arms we investigated the separate and combined effects of multimodal exercise training and vitamin D supplementation in reducing falls and injurious falls, and in improving bone density and physical functioning among 70–80-year old home-dwelling women at risk for falling. After the intervention there was a 2-year follow-up period.
409 participants were randomly assigned to one of four groups:
- vitamin D 800 IU/d and exercise (D+Ex+)
- placebo and exercise (D-Ex+)
- vitamin D 800 IU/d without exercise (D+Ex-)
- placebo without exercise (D-Ex-).
The exercisers participated in supervised training two times a week during the first year and once a week during the following year. In addition to the supervised training sessions, the participants did daily exercises at home.
Primary outcome was monthly reported falls. Injurious falls were reported as a secondary outcome. In addition, bone density, physical functioning (muscle strength, balance and mobility), and vitamin D metabolism were assessed.
The trial was done between April 2010 and March 2013. The 2-year follow-up ended on March 2015.
The risk for injurious falls more than halved with strength and balance training in home-dwelling older women, while neither exercise nor vitamin D affected the rate of falls. Exercise improved physical functioning. Future research is needed to determine the role of vitamin D in enhancement of strength, balance and mobility.
Clinical Trials NCT00986466
Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, Sievänen H. A 2-year follow-up after a 2-year RCT with vitamin D and exercise: Effects on falls, injurious falls and physical functioning among older women. Journals of Gerontology. A. Medical Sciences 2017;72(9):1239-1245. doi.org/10.1093/gerona/glx044
Patil R, Karinkanta S, Tokola K, Kannus P, Sievänen H, Uusi-Rasi K. Effects of vitamin D and exercise on the wellbeing of older community-dwelling women: a randomized controlled trial. Gerontology 2016;62():401-408.
Uusi-Rasi K, Patil R, Karinkanta S, Tokola K, Kannus K, Lamberg-Allardt C, Sievänen H. Long-Term Effects of Vitamin D and Multimodal Exercise on Prevention of Injurious Falls in Older Women. A 2-year follow-up after intervention. J Bone Miner Res 31 (Suppl 1). Accessed September 27, 2016.
Patil R, Kolu P, Raitanen J, Valvanne J, Kannus P, Karinkanta S, Sievänen H, Uusi-Rasi K: Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT. Osteoporos Int 2016; 27:193-201. Epub 2015 Jul 24. PMID: 26205890.
Uusi-Rasi K, Patil P, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, Sievänen H: Exercise and vitamin D in falls prevention among older women: A randomized controlled trial. JAMA Intern Med 2015; 175: 703-11. doi:10.1001/jamainternmed.2015.0225.
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Last updated: 19.11.2020