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Do exercise programmes prevent falls in elderly people? What are the most important components of effective exercise interventions?
Included studies evaluated exercise interventions for fall prevention in elderly people. Studies in which the control group received exercise or the intervention group received additional non-exercise interventions for >25% of the time were excluded. Outcome was the pooled incidence rate ratio (IRR) of falls, which allows for multiple falls per person.
Medline, CINAHL, EMBASE/Excerpta Medica, PubMed, Physiotherapy Evidence Database, SafetyLit, Prevention of Falls Network Europe, and Cochrane Bone, Joint, and Muscle Trauma Group’s trial register (May 2007); and references were searched for published randomised controlled trials (RCTs). 44 RCTs (49 comparisons, n = 9603) met the selection criteria. Mean age was ⩾75 years in 65% of comparisons. 16 trials reported allocation concealment, and 22 used intention-to-treat analysis. Most trials involved community-dwelling elderly people who were at increased risk of falling. Most exercise programmes were done under supervision and tailored to the individual. Duration of follow-up ranged from 0.5 to 30 months (median 12 mo).
Overall, exercise programmes reduced risk of falling (table), but there was significant heterogeneity in treatment effect among trials. By meta-regression, 3 factors influenced treatment effect: high-challenge balance training (used in 25 comparisons) and total dose of exercise ⩾50 hours (used in 25 comparisons) increased the treatment effect by 21% and 20%, respectively, whereas the inclusion of walking in the exercise programme (used in 27 comparisons) decreased the treatment effect by 32% (table). These 3 factors explained 68% of the variability among trials.
Exercise programmes prevent falls in elderly people. The most important components of effective exercise interventions are high-challenge balance training, sustained exercise over time, and exercise other than walking.
A modified version of this abstract appears in Evidence-Based Medicine.
Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008;56:2234–43.
Clinical impact rating: Elderly care 6/7
Falls and fall-related injuries are associated with considerable mortality and morbidity in the geriatric population.1 The systematic review and meta-analysis by Sherrington et al clarifies the important role of exercise-based activity in fall prevention.
Fall prevention is a complex issue that requires a comprehensive understanding of all factors contributing to falls. Muscle weakness and impaired balance are common risk factors underlying falls.2 The review by Sherrington et al found exercise to be a beneficial component of a fall-prevention plan, especially when high-challenge balance activities are emphasised. Inferences about the effects of participant risk factors or individual participant dosing variations cannot be made from the data presented. Although strength training and walking programmes did not show significant effects on fall rates in this meta-analysis, their contribution to the overall fitness of elderly people can not be discounted.
The review is specifically relevant to geriatric and rehabilitation nurses across the continuum of care, from acute care hospitals to rehabilitation to the community; however, other health professionals who care for elderly people will also find the results useful. In providing some basic dosing parameters, this meta-analysis can help to optimise the exercise component of fall-prevention programmes. Future research should focus on gaining a greater understanding of which exercises (in what combinations and at what doses) are most beneficial in preventing falls and which groups are most likely to benefit, as well as identifying determinants of programme compliance and sustainability.3
Source of funding: no external funding.
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