Move It or Lose It:
A Clear Return on Investment

It’s budget time around my hospital system, so I’m thinking a lot about the ever-important return on investment (ROI). That endless quest for economic value has me thinking of the clinical corollary for disease prevention. Where’s some ROI we can provide for our patients? Some of the strongest data for ROI I’ve seen lately concern the range of benefits older adults receive from good old-fashioned exercise.

Boost Brain Fitness
Believe it or not, the evidence for improving brain fitness continues to be strongest for physical exercise, even more so than cognitive pursuits, such as word games. The data are so compelling that if a patient tells me he or she has only 10 minutes to invest in health maintenance, I’d say put down the crossword puzzle and take a walk. Research performed by the National Institutes of Health concluded, “Longitudinal observational studies show an association between higher levels of physical activity and a reduced risk of cognitive decline and dementia.”

Exercise and Fall Prevention
The updated Cochrane Review of fall prevention interventions found strong evidence of a link between physical exercise and fall prevention.

Researchers found evidence of effectiveness for a number of different approaches to fall prevention, some in all older adults living in the community and others in particular subgroups. This evidence may not be applicable to older individuals with dementia, as most included studies excluded them from participation. The updated review indicated the following:

• There is strong evidence that certain exercise programs prevent falls. Group exercise classes and exercises delivered individually at home reduce the rate of falls and the risk of falling. Tai chi as a group exercise reduces the risk of falling but is less effective in those at higher risk of falling. Overall, exercise programs aimed at reducing falls appear to reduce fractures.
• Multifactorial interventions integrating assessment with individualized intervention, usually involving a multidisciplinary team, are effective in reducing the rate of falls but not the risk of falling.

Home safety interventions reduce the rate of falls and the risk of falling. These interventions are more effective in people at higher risk of falling and when delivered by an occupational therapist.1

The Centers for Disease Control and Prevention STEADI program offers a comprehensive toolkit for primary care providers, available at www.cdc.gov/steadi/materials.html.

The STEADI interventions, Phase One, provide the following three steps clinicians can complete in a single visit:

• Ask patients whether they’ve fallen in the past year, feel unsteady, or worry about falling.
• Review medications and stop, switch, or reduce the dosage of drugs that increase fall risk.
• Recommend vitamin D supplements of at least 800 IU/day with calcium.

The National Council on Aging has declared September 22, 2016, as Falls Prevention Day. Visit www.ncoa.org/healthy-aging/falls-prevention for extensive information about fall prevention information you can provide to patients, including information about home safety inspection and exercise recommendations.

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.

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