Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations
Catherine Sherrington A B E , Anne Tiedemann A B , Nicola Fairhall A C , Jacqueline C.T. Close B D and Stephen R. Lord B
+ Author Affiliations
- Author Affiliations
A Musculoskeletal Division, The George Institute for Global Health, The University of Sydney
B Falls and Balance Research Group, Neuroscience Research Australia, The University of New South Wales
C Rehabilitation Studies Unit, Sydney Medical School, The University of Sydney
D Prince of Wales Hospital Clinical School, The University of New South Wales
E Corresponding author. Email: csherrington@georgeinstitute.org.au
NSW Public Health Bulletin 22(4) 78-83 https://doi.org/10.1071/NB10056
Published: 2 June 2011
Abstract
This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95% CI 0.77–0.91). Meta-regression revealed programs that included balance training, contained a higher dose of exercise and did not include walking training to have the greatest effect on reducing falls. We therefore recommend that exercise for falls prevention should provide a moderate or high challenge to balance and be undertaken for at least 2 hours per week on an ongoing basis. Additionally, we recommend that: falls prevention exercise should target both the general community and those at high risk for falls; exercise may be undertaken in a group or home-based setting; strength and walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs; and other health-related risk factors should also be addressed.
References
[1] Australia to 2050: future challenges. The 2010 Intergenerational Report. Canberra: Commonwealth of Australia; 2010.[2] Moller J. Projected costs of fall related injury to older persons due to demographic change in Australia: report to the Commonwealth Department of Health and Ageing. Canberra: New Directions in Health and Safety; 2003.
[3] Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 1993; 17 240–5.
| An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c7hsVKmuw%3D%3D&md5=9d2d222400e8da1ed9c15d8c5be7e8d4CAS | 8286498PubMed |
[4] Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997; 337 1279–84.
| Falls, injuries due to falls, and the risk of admission to a nursing home.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svnsFyguw%3D%3D&md5=88362adbb8c8db2391ec281df78d0bbaCAS | 9345078PubMed |
[5] Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009; CD007146
| 19370674PubMed |
[6] Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56 2234–43.
| Effective exercise for the prevention of falls: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 19093923PubMed |
[7] Lord SR, Sherrington C, Menz HB, Close JCT. Falls in older people: risk factors and strategies for prevention. 2nd ed. Cambridge: Cambridge University Press; 2006.
[8] Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing 2007; 36 656–62.
| Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions.Crossref | GoogleScholarGoogle Scholar | 18056731PubMed |
[9] Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. J Am Geriatr Soc 2007; 55 1185–91.
| A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial.Crossref | GoogleScholarGoogle Scholar | 17661956PubMed |
[10] Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996; 44 489–97.
| 1:STN:280:DyaK283gvVyqug%3D%3D&md5=bca7866669bcd720427a55cf0ba8bf03CAS | 8617895PubMed |
[11] Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003; 32 407–14.
| Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 12851185PubMed |
[12] Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005; 34 636–9.
| Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT).Crossref | GoogleScholarGoogle Scholar | 16267192PubMed |
[13] Yardley L, Bishop FL, Beyer N, Hauer K, Kempen GI, Piot-Ziegler C, et al. Older people's views of falls-prevention interventions in six European countries. Gerontologist 2006; 46 650–60.
| 17050756PubMed |
[14] Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc 2002; 50 905–11.
| Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data.Crossref | GoogleScholarGoogle Scholar | 12028179PubMed |
[15] Day L, Hoareau E, Finch C, Harrison J, Segal L, Bolton T et al. Modelling the impact, costs and benefits of falls prevention measures to support policy-makers and program planners. Monash University Accident Research Centre; 2009.
[16] Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 2010; 44 80–9.
| Does a home-based strength and balance programme in people aged > or =80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3c7gsFCgsQ%3D%3D&md5=88c7b6863421c45405b047983fa06b0aCAS | 20154094PubMed |
[17] Hektoen LF, Aas E, Luras H. Cost-effectiveness in fall prevention for older women. Scand J Public Health 2009; 37 584–9.
| Cost-effectiveness in fall prevention for older women.Crossref | GoogleScholarGoogle Scholar | 19666674PubMed |
[18] Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39 1435–45.
| Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.Crossref | GoogleScholarGoogle Scholar | 17762378PubMed |
[19] Ebrahim S, Thompson PW, Baskaran V, Evans K. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing 1997; 26 253–60.
| Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svhsFCrug%3D%3D&md5=bd353a04a4e92568caca213881cacf73CAS | 9271287PubMed |
[20] American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009; 30 992–1008.
[21] Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2004; 52 1121–9.
| Muscle weakness and falls in older adults: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 15209650PubMed |
[22] Haran MJ, Cameron ID, Ivers RQ, Simpson JM, Lee BB, Tanzer M, et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 2010; 340 c2265
| Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 20501583PubMed |
