Benefits and Harms of Exercise for Preventing Falls in Older People Living in the Community
New evidence published in the Cochrane Library recently provides strong evidence that falls in people over age 60 can be prevented by exercise programs.
Falls are a leading cause of accidental or unintentional injury deaths worldwide. Older adults suffer the greatest number of fatal falls and over 37 million falls are severe enough to require medical attention each year.
A new Cochrane Review produced by a team comprising researchers from the University of Sydney in Australia and University of Oxford, UK, summarized the results from 108 randomized controlled trials with 23,407 participants from across 25 countries.
The average age of the participants in the studies was 76 years and 75% were women. Eighty-one of these trials compared exercise (all types) versus a control intervention (no exercise or minimal gentle exercise that is not thought to reduce falls) in people living independently at home, in retirement villages, or in sheltered accommodation.
The review found exercise programs carried out in group classes or done at home prescribed by a health professional (such as a physiotherapist) or a trained exercise leader were effective.
Exercises were mostly done while standing as this better enhances balance and the ability to do daily activities such as standing up from a low chair or climbing stairs. Some effective exercise programs also used weights to make the exercises harder.
The results of the studies varied so the researchers assessed different types of exercise programs to see how they compared. There was high certainty evidence that programs that mainly involve balance and functional exercises reduce falls, while there was less certainty about programs that include multiple exercise categories (most commonly balance and functional exercises plus resistance exercises).
Tai Chi may also prevent falls but there is uncertain evidence on the effectiveness of resistance exercises (without balance and functional exercises) including dance or walking.
The certainty of evidence for the overall effect of exercise on preventing falls was high. However, the findings that exercise reduces fractures and the need for medical attention was less certain, reflecting in part the relatively small number of studies and participants for those outcomes.
The reporting of the side effects of exercise in the trials was limited but when side effects were reported they were usually not serious, such as joint or muscle pain; however, one trial reported a pelvic stress fracture.
For more info see Sherrington, C. et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 1, Art. No.: CD012424. DOI: 10.1002/14651858.CD012424.pub2
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