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Falls and Frailty – Reduces falls and falls risk

Reduces falls and falls risk

Evidence summary

Multiple-component group exercise significantly reduces the rate of falls (RaR 0.71, 95% CI 0.63 to 0.82) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96), as do multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80 and RR 0.78, 95% CI 0.64 to 0.94) (1).

Classes that included just gait, balance or functional training achieved a statistically significant reduction in rate of falls (RaR 0.72, 95% CI 0.55 to 0.94) but not in risk of falling (RR 0.81, 0.62 to 1.07) (1).

In community-dwelling older people, greater intervention effects are seen in trials that include exercise programmes which provide a high challenge to balance and 3 or more hours per week of prescribed exercise over the programme period (2).

Exercise may have a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97) in those in a care-facility. This effect is stronger when exercise is combined with other fall interventions (RR 0.61, 95% CI 0.52-0.72) (3). However other meta-analyses show a lack of fall prevention effect from exercise as a single intervention in residential care settings (1,2). This does not mean that there is no role for exercise as a component of a multiple-intervention fall prevention programme.

Quality of evidence

Community: High quality

Residential Care:  Moderate quality

Strength of recommendation

Community: Strong

Residential Care: Weak

Conclusion

Physical activity can be recommended for the prevention of falls in most community dwelling people in most circumstances.

For those in residential care, there is unclear evidence regarding the effects of physical activity. The benefits are not seen consistently, but as there are few significant adverse events, exercise could be considered alongside other falls-prevention strategies.

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.