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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　February 4, 2010 — 一項發表於1月25日內科醫學誌（Archives of Internal Medicine）的隨機分派、單盲、控制組研究結果顯示，年長婦女接受運動計劃，相較於一般健康介入，可能改善骨質密度（BMD）且降低骨折風險，但是不會改變心血管疾病風險。
　　
　　德國埃朗根Freidrich-Alexander Erlangen-Nuremberg大學的Wolfgang Kemmler博士與其來自隨機分派控制長者健康與預防研究（the Randomized Controlled Senior Fitness and Prevention；SEFIP）的同事們寫到，運動影響許多危險因子以及疾病，因此在老年患者一般疾病預防與治療，甚至是降低醫療費用上扮演了重要角色。我們想要確認單一運動計劃是否會影響居住在社區之年長婦女的骨折風險（骨質密度[BMD]下降與跌倒）、冠狀動脈心臟疾病（CHD）危險因子、以及健康照護費用。
　　
　　在2005年1月到2008年7月31日間，總共有246位獨居在德國Erlangen-Nuremberg地區、年齡在65歲以上的婦女，她們被徵集且以一比一的比例隨機分派接受運動計畫（運動組）或是健康計畫（控制組）；運動介入包括多目的運動計畫，強調運動密集度，但控制組強調低密集度、低頻率的維持健康計畫。試驗終點包括BMD、跌倒次數、佛明罕10年CHD風險以及直接的健康照護費用。
　　
　　在277位完成18個月追蹤的婦女中，運動對腰椎BMD有顯著效應（運動組受試者試驗前到後續追蹤的BMD變化平均改變比例為1.77%（95%信賴區間[CI]為1.26%~2.28%，控制組為0.33%；95% CI為-0.24%~0.91%；P<0.001）、股骨（運動組1.01%；95% CI為0.37%-1.65%相較於控制組的-1.05%；95% CI為-1.70%~-0.40%；P<0.001），以及每位病患在18個月之間的跌倒機率（運動組為1.00；95% CI為0.76-1.24相較於控制組的1.66；95% CI為1.33-1.99；P=0.002）。
　　
　　在這兩組的次組分析中，對10年的CHD風險有顯著差異，但是在組與組之間沒有顯著差異（運動組的絕對風險變化為-1.15%；95% CI為-1.69%~-0.62%；P=0.22）。在18個月的介入期中，每位受試者的直接醫療費用在組與組之間並無差異（運動組為2255歐元；95% CI為1791歐元至2718歐元；控制組則是2780歐元；95% CI為2187歐元至3372歐元；P=0.20）。
　　
　　研究作者們寫到，相較於一般健康計畫，我們的18個月運動計畫顯著地改善年長婦女的BMD與跌倒風險，但是並不能預測CHD風險。好處在於不會增加直接費用。
　　
　　這項研究的限制包括兩組都有運動，可能減少了兩組之間10年的CHD風險差異，以及可能的交叉與不足的盲性。
　　
　　研究作者的結論是，這項試驗擴展了現有的研究數據，小量、高密集度學說且專為長者設計的單一多目的運動計畫，可以改善整體健康、維持骨骼健康且能降低跌倒風險。由於此項訓練計畫可以簡單地被其他機構與健康照護者採用，更廣泛地應用這項計畫將是可行的。
　　
　　Siemens Betriebs Krankenkasse、Behinderten-undRehabilitations-Sportverband Bayern、 Netzwerk Knochengesundheit e.V.,Opfermann Arzneimittel GmbH、Thera-Band、運動科學機構以及醫用物理學機構贊助這項研究。研究作者們表示沒有相關資金上的往來。


Exercise in Older Women May Improve BMD and Reduce Fall Risk

By Laurie Barclay, MD
Medscape Medical News

February 4, 2010 — An exercise program vs a general wellness intervention in older women may improve bone mineral density (BMD) and reduce fall risk, but not cardiovascular disease risk, according to the results of a randomized, single-blinded, controlled trial reported in the January 25 issue of Archives of Internal Medicine.

"Physical exercise affects many risk factors and diseases and therefore can play a vital role in general disease prevention and treatment of elderly individuals and may reduce costs, write Wolfgang Kemmler, PhD, from Freidrich-Alexander University of Erlangen-Nuremberg in Erlangen, Germany, and colleagues from the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study. "We sought to determine whether a single exercise program affects fracture risk (bone mineral density [BMD] and falls), coronary heart disease (CHD) risk factors, and health care costs in community dwelling elderly women."

From May 1, 2005, through July 31, 2008, a total of 246 women 65 years or older who were living independently in the area of Erlangen-Nuremberg, Germany, were recruited and randomly assigned 1:1 to an 18-month exercise program (exercise group) or to a wellness program (control group). The exercise intervention consisted of a multipurpose exercise program emphasizing exercise intensity, whereas the control intervention emphasized well-being with a low-intensity, low-frequency program. Study endpoints included BMD, the number of falls, Framingham-based 10-year CHD risk, and direct healthcare costs.

Among 227 women who completed the 18-month study, there were significant effects of exercise for BMD of the lumbar spine (mean percentage of change in BMD from baseline to follow-up for the exercise group: 1.77% (95% confidence interval [CI], 1.26% - 2.28% vs control subjects: 0.33%; 95% CI, ?0.24% to 0.91%; P < .001), femoral neck (exercise group: 1.01%; 95% CI, 0.37% - 1.65% vs control subjects: ?1.05%; 95% CI, ?1.70% to ?0.40%; P < .001), and fall rate per person for 18 months (exercise group: 1.00; 95% CI, 0.76 - 1.24 vs control subjects: 1.66; 95% CI, 1.33 - 1.99; P = .002).

In both subgroups, there was a significantly effect on 10-year CHD risk, but this was not significantly different between the groups (absolute change for the exercise group: ?1.96%; 95% CI, ?2.69% to ?1.23% vs control subjects: ?1.15%; 95% CI, ?1.69% to ?0.62%; P = .22). During the 18-month intervention, direct healthcare costs per participant were not significantly different between the groups (exercise group: €2255; 95% CI, €1791 - €2718; vs control subjects : €2780; 95% CI, €2187 - €3372; P = .20).

"Compared with a general wellness program, our 18-month exercise program significantly improved BMD and fall risk, but not predicted CHD risk, in elderly women," the study authors write. "This benefit occurred at no increase in direct costs."

Limitations of this study include exercise in both groups, which may have prevented significant group differences for 10-year CHD risk; and possible crossover and inadequate blinding.

"This contribution extends the existing data in that a single multipurpose exercise program that is based on a low-volume, high-intensity philosophy and is designed for the elderly improves overall fitness, maintains bone health, and reduces fall risk," the study authors conclude. "Because this training regimen can be easily adopted by other institutions and health care providers, a broad implementation of this program is feasible."

The Siemens Betriebs Krankenkasse, Behinderten-undRehabilitations-Sportverband Bayern, Netzwerk Knochengesundheit e.V.,Opfermann Arzneimittel GmbH, Thera-Band, Institute of Sport Science, and Institute of Medical Physics supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:179-185.