Karinkanta 2007.
| Methods | Study design: RCT Number of study arms: 4 Length of follow‐up: 12 months |
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| Participants | Setting: Tampere, Finland Number of participants: 149 Number analysed: 144 Number lost to follow‐up: 5 Sample: community‐dwelling women Age (years): Balance group mean 72.9 (SD 2.3), Combined group mean 72.9 (SD 2.2), Resistance group mean 72.7 (SD 2.5), Control group mean 72.0 (SD 2.1) Sex: 100% female Inclusion criteria: Willingness to participate, aged 70 ‐ 79 years, female, full understanding of the study procedures, no history of any illness that would contraindicate exercise or limiting participation in exercise, no history of any illness that affects the bones or balance, No uncorrected vision problems, not taking medications known to affect balance or bone metabolism (for 12 months prior to recruitment) Exclusion criteria: Already involved in intense exercise > twice a week BMD score T score < −2.5 in femoral neck |
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| Interventions | 1. Group‐based balance and agility training: static and dynamic balance, agility training, jumps and other impacts, and changes of direction exercises, 50‐minute sessions, 3 a week for 12 months 2. Group‐based balance and strength training: strength and balance training as described in (1) and (3) on alternate weeks, 50‐minute sessions, 3 a week for 12 months 3. Group‐based resistance training: tailored resistance exercises for large muscle groups using machines tailored up to 70 ‐ 80% of 1RM, 50‐minute sessions, 3 a week for 12 months 4. Control group: asked to maintain same level of activity |
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| Outcomes | 1. Rate of falls 2. Number of people who experienced 1 or fall‐related fractures 3. Number of people who experienced a fall requiring medical attention |
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| Duration of the study | 52 weeks | |
| Adherence | Adherence measured as attendance rate 1. Group‐based balance and agility training: mean attendance rate 59% 2. Group‐based balance and strength training: mean attendance rate 67% 3. Group‐based resistance training: mean attendance rate 74% |
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| Notes | Source of funding: Academy of Finland, the Finnish Ministry of Education, and the Medical Research Fund of the Tampere University Hospital Economic information: not reported |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Computer‐generated randomization list" |
| Allocation concealment (selection bias) | Low risk | Blinded statistician allocated participants |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and personnel unblinded but impact of unblinding unknown |
| Blinding of outcome assessment (detection bias) Falls | Unclear risk | Assume falls assessed using same method for all participants. Unclear whether researcher assessing files was blinded |
| Blinding of outcome assessment (detection bias) Fractures | Low risk | Medical files examined for fractures by researcher blinded to group allocation |
| Blinding of outcome assessment (detection bias) Hospital admission, medical attention and adverse events | Low risk | Medical files examined for injurious falls by researcher blinded to group allocation |
| Blinding of outcome assessment (detection bias) Health related quality of life (self report) | Unclear risk | Not applicable |
| Incomplete outcome data (attrition bias) Falls and fallers | Low risk | Less than 20% of fall outcome data are missing (3%). Missing data were balanced between balance group (n = 2), combination group (n = 2) and control (n = 1), with 2 participants dying (1 balance, 1 control) and the remaining 3 losing interest |
| Selective reporting (reporting bias) | High risk | Falls were measured, but number of fallers not reported. Adverse events not reported |
| Method of ascertaining falls (recall bias) | High risk | Medical files examined for injurious falls |