A recently published Cochrane review evaluates the benefits and harms of exercise interventions for preventing falls in older people living in the community. This review included randomised controlled trials evaluating any form of exercise as a single intervention in people over 60 years old. The primary outcome was rate of falls (falls per person-year) measured at the time point closest to 18 months post-randomisation. Methodological quality of the included trials was evaluated with the Cochrane risk of bias tool, and the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
This review included 108 trials with 23,407 participants conducted mostly in high income countries. 77% of included participants were women. The average participant age in the included trials was 76 years. Exercise was compared to a control intervention not thought to reduce the rate of falls in people not recently discharged from hospital in 81 trials (n = 19,684 participants) and in people who were recently discharged from hospital in four trials (n = 816 participants). 53% of the interventions included balance and functional exercises as the primary intervention, followed by three-dimensional training (constant repetitive movement through all three spatial planes; 15% of the interventions).
This review found high-quality evidence from 59 trials (n = 12,981 participants) that exercise interventions reduced the rate of falls by 23% (95% CI 17% to 29%) compared to control intervention not thought to reduce falls. There was low-quality evidence from 10 trials (n = 4,047 participants) that exercise interventions reduced the number of people experiencing a fracture following a fall by 27% (95% CI 5% to 44%) compared to control intervention.
Strong evidence shows that exercise interventions reduce the rate of falls in older people living in the community. Further work is needed to understand the impact of resistance training, dance or walking programs. Larger studies are needed to evaluate the impact of exercise on fall-related fractures and falls requiring medical attention.
Listen to Norman Swan interview Cathie Sherrington (Professor from the Institute for Musculoskeletal Health, University of Sydney who is the lead author of the review) for ABC Radio National’s Health Report.
Sherrington C et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019 Jan 31;1:CD012424