Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis

Abstract

BackgroundThe risk of falling and associated injuries increases with age. Therefore, the prevention of falls is a key priority in geriatrics and is particularly based on physical exercising, aiming to improve the age-related decline in motor performance, which is crucial in response to postural threats. Although the benefits and specifications of effective exercise programs have been well documented in pre-post design studies, that is during the treatment, the definitive retention and transfer of these fall-related exercise benefits to the daily life fall risk during follow-up periods remains largely unclear. Accordingly, this meta-analysis investigates the efficacy of exercise interventions on the follow-up risk of falling.MethodsA systematic database search was conducted. A study was considered eligible if it examined the number of falls (fall rate) and fallers (fall risk) of healthy older adults (≥ 65 years) during a follow-up period after participating in a randomized controlled physical exercise intervention. The pooled estimates of the fall rate and fall risk ratios were calculated using a random-effects meta-analysis. Furthermore, the methodological quality and the risk of bias were assessed.ResultsTwenty-six studies with 31 different intervention groups were included (4739 participants). The number of falls was significantly (p <0.001) reduced by 32% (rate ratio 0.68, 95% confidence interval 0.58 to 0.80) and the number of fallers by 22% (risk ratio 0.78, 95% confidence interval 0.68 to 0.89) following exercising when compared with controls. Interventions that applied posture-challenging exercises showed the highest effects. The methodological quality score was acceptable (73 ± 11%) and risk of bias low.ConclusionsThe present review and meta-analysis provide evidence that physical exercise interventions have the potential to significantly reduce fall rate and risk in healthy older adults. Posture-challenging exercises might be particularly considered when designing fall prevention interventions.Electronic supplementary materialThe online version of this article (10.1186/s40798-018-0170-z) contains supplementary material, which is available to authorized users.

A trip to remember

“…In alignment with our study, another training study (14 weeks, 2 sessions per week) comparing 1.5-hour sessions of perturbation-based balance training (PBT) with sessions including 45 minutes PBT and 45 minutes muscle strength training in older adults found larger improvements in stability following a gait perturbation task in the 1.5-hours PBT group (Bierbaum et al, 2013). These results seem to agree with recent meta-analyses demonstrating a 39-48% reduction in the number of people experiencing a fall when higher intensity balance exercise or stability-challenging exercise programmes are followed (Sherrington et al, 2017, Hamed et al, 2018. Exercise programmes focussing specifically on volitional and reactive stepping also show similar reductions at 49% (Okubo et al, 2017).…”

“…Given the age-related declines in lower limb muscle strength and tendon properties important for force production and locomotion, it is not surprising that interventions aimed at improving these qualities generally show favourable outcomes with regards to falls reduction. Several recent, meta-analyses have estimated that exercise interventions including general muscle strengthening and balance exercises can reduce the number of people who experience a fall in a given year by 17-22% compared to control groups (Sherrington et al, 2017, Tricco et al, 2017, Hamed et al, 2018, Sherrington et al, 2019. However, due to the multifactorial nature of the interventions included in these metaanalyses, as well as the various potential causes of falls, specific mechanisms behind these results are difficult to determine.…”

“…A major challenge of exercise-based falls prevention programmes is that most general exercise programmes require relatively long term and consistent participation to achieve physiological adaptations that translate to a reduced risk of falls. In the meta-analyses described above, exercise programmes of 5 to 130 weeks were included, typically with 1-3 sessions per week, and a weekly training time of 3 hours or more typically showing larger effects (Sherrington et al, 2017, Hamed et al, 2018, Sherrington et al, 2019. To have any meaningful impact on population level falls statistics, this implies a huge logistic undertaking to have the facilities, staff and financial support to provide even a proportion of our populations with such extensive interventions.…”

The Rose-Colored Glasses of Geriatric Fall Patients: Inconsistencies Between Knowledge of Risk Factors for and Actual Causes of Falls

“…This is an important concept in the fall literature as falls can often cause injuries that can subsequently cause anxiety and avoidance of physical activity leading to further physiologic decline ( Delbaere et al., 2004 ; Friedman et al, 2002 ). Our findings indicate that this fear is indeed pervasive in community-dwelling older adults and fall education that exacerbates this anxiety and perpetuates sedentary behavior could therefore be counterproductive, given that maintaining daily physical movement is known to be an important preventative measure for fall reduction over time( Hamed et al, 2018 ; Liu-Ambrose et al, 2019 ; Roitto et al, 2018 ).…”

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

“…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].…”