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Falls and Frailty – Faster walking speed

Faster walking speed

Evidence summary

A systematic review identified eleven trials investigating the effects of exercise interventions on gait ability in those with frailty. Six studies revealed improvements in gait after the physical training period, whereas five studies demonstrated no improvement. Three of the studies that demonstrated improvements used multi-component exercise programs, two studies used only resistance exercises, and one study used endurance training combined with yoga. The mean improvement in gait ranged from 4% to 50% (13).

Ten studies investigated the effects of exercise interventions on balance. Eight of the investigations revealed enhanced balance after the physical training period, whereas two studies did not demonstrate any improvement. Seven of the studies with balance improvements used multi-component exercise programs that included balance training, and one study included Tai Chi exercises. The mean improvement in balance ranged from 5% to 80% (13).

Thirteen studies investigated the effects of exercise interventions on lower-body muscle strength. Nine studies revealed increased muscle strength after the physical training period, whereas four studies did not identify any improvement. Five of the studies that demonstrated enhanced strength used resistance exercise programs, and four studies used multi-component exercise interventions. The mean increase in strength ranged from 6% to 60% (13).

A meta-analysis found no effects upon gait speed (n= 3 studies, SMD -0.06 (CI -0.49 to 0.37), moderate heterogeneity) or timed up and go speed (n = 2 studies, SMD 0.57 (CI -0.01 to 1.16), low heterogeneity), but significant differences in muscle strength (n = 4, SMD 0.44 (CI 0.11 to 0.77)), moderate heterogeneity) and balance (n = 3 studies, SMD 0.33 (CI 0.08 to 0.57), low heterogeneity)) were observed. Included studies were generally small and low quality, with short follow-ups and focused on observed physical functioning outcomes (9).

Quality of evidence

B

Strength of recommendation

1

Conclusion

Group exercise may produce some benefits to physical functioning, in particular strength and balance, but conclusions limited by moderate heterogeneity. Exercise prescriptions that start slow and are then gradually titrated to continually deliver a training stimulus in the form of volume, intensity and complexity will be most effective.

References

  1. Gillespie, Lesley D., et “Interventions for preventing falls in older people living in the      community.” Cochrane Database Syst Rev 9.11 (2012).
  2. Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2016 Oct 4:bjsports-2016.
  3. Lee SH, Kim HS. Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta‐Analysis. Worldviews on Evidence‐Based Nursing. 2017 Feb 1;14(1):74-80.
  4. Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy. 2012 May 1;66(3):284-91.
  5. Fairhall N, Sherrington C, Clemson L, Cameron ID. Do exercise interventions designed to prevent falls affect participation in life roles? A systematic review and meta-analysis. Age and ageing. 2011 Jul 14;40(6):666-74.
  6. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj. 2013 Oct 29;347:f6234.
  7. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, Jones GR. The effectiveness of exercise interventions for the management of frailty: a systematic review. Journal of aging research. 2011.
  8. Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, Grady JN, Perry TJ, Lloyd BD, Smith EU, Singh MA. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. Journal of the American Medical Directors Association. 2012 Jan 1;13(1):24-30.
  9. Frost R, Belk C, Jovicic A, Ricciardi F, Kharicha K, Gardner B, Iliffe S, Goodman C, Manthorpe J, Drennan VM, Walters K. Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC geriatrics. 2017 Dec;17(1):157.
  10. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, D’avanzo B, Gwyther H, Holland C. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI database of systematic reviews and implementation reports. 2018 Jan 1;16(1):140-232.
  11. Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. Journal of the American Medical Directors Association. 2012 Jul 1;13(6):507-11.
  12. Rogers NT, Marshall A, Roberts CH, Demakakos P, Steptoe A, Scholes S. Physical activity and trajectories of frailty among older adults: Evidence from the English Longitudinal Study of Ageing. PloS one. 2017 Feb 2;12(2):e0170878.
  13. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation research. 2013 Apr 1;16(2):105-14.