Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations

Abstract

This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95% CI 0.77-0.91). Metaregression revealed programs that included balance training, contained a higher dose of exercise and did not include walking training to have the greatest effect on reducing falls. We therefore recommend that exercise for falls prevention should provide a moderate or high challenge to balance and be undertaken for at least 2 hours per week on an ongoing basis. Additionally, we recommend that: falls prevention exercise should target both the general community and those at high risk for falls; exercise may be undertaken in a group or home-based setting; strength and walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs; and other health-related risk factors should also be addressed.The prevention of falls and mobility-related disability among older people is an urgent public health challenge in Australia and internationally. Falls and fractures already have a major impact on older individuals, their carers, health services and the community. This impact will grow substantially in the near future due to the increased proportion of older people in the population. The proportion of Australians aged 65 years and over is predicted to increase from 14% (3 million people) in 2010 to 23% (8.1 million people) by 2050.1 By 2051, the Australian total annual health costs from fall-related injury are predicted to increase almost threefold to $1.4 billion. 2Many older individuals and their families are affected by falls. One-third of people aged 65 years and over fall once or more annually.3 Falls can result in injuries, a loss of confidence and a subsequent reduction in physical activity and community participation. Falls are associated with a threefold increase in the risk of being admitted to a residential aged-care facility after adjusting for other risk factors. 4Exercise can prevent falls Trials and systematic reviews 5,6 now provide clear evidence that falls in older people can be prevented with appropriately designed intervention programs. The recently updated Cochrane systematic review 5 concluded that exercise interventions reduce the risk and rate of falls. Although many risk factors for falls have been identified, 7 intervention trials have found that the effects of exercise as a single falls prevention intervention are comparable to those from multifaceted interventions. 5,8 Therefore, widespread implementation of exercise as a single intervention seems to be the best approach to falls prevention at a population level. Our previous meta-analysis 6 found that up to 42% of falls can be prevented by well-designed exercise programs and that the exercises which had the biggest effect on fall rates involved a challenge to balance abilities and were undertaken frequently (e.g. for more than 2 hours a week over a 6-month period).Both home-based...

Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial

“…There is some evidence that increasing physical activity in those at high risk of falls can increase exposure to risk (Sherrington 2011), so it is heartening that, in older people recruited through general practice (not frequent fallers), the interventions did not increase risk of falls alongside the increase in MVPA. However, ProAct65+ deliberately chose two interventions that focused on improving strength and balance and therefore this may have prepared the older adults in this study for safer movement.…”

“…In fact, there is some concern that increasing physical activity, particularly brisk walking, may increase exposure to risk of falls (Sherrington 2011). Two falls reduction programmes (Falls Management Exercise and the Otago Exercise Programme) which have previously been successful in higher risk populations, were evaluated in this study, ProAct65+, in a primary falls prevention context.…”

“…There is already robust evidence to support the use of exercise in falls prevention and rehabilitation following falls, with as many as 42% of falls being prevented by a 'well-designed' exercise intervention; balance retraining and lower limb strengthening exercises with a total dose of at least 50 hour (Sherrington 2008, Sherrington 2011. The Cochrane Systematic Review of falls interventions in community dwelling older people states that both group and home based exercise reduce falls rate (Rate Ratios 0.71 and 0.68, respectively) (Gillespie 2012).…”

Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen

“…Sie können in monofaktorielle Trainingsprogramme (Cumming et al, 1999;Steultjens, Dekker, Bouter, Jellema, & Bakker, 2004;Clemson, Mackenzie, Ballinger, Close, & Cumming, 2008;Costello, & Edelstein, 2008;Sherrington et al, 2008;Davis et al, 2010;Sherrington, Tiedemann, Fairhall, Close, & Lord, 2011;Leland, Elliott, O'Malley, & Murphy, 2012) und in multifaktorielle Trainingsprogramme (Steultjens et al, 2004;Costello, & Edelstein, 2008;Peterson, & Clemson, 2008, Sherrington et al, 2008Davis et al, 2010;Sherrington et al, 2011;Leland, et al, 2012) eingeteilt werden. Beide Formen können entweder als Gruppen-oder Einzeltraining in der eigenen Häuslichkeit angeboten werden (Costello, & Edelstein, 2008 (Steultjens et al, 2004;Costello, & Edelstein, 2008;Sherrington et al, 2008;Davis et al, 2010;Sherrington et al, 2011), c) Anleitung, Beratung und Edukation von Angehörigen (Steultjens et al, 2004) sowie d) additiv-begleitendes Training kognitiver Funktionen (Steultjens et al, 2004). Multifaktorielle Programme kombinieren einzelne Interventionskomponenten in unterschiedlicher Variation und bieten diese zudem als Einzel-und Gruppentraining an (Costello, & Edelstein, 2008;Leland et al, 2012).…”

“…Monofaktorielle wie auch multifaktorielle Programme sind maßgeschneidert und enthalten vornehmlich diejenigen Trainingselemente, die zuvor mittels Assessments identifiziert wurden. Gemäß der Meta-Analyse von Sherrington et al (2011) (Cumming et al, 1999;Pardessus et al, 2002;Steultjens et al, 2004;Costello, & Edelstein, 2008;Clemson et al, 2008;Davis et al, 2010;Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011;Leland et al, 2012;Ballinger, & Brooks, 2013 (Peterson, & Clemson, 2008). Der Durchführung von Wohnraumanpassungen durch Ergotherapeuten/-innen wird hohes Potenzial zugeschrieben (Costello, & Edelstein, 2008), da Ergotherapeuten/-innen über die notwendigen fachlichen Qualifikationen verfügen, insbesondere bei der Durchführung von Wohnraumassessments und -anpassungen (Steinmetz, & Hobson, 1994;Cumming et al, 1999;Lampiasi, & Jacobs, 2010).…”