Integrating Patient-Centered Exercise Coaching into Primary Care to Reduce Fragility Fracture

What was the research about? After older adults fall and fracture a bone, regular exercise can decrease the risk of falls and help prevent another bone fracture. In this study, the research team compared two ways of reducing bone fractures from falls in adults ages 65 and older who had fallen and fractured a bone in the past: Exercise with coaching. Patients went to exercise classes for strength, balance, and walking. A trained volunteer led in-person group classes. Patients could also request to do classes at home with an exercise DVD. During the COVID-19 pandemic, in-person classes moved to a virtual format. A coach met with patients in person or by phone and encouraged them to exercise. Every six months, doctors received reports on the patients' progress. Usual care plus information. Patients received a list of exercises and information about how to prevent falls. What were the results? After three years, patients who received exercise with coaching and patients who received usual care didn't differ in: The risk of serious injury or bone fractures due to a fall Depression, loneliness, and anxiety Physical function Belief that they had a lower risk of falling Minutes of physical activity per week Patients who received exercise with coaching reported more minutes of strength training per week than patients who received usual care (64 minutes versus 36 minutes). Who was in the study? The study included 1,139 older patients with a previous fall injury. All received care from one of three health systems in Pennsylvania. Among patients, 91 percent were White, and 9 percent were a race other than White. Also, 64 percent were between the ages of 65 and 75, and 84 percent were women. What did the research team do? The research team assigned patients by chance to receive exercise with coaching or usual care plus information. Every four months for three years, the research team called patients to ask about falls. When a fall led to a healthcare visit, the team requested health records to confirm the severity of the fall. At the start of the study and every year, the team asked patients about depression, loneliness, anxiety, their risk of falling, and physical function. Patients with a history of fall injuries, agencies on aging, and clinicians provided input throughout the study. What were the limits of the study? Trained peer volunteers led the exercise classes. Patients took part in fewer exercise classes toward the end of the study. Results may have differed if paid staff with a background in health or exercise led the classes or if patients took part in more classes. Future research could look at other ways to encourage exercise among older adults who have fallen and fractured a bone in the past. How can people use the results? Organizations that serve older adults can use the results when considering ways to encourage exercise among older adults who have fallen and fractured a bone in the past.