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Published in: Osteoporosis International 7/2010

Open Access 01-07-2010 | Original Article

Is there a U-shaped association between physical activity and falling in older persons?

Authors: G. M. E. E. Peeters, N. M. van Schoor, S. M. F. Pluijm, D. J. H. Deeg, P. Lips

Published in: Osteoporosis International | Issue 7/2010

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Abstract

Summary

This study tests whether the relationship between physical activity and (recurrent) falling is U-shaped. Among 1,337 community-dwelling older persons, no evidence for a nonlinear association was found. If all older persons increase their physical activity level with 100 units, 4% may be prevented to become recurrent fallers.

Introduction

Previous studies suggest a U-shaped relationship between physical activity and falling. This study tests this hypothesis and examines whether this relationship is modified by level of physical functioning.

Methods

Community-dwelling persons (65+) from the Longitudinal Aging Study Amsterdam (LASA) were prospectively followed on falls for 3 years after baseline assessment in 1995/1996 (n = 1,337). Outcome measures were time to first fall and time to recurrent falling. The LASA Physical Activity Questionnaire was used to calculate physical activity in minutes per day weighted for intensity (range 0–2000). Physical functioning was measured with physical performance tests and self reported functional limitations. Confounders were age, sex, body mass index, chronic diseases, psychotropic medication, cognitive functioning, depressive symptoms, and fear of falling.

Results

No evidence for a nonlinear association was found (p for physical activity2 > 0.20). No significant association was found between physical activity and time to first fall. An increase in physical activity of 100 units led to a 4% decrease in risk of recurrent falling (adjusted hazard ratio 0.96, 95% confidence interval 0.92, 0.99). No interactions with physical performance or functional limitations were found (p > 0.50).

Conclusions

The hypothesized U-shaped relationship between physical activity and falling could not be confirmed. At higher levels of physical activity, the risk of recurrent falling decreased, while no association was found with fall risk.
Literature
1.
go back to reference Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P (1998) Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 13(12):1932–1939CrossRefPubMed Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P (1998) Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 13(12):1932–1939CrossRefPubMed
2.
go back to reference Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707PubMed Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707PubMed
3.
go back to reference Stel VS, Smit JH, Pluijm SM, Lips P (2004) Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 33(1):58–65CrossRefPubMed Stel VS, Smit JH, Pluijm SM, Lips P (2004) Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 33(1):58–65CrossRefPubMed
4.
go back to reference Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI (2007) Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 36(3):304–309CrossRefPubMed Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI (2007) Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 36(3):304–309CrossRefPubMed
5.
go back to reference Dunn JE, Rudberg MA, Furner SE, Cassel CK (1992) Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health 82(3):395–400CrossRefPubMed Dunn JE, Rudberg MA, Furner SE, Cassel CK (1992) Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health 82(3):395–400CrossRefPubMed
6.
go back to reference Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65(3):183–187CrossRefPubMed Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65(3):183–187CrossRefPubMed
7.
go back to reference Youm T, Koval KJ, Kummer FJ, Zuckerman JD (1999) Do all hip fractures result from a fall? Am J Orthop 28(3):190–194PubMed Youm T, Koval KJ, Kummer FJ, Zuckerman JD (1999) Do all hip fractures result from a fall? Am J Orthop 28(3):190–194PubMed
8.
go back to reference O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137(3):342–354PubMed O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137(3):342–354PubMed
9.
go back to reference Gregg EW, Pereira MA, Caspersen CJ (2000) Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc 48(8):883–893PubMed Gregg EW, Pereira MA, Caspersen CJ (2000) Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc 48(8):883–893PubMed
10.
go back to reference Tinetti ME, Williams CS (1998) The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 53(2):M112–M119PubMed Tinetti ME, Williams CS (1998) The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 53(2):M112–M119PubMed
11.
go back to reference Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44(4):M112–M117PubMed Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44(4):M112–M117PubMed
12.
go back to reference Chan BK, Marshall LM, Winters KM, Faulkner KA, Schwartz AV, Orwoll ES (2007) Incident fall risk and physical activity and physical performance among older men: the Osteoporotic Fractures in Men Study. Am J Epidemiol 165(6):696–703CrossRefPubMed Chan BK, Marshall LM, Winters KM, Faulkner KA, Schwartz AV, Orwoll ES (2007) Incident fall risk and physical activity and physical performance among older men: the Osteoporotic Fractures in Men Study. Am J Epidemiol 165(6):696–703CrossRefPubMed
13.
go back to reference Graafmans WC, Lips P, Wijlhuizen GJ, Pluijm SM, Bouter LM (2003) Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting. Z Gerontol Geriatr 36(1):23–28CrossRefPubMed Graafmans WC, Lips P, Wijlhuizen GJ, Pluijm SM, Bouter LM (2003) Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting. Z Gerontol Geriatr 36(1):23–28CrossRefPubMed
14.
go back to reference Heesch KC, Byles JE, Brown WJ (2008) Prospective association between physical activity and falls in community-dwelling older women. J Epidemiol Community Health 62(5):421–426CrossRefPubMed Heesch KC, Byles JE, Brown WJ (2008) Prospective association between physical activity and falls in community-dwelling older women. J Epidemiol Community Health 62(5):421–426CrossRefPubMed
15.
go back to reference Puts MT, Lips P, Deeg DJ (2005) Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol 58(11):1188–1198CrossRefPubMed Puts MT, Lips P, Deeg DJ (2005) Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol 58(11):1188–1198CrossRefPubMed
16.
go back to reference Szulc P, DuBoeuf F, Marchand F, Delmas PD (2004) Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr 80(2):496–503PubMed Szulc P, DuBoeuf F, Marchand F, Delmas PD (2004) Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr 80(2):496–503PubMed
17.
go back to reference Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P (2003) A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc 51(10):1356–1364CrossRefPubMed Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P (2003) A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc 51(10):1356–1364CrossRefPubMed
19.
go back to reference Kwaliteitsinstituut voor de Gezondheidszorg CBO (2002) Osteoporose. Tweede herziene richtlijn. Van Zuiden Communications B.V. Alphen aan den Rijn, the Netherlands Kwaliteitsinstituut voor de Gezondheidszorg CBO (2002) Osteoporose. Tweede herziene richtlijn. Van Zuiden Communications B.V. Alphen aan den Rijn, the Netherlands
20.
go back to reference Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P (1996) Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 143(11):1129–1136PubMed Graafmans WC, Ooms ME, Hofstee HM, Bezemer PD, Bouter LM, Lips P (1996) Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 143(11):1129–1136PubMed
21.
go back to reference Deeg DJ, van Tilburg T, Smit JH, de Leeuw ED (2002) Attrition in the longitudinal aging study Amsterdam. The effect of differential inclusion in side studies. J Clin Epidemiol 55(4):319–328CrossRefPubMed Deeg DJ, van Tilburg T, Smit JH, de Leeuw ED (2002) Attrition in the longitudinal aging study Amsterdam. The effect of differential inclusion in side studies. J Clin Epidemiol 55(4):319–328CrossRefPubMed
22.
go back to reference Smith JH, de Vries MZ (1994) Procedures and results of the field work. In: Deeg DJH, Westendorp-de Serriere M (eds) Autonomy and well-being in the aging population I: report from the Longitudinal Aging Study Amsterdam 1992–1993. Vu University Press, Amsterdam, pp 7–13 Smith JH, de Vries MZ (1994) Procedures and results of the field work. In: Deeg DJH, Westendorp-de Serriere M (eds) Autonomy and well-being in the aging population I: report from the Longitudinal Aging Study Amsterdam 1992–1993. Vu University Press, Amsterdam, pp 7–13
23.
go back to reference Stel VS, Smit JH, Pluijm SM, Lips P (2003) Balance and mobility performance as treatable risk factors for recurrent falling in older persons. J Clin Epidemiol 56(7):659–668CrossRefPubMed Stel VS, Smit JH, Pluijm SM, Lips P (2003) Balance and mobility performance as treatable risk factors for recurrent falling in older persons. J Clin Epidemiol 56(7):659–668CrossRefPubMed
24.
go back to reference Kellogg International Work (1987) The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Dan Med Bull 34(Suppl 4):1–24 Kellogg International Work (1987) The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Dan Med Bull 34(Suppl 4):1–24
25.
go back to reference Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17(3):417–425CrossRefPubMed Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17(3):417–425CrossRefPubMed
26.
go back to reference Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004) Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 57(3):252–258CrossRefPubMed Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004) Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol 57(3):252–258CrossRefPubMed
27.
go back to reference Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80CrossRefPubMed Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80CrossRefPubMed
28.
go back to reference Caspersen CJ, Bloemberg BP, Saris WH, Merritt RK, Kromhout D (1991) The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985. Am J Epidemiol 133(11):1078–1092PubMed Caspersen CJ, Bloemberg BP, Saris WH, Merritt RK, Kromhout D (1991) The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985. Am J Epidemiol 133(11):1078–1092PubMed
29.
go back to reference Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94PubMed Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94PubMed
30.
go back to reference Kriegsman DM, Deeg DJ, van Eijk JT, Penninx BW, Boeke AJ (1997) Do disease specific characteristics add to the explanation of mobility limitations in patients with different chronic diseases? A study in The Netherlands. J Epidemiol Community Health 51(6):676–685CrossRefPubMed Kriegsman DM, Deeg DJ, van Eijk JT, Penninx BW, Boeke AJ (1997) Do disease specific characteristics add to the explanation of mobility limitations in patients with different chronic diseases? A study in The Netherlands. J Epidemiol Community Health 51(6):676–685CrossRefPubMed
31.
go back to reference Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. J Clin Epidemiol 49(12):1407–1417CrossRefPubMed Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy. J Clin Epidemiol 49(12):1407–1417CrossRefPubMed
32.
go back to reference Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMed Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMed
33.
go back to reference Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45(6):239–243 Tinetti ME, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45(6):239–243
34.
go back to reference Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. (2009) Interventions for preventing falls in older people living in the community. Cochrane Database of Syst Rev (2) CD007146. doi:10.1002/14651858.CD007146.pub2 Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. (2009) Interventions for preventing falls in older people living in the community. Cochrane Database of Syst Rev (2) CD007146. doi:10.​1002/​14651858.​CD007146.​pub2
35.
go back to reference Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56(12):2234–2243CrossRefPubMed Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56(12):2234–2243CrossRefPubMed
36.
go back to reference Jorstad-Stein EC, Hauer K, Becker C, Bonnefoy M, Nakash RA, Skelton DA, Lamb SE (2005) Suitability of physical activity questionnaires for older adults in fall-prevention trials: a systematic review. J Aging Phys Act 13(4):461–481PubMed Jorstad-Stein EC, Hauer K, Becker C, Bonnefoy M, Nakash RA, Skelton DA, Lamb SE (2005) Suitability of physical activity questionnaires for older adults in fall-prevention trials: a systematic review. J Aging Phys Act 13(4):461–481PubMed
37.
go back to reference Visser M, Pluijm SM, van der Horst MH, Poppelaars JL, Deeg DJ (2005) Lifestyle of Dutch people aged 55–64 years less healthy in 2002/'03 than in 1992/'93. Ned Tijdschr Geneeskd 149(53):2973–2978PubMed Visser M, Pluijm SM, van der Horst MH, Poppelaars JL, Deeg DJ (2005) Lifestyle of Dutch people aged 55–64 years less healthy in 2002/'03 than in 1992/'93. Ned Tijdschr Geneeskd 149(53):2973–2978PubMed
Metadata
Title
Is there a U-shaped association between physical activity and falling in older persons?
Authors
G. M. E. E. Peeters
N. M. van Schoor
S. M. F. Pluijm
D. J. H. Deeg
P. Lips
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2010
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-1053-4

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