Background: Evidence for the effects of exercise and vitamin D supplementation on quality of life (QoL), fear of falling (FoF) and mental wellbeing in older adults is conflicting. Objective: To study the effects of vitamin D supplementation and multimodal group exercise on psychosocial functions of wellbeing, including QoL, mental wellbeing and FoF. Method: This is a 2-year, double-blind, placebo-controlled vitamin D and open exercise intervention trial with 409 older Finnish women (70-80 years of age) randomized to 4 treatment arms: (1) placebo without exercise, (2) vitamin D (800 IU/day) without exercise, (3) placebo and exercise, and (4) vitamin D (800 IU/day) with exercise. Exercisers participated in group exercise twice per week for 12 months and once per week for the subsequent 12 months, plus home exercises. Results: When comparing with the placebo without exercise group, there were no statistically significant differences between groups receiving either vitamin D, exercise or both treatments for changes in QoL or mental wellbeing (although a slight decline was seen in mental wellbeing in those receiving vitamin D only, p = 0.044). The initial slight reduction in FoF was significant in all intervention groups compared with controls (p < 0.05), but this was only temporary. Conclusion: Neither vitamin D nor exercise contributes to better QoL, FoF or mental wellbeing in community-dwelling healthy older women with sufficient vitamin D levels.

Keywords:
Vitamin D, Exercise, Mental wellbeing, Quality of life, Fear of falling, Older adults
1.
La Grow S, Yeung P, Towers A, Alpass F, Stephens C: The impact of mobility on quality of life among older persons. J Aging Health 2013;25:723-736.
2.
Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen T, Webster IW, Eisman JA: Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Austr 1994;160:684-691.
3.
Austin N, Devine A, Dick I, Prince R, Bruce D: Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc 2007;55:1598-1603.
4.
Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D: Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 2004;33:368-373.
5.
Gillison FB, Skevington SM, Sato A, Standage M, Evangelidou S: The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis. Soc Sci Med 2009;68:1700-1710.
6.
Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K: Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev 2014;11:CD009848.
7.
Patil R, Uusi-Rasi K, Pasanen M, Kannus P, Karinkanta S, Sievanen H: Concern about falling in older women with a history of falls: associations with health, functional ability, physical activity and quality of life. Gerontology 2014;60:22-30.
8.
Bize R, Johnson JA, Plotnikoff RC: Physical activity level and health-related quality of life in the general adult population: a systematic review. Prev Med 2007;45:401-415.
9.
Heesch KC, van Uffelen JG, van Gellecum YR, Brown WJ: Dose-response relationships between physical activity, walking and health-related quality of life in mid-age and older women. J Epidemiol Comm Health 2012;66:670-677.
10.
Imayama I, Alfano CM, Cadmus Bertram LA, Wang C, Xiao L, Duggan C, McTiernan A: Effects of 12-month exercise on health-related quality of life: a randomized controlled trial. Prev Med 2011;52:344-351.
11.
Karinkanta S, Nupponen R, Heinonen A, Pasanen M, Sievänen H, Uusi-Rasi K, Fogelholm M, Kannus P: Effects of exercise on health-related quality of life and fear of falling in home-dwelling older women. J Aging Phys Act 2012;20:198-214.
12.
El-Khoury F, Cassou B, Charles MA, Dargent-Molina P: The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f6234.
13.
Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, Sievänen H: Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Int Med 2015:175:703-711.
14.
Bischoff-Ferrari H, Dawson-Hughes B, Willett W, Staehelin H, Bazemore M, Zee R, Wong J: Effect of Vitamin D on falls: a meta-analysis. JAMA 2004;291:1999-2006.
15.
Kalyani R, Stein B, Valiyil R, Manno R, Maynard J, Crews D: Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. J Am Geriatr Soc 2010;58:1299-1310.
16.
Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H: Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int 2009;20:315-322.
17.
Anglin RE, Samaan Z, Walter SD, McDonald SD: Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry 2013;202:100-107.
18.
Rafiq R, Swart KM, van Schoor NM, Deeg DJ, Lips P, de Jongh RT: Associations of serum 25-hydroxyvitamin D concentrations with quality of life and self-rated health in an older population. J Clin Endocrinol Metabol 2014;99:3136-3143.
19.
Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ: Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat 2005;29:21-30.
20.
Shaffer JA, Edmondson D, Wasson LT, Falzon L, Homma K, Ezeokoli N, Li P, Davidson K: Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials. Psychosom Med 2014;76:190-196.
21.
Patil R, Uusi-Rasi K, Tokola K, Karinkanta S, Kannus P, Sievanen H: Effects of a multimodal exercise program on physical function, falls and injuries among older women: a two-year community-based, randomized controlled trial. J Am Geriatr Soc 2015;63:1306-1313.
22.
Uusi-Rasi K, Kannus P, Karinkanta S, Pasanen M, Patil R, Lamberg-Allardt C, Sievänen H: Study protocol for prevention of falls: a randomized controlled trial of effects of vitamin D and exercise on falls prevention. BMC Geriatr 2012;12:12.
23.
De Leo D, Diekstra R, Lonnquist J, Trabicchi M, Cleiren M, Frisoni G, Dello Buono M, Haltunen A, Zucchetto M, Rozzini R, Grigoletto F, Sampaio-Faria J: LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behav Med 1998;24:17-27.
24.
Bech P, Olsen LR, Kjoller M, Rasmussen NK: Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. Int J Methods Psychiatr Res 2003;12:85.
25.
Bech P: Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsletter 2004;32:15-16.
26.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 2005;34:614-619.
27.
Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR: The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 2010;39:210-216.
28.
Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, et al: Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330:1003.
29.
Witham MD, Crighton LJ, Gillespie ND, Struthers AD, McMurdo ME: The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial. Circ Heart Fail 2010;3:195-201.
30.
Sanders KM, Stuart AL, Williamson EJ, Jacka FN, Dodd S, Nicholson G, Berk M: Annual high-dose vitamin D3 and mental well-being: randomised controlled trial. Br J Psychiatry 2011;198:357-364.
31.
Åberg V, Norenstedt S, Zedenius J, Sääf M, Nordenström J, Pernow Y, Nilsson IL: Health-related quality of life after successful surgery for primary hyperparathyroidism: no additive effect from vitamin D supplementation: results of a double-blind randomized study. Eur J Endocrinol 2015;172:181-187.
32.
Dechamps A, Diolez P, Thiaudiere E, Tulon A, Onifade C, Vuong T, Helmer C, Bourdel-Marchasson I: Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial. Arch Int Med 2010;170:162-169.
33.
Frandsen TB, Pareek M, Hansen JP, Nielsen CT: Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: a double-blind randomised placebo-controlled trial. BMC Res Notes 2014;7:528.
34.
Li G, Mbuagbaw L, Samaan Z, Falavigna M, Zhang S, Adachi JD, et al: Efficacy of vitamin D supplementation in depression in adults: a systematic review. J Clin Endocrinol Met 2014;99:757-767.
35.
Bridle C, Spanjers K, Patel S, Atherton NM, Lamb SE: Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2012;201:180-185.
36.
Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE: Exercise for depression. Cochrane Database Syst Rev 2013;9:CD004366.
37.
El-Khoury F, Cassou B, Latouche A, Aegerter P, Charles MA, Dargent-Molina P: Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial. BMJ 2015;351:h3830.
38.
Zijlstra G: Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 2007;55:603-615.
39.
Halvarsson A, Olsson E, Faren E, Pettersson A, Stahle A: Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clin Rehabil 2011;25:1021-1031.
40.
Wolf B, Feys H, de Weerdt W, van der Meer J, Noom M, Aufdemkampe G: Effect of a physical therapeutic intervention for balance problems in the elderly: a single-blind, randomized, controlled multicentre trial. Clin Rehabil 2001;15:624-636.
41.
Schacht E, Ringe J: Alfacalcidol improves muscle power, muscle function and balance in elderly patients with reduced bone mass. Rheumatol Int 2012;32:207-215.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.