***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent disability in an elderly population . Design . R and omized , controlled trial with intention-to-treat and subgroup analyses . Subjects and setting . All home-dwelling persons aged 85 years or older in the City of Oulu ( n = 555 , 67 % ) , including 486 persons with a history of recurrent falls or at least one risk factor for disability in the activities of daily living ( ADL ) or mobility . Interventions . Programme consisting of home exercise , walking exercise , group exercise , and self-care exercise . Main outcome measures . Change in ADL and mobility during the intervention . Results . Change in ADL performance did not differ ( p = 0.462 ) but a positive change was found in mobility performance ( p = 0.013 ) in the intervention subjects ( n = 243 ) compared with the controls ( n = 243 ) . At the end of the intervention period , severe mobility restrictions existed similarly in intervention and control subjects : 48 ( 34 % ) and 46 ( 31 % ) ( p = 0.650 ) respectively . Frequency of admissions into long-term institutional care were similar in intervention and control groups : 15 ( 7 % ) and 13 ( 6 % ) ( p = 0.669 ) . Impaired balance existed in fewer intervention subjects ( 64 , 45 % ) than controls ( 89 , 59 % ) ( p = 0.015 ) . Frequency and times of home exercise activity reduced in control subjects ( p < 0.001 ) but did not change in subjects assigned to home exercise intervention ( p > 0.05 ) . Conclusion . A pragmatic intervention slowed down the reduction of movement performance but positive effects could not be found in subjects with severe movement and any ADL dysfunction . Positive effects were also found in balance performance Background Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT STUDY OBJECTIVE In the causative mechanism of falls among older community dwellers , slips and trips have been found to be significant precursors . The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips , trips and falls among the well , older community . DESIGN Four groups with approximately equal numbers of participants were r and omly allocated to interventions . The prevention strategies included education and awareness raising of falls risk factors , exercise sessions to improve strength and balance , home safety advice to modify environmental hazards , and medical assessment to optimise health . The interventions combined the strategies in an add on approach . The first intervention group receiving the information session only was regarded as the control . The outcome of interest was the occurrence of a slip , trip or fall , monitored prospect ively using a daily calendar diary . PARTICIPANTS AND SETTING Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate . National Seniors clubs provide a forum for active , community dwelling Australians aged 50 and over to participate in policy , personal development and recreation . MAIN RESULTS Using Cox 's proportional hazards regression model , adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 ( 95 % CI 0.17 , 0.73 ) to 0.48 ( 0.25 , 0.91 ) for slips ; 0.29 ( 0.16 , 0.51 ) to 0.45 ( 0.27 , 0.74 ) for trips ; and 0.60 ( 0.36 , 1.01 ) to 0.82 ( 0.51 , 1.31 ) for falls . While calendar monitoring recorded outcome , it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical non-intervened group . At one year after intervention , reductions in the probability of slips , trips and falls ( 61(95%CI 54 , 66)% ; 56 ( 49 , 63)% ; 29 ( 22 , 36)% respectively ) were demonstrated . CONCLUSIONS This study makes an important contribution to the priority community health issue of falls prevention by showing that effective , sustainable , low cost programmes can be introduced through community-based organisations to reduce the incidence of slips , trips and falls in well , older people Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture BACKGROUND the study compares the effects of a Nintendo Wii exercise programme and a st and ard Gym-based exercise intervention on fear of falling , knee strength , physical function and falls rate in older adults . METHODS eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5 - 9 points and modified falls efficacy scale ( MFES ) score of ≤9 points participated in the parallel-group r and omised trial . Each intervention arm involved an hour of intervention per week , totalling 12 sessions over 12 weeks . Besides 1-year fall incidence , the participants were evaluated on MFES , knee extensor strength ( KES ) , timed-up- and -go test , gait speed , 6-minute walk test and narrow corridor walk test at weeks 13 and 24 . RESULTS at week 13 , between interventions , the effect of MFES changes did not reach statistical significance ( difference = -0.07 point , 95 % CI -0.56 to 0.42 , P = 0.78 ) ; at week 24 , the Wii group showed statistically significant effects over the Gym group ( difference = 0.8 point , 95 % CI 0.27 to 1.29 , P < 0.01 ) . For KES , the two groups did not differ statistically at week 13 ( difference = -2.0 % , 95 % CI -5.6 to -1.7 , P = 0.29 ) ; at week 24 , the Gym group had greater strength gains than the Wii group ( difference = -5.1 % , 95 % CI -8.7 to -1.5 , P < 0.01 ) . No between-group differences were observed for other outcome measures . CONCLUSION on completion of a 12-week Nintendo Wii exercise programme , there was no significant benefit seen on fear of falling when compared to a st and ard Gym-based exercise intervention ; however , post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training , despite knee strength apparently improving more in those allocated to the Gym . It is possible that long-term gains after using the Wii might be due to a carry-over effect . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12610000576022 OBJECTIVE To assess the effectiveness of psychotropic medication withdrawal and a home-based exercise program in reducing  falls in older people .  DESIGN A r and omized controlled trial with a two by two factorial design . SETTING Seventeen general practice s in Dunedin , New Zeal and . PARTICIPANTS Women and men aged 65 years registered with a general practitioner and currently taking psychotropic medication ( n = 93 ) . INTERVENTIONS Two interventions : ( 1 ) gradual withdrawal of psychotropic medication versus continuing to take psychotropic medication ( double blind ) and ( 2 ) a home-based exercise program versus no exercise program ( single blind ) . MEASUREMENTS Number of falls and falls risk during 44 weeks of follow-up . Analysis was on an intent to treat basis . RESULTS After 44 weeks , the relative hazard for falls in the medication withdrawal group compared with the group taking their original medication was .34 ( 95 % CI , .16-.74 ) . The risk of falling for the exercise program group compared with those not receiving the exercise program was not significantly reduced . CONCLUSIONS Withdrawal of psychotropic medication significantly reduced the risk of falling , but permanent withdrawal is very difficult to achieve Abstract Background Both exercise and vitamin D are recommended means to prevent falls among older adults , but their combined effects on fall-induced injuries are scarcely studied . Methods A 2-year follow-up of a previous 2-year r and omized controlled trial with vitamin D and exercise ( Ex ) of 409 older home-dwelling women using a factorial 2 × 2 design ( D−Ex− , D+Ex− , D−Ex+ , D+Ex+ ) . Besides monthly fall diaries , femoral neck bone mineral density ( fn-BMD ) , and physical functioning were assessed at 1 and 2 years after the intervention . Results After the intervention , S-25OHD concentrations declined to baseline levels in both supplement groups . The groups did not differ for change in fn-BMD or physical functioning , except for leg extensor muscle strength , which remained about 10 % greater in the exercise groups compared with the reference group ( D−Ex− ) . There were no between-group differences in the rate of all falls , but medically attended injurious falls reduced in D+Ex− and D−Ex+ groups compared with D−Ex−. However , all former treatment groups had less medically attended injured fallers , HRs ( 95 % CI ) being 0.62 ( 0.39–1.00 ) for D+Ex− , 0.46 ( 0.28–0.76 ) for D−Ex+ , and 0.55 ( 0.34–0.88 ) for D+Ex+ , compared with D−Ex−. Conclusions Exercise-induced benefits in physical functioning partly remained 2 years after cessation of supervised training . Although there was no difference in the rate of all falls , former exercise groups continued to have lower rate of medically attended injured fallers compared with referents even 2 years after 
    Output:
    
Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not .
AUTHORS ' CONCLUSIONS Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community ( high-certainty evidence ) .
The effects of such exercise programmes are uncertain for other non-falls outcomes .
Where reported , adverse events were predominantly non-serious .
Exercise programmes that reduce falls primarily involve balance and functional exercises , while programmes that probably reduce falls include multiple exercise categories ( typically balance and functional exercises plus resistance exercises ) .
Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise ( without balance and functional exercises ) , dance , or walking on the rate of falls