Exercise for preventing falls in older people living in the community

Sherrington, Catherine; Tiedemann, Anne; Fairhall, Nicola; Hopewell, Sally; Michaleff, Zoe A; Howard, Kirsten; Clemson, Lindy; Lamb, Sarah E

doi:10.1002/14651858.cd012424.pub2

Cited by 685 publications

(743 citation statements)

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“…37 38 Weight-bearing impact exercise and/or resistance training promotes strong bones and improves physical performance, 38 while exercise interventions incorporating balance and functional training reduce rate of falls and number of fallers in older people at high-risk of falls living in the community. 39 In people with bone fragility, we found sufficient evidence that multicomponent exercise incorporating dynamic weightbearing, strength and balance training undertaken 2 to 3 days a week for at least 10 weeks, reduces risk of falling, 40 and some evidence that multicomponent exercise undertaken for >1 year positively influences BMD. 35 41 Evidence about whole body vibration or low impact exercise is limited and insufficient to determine effect on bone health-related outcomes in people with bone fragility.…”

Section: Recommendationmentioning

confidence: 74%

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

et al. 2020

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ObjectiveTo establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.MethodsPoints to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated.ResultsTwo overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6.ConclusionThese first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.

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Section: Recommendationmentioning

confidence: 74%

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

et al. 2020

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“…Background Falls among the increasing older population is a growing problem in society globally, and actions to prevent falls is necessary. Exercise programmes have been shown to be important interventions for community-dwelling seniors to reduce both rate and risk of falls [1,2]. Fall and fall related injuries lead to substantial health care costs, for example in 2015 the cost was estimated at $ 50 billion in the US [3].…”

Section: Trial Registration: Clintrial: Nct02916849mentioning

confidence: 99%

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

Månsson

Lundin-Olsson

Skelton

et al. 2020

Preprint

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Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet.Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.Results: Sixty-seven participants, with mean age 77±4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p=.078). In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p=.001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p=.026) degree of being content, and feeling supported by the programme (p=.044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p=.036).Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.Trial registration: ClinTrial: NCT02916849

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“…29 Balance and coordination exercises from the OTAGO programme 30 will also be incorporated since it has been reported that a combination of RET and balance exercises were more effective at reducing the rate of falls than balance or function exercise alone. 31 The specialist exercise instructor has over 10 years of experience of delivering these exercises to older adults across the range of functional abilities, including those with very limited mobility, within the community and population from which we will recruit. The programme has the support of experts in the field including Janet Lord, Professor The EXVITD RET programme will follow the same format as the PEPPI programme including a dynamic warm-up and aerobic section with range of motion stretches (approximately 15 min), balance and coordination section (approximately 10 min), resistance training section (approximately 20-25 min) and a cool down with stretches (approximately 10-15 min).…”

Section: Consentmentioning

confidence: 99%

Influence of combined vitamin D₃supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial

et al. 2020

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IntroductionSarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study’s hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D3supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults.Methods and analysisThis double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3. Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned.Ethics and disseminationThe EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki.Trial registration numberNCT02467153; Post-results.

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Exercise for preventing falls in older people living in the community

Cited by 685 publications

References 230 publications

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

Influence of combined vitamin D₃supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial

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Exercise for preventing falls in older people living in the community

Cited by 685 publications

References 230 publications

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

Influence of combined vitamin D3supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial

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Influence of combined vitamin D₃supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial