Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

Sara A. Suikkanen; Paula K. Soukkio; Eeva M. Aartolahti; Hannu Kautiainen; Sanna Kääriä; Markku T. Hupli; Sarianna Sipilä; Kaisu Pitkälä; Katriina  Kukkonen- Harjula

doi:10.1016/j.jamda.2020.06.005

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

Sara A. Suikkanen, Paula K. Soukkio, Eeva M. Aartolahti, Hannu Kautiainen, Sanna Kääriä, Markku T. Hupli, Sarianna Sipilä, Kaisu Pitkälä, Katriina Kukkonen- Harjula

Research output: Contribution to journal › Article › Scientific › peer-review

Abstract

Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.

Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17.

Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.

Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group

Conclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.

Original language	English
Journal	Journal of the American Medical Directors Association
Volume	22
Issue number	4
Pages (from-to)	773-779
Number of pages	7
ISSN	1525-8610
DOIs	https://doi.org/10.1016/j.jamda.2020.06.005
Publication status	Published - Apr 2021
MoE publication type	A1 Journal article-refereed

Fields of Science

3121 General medicine, internal medicine and other clinical medicine

Access to Document

10.1016/j.jamda.2020.06.005

Effects of Home-Based Physical ExerciseAccepted author manuscript, 609 KBLicence: CC BY-NC-ND

Cite this

Suikkanen, S. A., Soukkio, P. K., Aartolahti, E. M., Kautiainen, H., Kääriä, S., Hupli, M. T., Sipilä, S., Pitkälä, K., & Kukkonen- Harjula, K. (2021). Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial. Journal of the American Medical Directors Association, 22(4), 773-779. https://doi.org/10.1016/j.jamda.2020.06.005

@article{2a79fbaae3d64a43b24fb7b6a08f18b3,

title = "Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial",

abstract = "Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17.Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for groupConclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.(c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.",

keywords = "3121 General medicine, internal medicine and other clinical medicine",

author = "Suikkanen, {Sara A.} and Soukkio, {Paula K.} and Aartolahti, {Eeva M.} and Hannu Kautiainen and Sanna K{\"a}{\"a}ri{\"a} and Hupli, {Markku T.} and Sarianna Sipil{\"a} and Kaisu Pitk{\"a}l{\"a} and {Kukkonen- Harjula}, Katriina",

year = "2021",

month = apr,

doi = "10.1016/j.jamda.2020.06.005",

language = "English",

volume = "22",

pages = "773--779",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

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Suikkanen, SA , Soukkio, PK, Aartolahti, EM, Kautiainen, H, Kääriä, S, Hupli, MT, Sipilä, S, Pitkälä, K & Kukkonen- Harjula, K 2021, 'Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial', Journal of the American Medical Directors Association, vol. 22, no. 4, pp. 773-779. https://doi.org/10.1016/j.jamda.2020.06.005

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial. / Suikkanen, Sara A.; Soukkio, Paula K.; Aartolahti, Eeva M. et al.
In: Journal of the American Medical Directors Association, Vol. 22, No. 4, 04.2021, p. 773-779.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons

T2 - Randomized Controlled Trial

AU - Suikkanen, Sara A.

AU - Soukkio, Paula K.

AU - Aartolahti, Eeva M.

AU - Kautiainen, Hannu

AU - Kääriä, Sanna

AU - Hupli, Markku T.

AU - Sipilä, Sarianna

AU - Pitkälä, Kaisu

AU - Kukkonen- Harjula, Katriina

PY - 2021/4

Y1 - 2021/4

N2 - Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17.Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for groupConclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.(c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.

AB - Objectives: Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored.Design: Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and Participants: A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: >65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score >17.Methods: Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records.Results: The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for groupConclusions and Implications: Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.(c) 2020 AMDA The Society for Post-Acute and Long-Term Care Medicine.

KW - 3121 General medicine, internal medicine and other clinical medicine

U2 - 10.1016/j.jamda.2020.06.005

DO - 10.1016/j.jamda.2020.06.005

M3 - Article

SN - 1525-8610

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JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 4

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