Falls occur in one third of community-dwelling individuals who are more than 65 year of age. Falls can cause serious injuries, and the rate of injuries increase as individuals get older. The aim of this systematic review was to assess the effects of exercise interventions for preventing falls in older people living in the community when compared with a usual care or attention control.
The review included randomised controlled trials that evaluated the effects of exercise interventions compared to usual care or attention control in community-dwelling individuals 60 years of age and older. Exercise programs were classified using the Prevention of Falls Network Europe (ProFaNE) taxonomy (balance and functional exercises, resistance exercises, flexibility, three‐dimensional exercise, walking programmes, endurance, other). The review defined community-dwelling individuals as those living at home or in residences where they do not provide residential health-related care or rehabilitation. The review excluded trials that only included individuals with clinical conditions known to increase the risk of falls, such as Parkinson’s disease, multiple sclerosis, and dementia. The main outcome for this review was the rate of falls. Risk of bias for all eligible trials was assessed using Cochrane’s risk of bias tool. The certainty of evidence was judged using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The review included 108 randomised controlled trials, conducted in 25 countries, involving 23,407 participants. 77% of the participants in these trials were women and the average age was 76 years. Overall, there was high-certainty evidence that exercise reduced the rate of falls by 23% when compared to control (rate ratio 0.77, 95% confidence interval (CI) 0.71 to 0.83, 59 trials, 12,981 participants). Certain exercise types reduced the rate of falls more than others when compared to control, there was: high-certainty evidence for interventions that mainly focussed on balance and functional tasks (rate ratio 0.76, 95% CI 0.70 to 0.81, 39 trials, 7,920 participants); moderate-certainty evidence for balance and functional exercises with resistance exercises (rate ratio 0.66, 95% CI 0.50 to 0.88, 11 trials, 1,374 participants); and, low-certainty evidence for three-dimensional exercise (Tai Chi or similar) (rate ratio 0.81, 95% CI 0.67 to 0.99, 7 trials, 2,655 participants).
Subgroup analyses showed that there was little difference in the effect of exercise on the rate of falling when:
- trials included participants at increased baseline risk of falling compared to trials that did not (rate ratio 0.80, 95% CI 0.72 to 0.88 versus 0.74, 95% CI 0.65 to 0.84)
- trials that only included participants 75 years of age and older compared to trials of participants less than 75 years of age (rate ratio 0.83, 95% CI 0.72 to 0.97 versus 0.75, 95% CI 0.69 to 0.82)
- trials where the exercise intervention was delivered in a group setting compared to individually delivered exercise (rate ratio 0.76, 95% CI 0.69 to 0.85 versus 0.79, 95% CI 0.71 to 0.88).
- Exercise interventions led by health professionals (such as a physiotherapist) resulted in a greater reduction in the rate of falls compared to those led by non-health professionals (such as a trained fitness leader), although both still resulted in a reduction in rate of falls (rate ratio 0.69, 95% CI 0.61 to 0.79 versus 0.82, 95% CI 0.75 to 0.90).
There is high-certainty evidence that exercise interventions reduce the rate of falls by 23% in community dwelling individuals aged over 60 years of age compared to control. If there were 850 falls in 1,000 people followed over 1 year, exercise would result in 195 fewer falls (95% CI 144 to 246). Exercise interventions that primarily focus on balance and functional activities can reduce the rate of falls. Exercise led by health professionals result in a greater reduction in the rate of falls.
Sherrington C et al. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med 2019 Dec 2:Epub ahead of print
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