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New Evidence On Physical Activity And Fall Prevention

New Evidence On Physical Activity And Fall Prevention

by Ms Danielle D Meldrum 26/09/2018

This article provides an updated systematic review and meta-analysis on exercise as a method of fall prevention in older adults. Eligible studies included randomised controlled trials that compared fall rates in older people who received exercise as a single intervention with a control group from January 2010 to January 2016.

Findings

  • Exercise reduced the rate of falls in community-dwelling older adults by 21%.
  • Exercise programs were more effective if they challenged balance and/or involved more than 3 hours of exercise a week.
  • Exercise programs that both challenged balance and involved more than 3 hours of exercise a week reduced fall rates by 39%.
  • Exercise had a fall prevention effect on community-dwelling older adults with a cognitive impairment or Parkinson’s Disease.
  • There was no evidence of exercise having a fall prevention effect among stroke survivors, people recently discharged from hospital, or for those in residential care settings.
  • Walking programs were not associated with reductions in intervention effectiveness.

Conclusions

  • Exercise as a single intervention can prevent falls in community-dwelling older adults.
  • Exercise that challenges balance and are of higher doses are more effective for fall prevention.
  • Although walking did not reduce intervention effectiveness, the authors suggest it should be used in addition to other fall prevention exercises rather than as a single intervention.

Implications for practice

Updated recommendations for fall prevention practice in community-dwelling older people

  • Exercise programs should aim to provide a high challenge to balance. Choose exercises that involve safely:
  • reducing the base of support (eg, standing with two legs close together, standing with one foot directly in front of the other, standing on one leg);
  • moving the centre of gravity and controlling body position while standing (eg, reaching, transferring body weight from one leg to another, stepping up onto a higher surface); and
  • standing without using the arms for support, or if this is not possible then aim to reduce reliance on the upper limbs (eg, hold onto a surface with one hand rather than two, or one finger instead of the whole hand)
  • At least 3 hours of exercise should be undertaken each week
  • Ongoing participation in exercise is necessary or benefits will be lost
  • Fall prevention exercise should be targeted at the general community as well as community-dwellers with an increased risk of falls
  • Fall prevention exercise may be undertaken in a group or home-based setting
  • Walking training may be included in addition to balance training but high-risk individuals should not be prescribed brisk walking programs
  • Strength training may be included in addition to balance training
  • Exercise providers should make referrals for other risk factors to be addressed
  • Exercise as a single intervention may prevent falls in people with Parkinson’s disease or cognitive impairment. There is currently no evidence that exercise as a single intervention prevents falls in stroke survivors or people recently discharged from hospital. Exercise should be delivered to these groups by providers with particular expertise.

Reference

Exercise to prevent falls in older adults: an updated systematic review and meta-analysis Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J Cumming RG, Herbert RD, Close JC , Lord SR. Br J Sports Med. 2016 Oct 4.