1. In this randomized controlled trial examining elderly women, exercise reduced the risk of falls requiring medical attention.
2. However, vitamin D supplementation and exercise did not significantly influence the overall rate of falls.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Falls in older adults result in great morbidity due to injury. Therefore, it is important to determine factors that influence the risk of fall. While it is readily established that vitamin D supplementation decreases bone loss and risk of fracture, it is not known if vitamin D with or without an exercise regimen decreases the risk of falls in the elderly. This study aimed to investigate the separate and combined effects of multimodal exercise training and vitamin D supplementation in decreasing falls among older women.
Both vitamin D administration and exercise regimens did not significantly decrease the rate of falls in the elderly women. However, the rate of falls resulting in injury decreased by just over 50% in the exercise and vitamin D with exercise only groups. Strengths of the study include being a placebo-controlled, double-blinded, randomized controlled trial with four interventional arms and low loss to follow-up rates. Limitations of this study include not being able to study the impact of vitamin D on women who are vitamin D depleted, as well as the fact that men were not included the study.
In-Depth [randomized controlled trial]: This double-blind, placebo-controlled trial was performed between April 2010 and March 2013 in Finland, and randomized 409 women aged 70 to 80 years to one of four intervention arms: vitamin D (800 IU/day) & exercise; placebo & exercise, vitamin D without exercise, and placebo without exercise. Exercise consisted of group-training classes for both strength and balance regimens. The primary outcome was monthly reported falls and injurious falls (falls for which the participant sought medical care). Using an intention-to-treat protocol, data was analyzed using negative binomial and Cox proportional hazards regression models.
The women across the four interventional groups did not differ significantly on baseline age and anthropometrical characteristics. In total, there were 928 falls from 281 fallers. There were no significant reductions in the rate of falls due to vitamin D or exercise. However, there was a significant reduction in injurious falls among exercisers with vitamin D (HR 0.38, 95% CI 0.17-0.83) and in exercisers without vitamin D (HR 0.47, 95% CI 0.23-0.99). The number of multiple fallers and multiple injured fallers were distributed similarly across all groups.
When we exercise we are doing a very good thing to our health because we are not meant to be sedentary. When we do exercise we are activating our body, so we are not only doing what we love (in my case), but we are also making our future brighter.
I have to say I find it a bit odd that there seemed to be no focus on calcium in this study? Vitamin D is usually associated with risk of falls and fractures because of its role in calcium absorption, likewise with exercise, as both are closely correlated with bone density. Essentially vitamin D alone can’t do the job, you need a good source of calcium as well – such as dark green leafy vegetables. Dairy is no longer considered a good source because the acid-forming nature of the animal protein is contains effectively wipes out any meaningful uptake of calcium. Maybe I’m missing something. But in any case, exercise outdoors in the sunshine, which provides both vitamin and exercise is a simple way of achieving a positive outcome, and I’m sure will leave the patient feeling better as well 🙂