Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall

Abstract

IMPORTANCEWhether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown.OBJECTIVE To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. DESIGN, SETTING, AND PARTICIPANTSA 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic.INTERVENTIONS Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. RESULTS Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported.CONCLUSIONS AND RELEVANCE Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.

The influence of age and overweight or obesity on foot sensitivity and postural control: A systematic review

“…5,19,26,27 This may be associated with a higher incidence of falls in older people, which is the third leading cause of chronic disability in this population. 32 However, any further association requires thorough investigation, given that cutaneous input may be less important for postural stability in walking than standing. 33 Moreover, the diversity of experimental approaches and confounder factors (eg fatigue, temperature and verbal commands) should be carefully considered when interpreting results from different studies.…”

“…36 Additionally, a strength and balance training program reduced the rate of subsequent falls in older people who have had a fall the previous year. 32 The rate of falls has been little explored in studies involving plantar sensitivity and balance, as this review shows that only one research described the number of falls. 19 Obesity was associated with lower plantar sensitivity in a group of adults 11 and women, 4 and was related to decreased postural stability.…”

Action Seniors! Cost‐Effectiveness Analysis of a Secondary Falls Prevention Strategy Among Community‐Dwelling Older Fallers

“…We conducted a cost‐effectiveness and cost‐utility analysis using patient‐level data from a 12‐month RCT that included 344 community‐dwelling older adults with a history of falls (ie, one or more falls in the past 12 months), aged 70 years and older. The primary results of the 12‐month RCT were previously reported . We conducted all analyses from a Canadian healthcare system perspective.…”

“…Thus, we conducted a concurrent prospective economic evaluation alongside a 12‐month RCT among community‐dwelling older adults, aged 70 years and older, who had already had a fall (ie, secondary prevention). The results of the 12‐month RCT—focused particularly on falls prevented—were previously reported and demonstrated a 36% reduction in the rate of falling among individuals receiving the OEP . All participants attended a geriatrician‐led Falls Pevention Clinic, where we assessed the efficacy and the cost‐effectiveness of the OEP as a secondary falls prevention strategy.…”

Social marketing interventions to promote physical activity among elderly people : a systematic review of the literature

“…Falls are a significant source of morbidity in people aged 65 and over, affecting one in three people in this age group (3). Physical activity (PA) represents the most effective method for preventing falls among seniors (3,4) while PA interventions focusing on balance are the most effective way of preventing loss of autonomy among seniors living at home (5,6).…”