Penn State College of Medicine was awarded nearly $14 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) to study the effectiveness of a program integrating strength training, balance exercises and walking for older adults who have had a fall-related fracture.
Christopher Sciamanna, professor of medicine and public health services, and his team will enroll 2,000 adults at least 65 years old who have had a fall-related fracture for the three-year study.
"Less than 5 percent of older adults get as much exercise as is recommended to stay fit and strong and to avoid fractures," Sciamanna said. "After a fracture occurs, people get even less exercise because they are concerned about falling. This creates a vicious cycle in which each fall causes people to further limit their activities, which further increases the risk for falling."
To overcome these barriers, the study will have exercise groups led by trained volunteers in community settings. Using a coach can address hesitation to exercise caused by not knowing how to do so safely.
Smaller studies by Sciamanna's team have shown that exercise assisted by a coach reduced the risk of a fracture by two-thirds. By studying a larger sample of adults, insurance companies and Medicare will have the data to determine if such a service should be covered.
The researchers will examine the effect of the key outcomes important to patients, their doctors and insurance companies. In addition to recording fall-related injuries, the study will also assess muscle strength, bone strength, loneliness, depression and use of emergency medical care. Patient surveys determined these additional measures are important. Patient input has helped Sciamanna develop an exercise program, which helped inspire this study.
"Using this input, we developed a strength-training program called Band Together that is both effective and enjoyable," Sciamanna said.
The program is currently available at 15 sites in central Pennsylvania, giving an opportunity for peer support during exercise.
The current study will use the same concept as Band Together, but with more walking, more balance exercises and a coach to help overcome barriers to exercise.
Building on the patient involvement started with the Band Together initiative, three patients will be co-investigators on the current study and provide input. Other partners on the study include Health Dialog, The American College of Sports Medicine, American Orthopaedic Association, National Osteoporosis Foundation and Highmark Blue Shield.
Sciamanna's team believes that patients who do not receive exercise coaching will be almost twice as likely to suffer a fracture or other fall-related injury than those who do receive coaching.
Sciamanna's award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI's funding awards, visit the Research and Results page on http://www.