Exercise to prevent falls in older adults: an updated systematic review and meta-analysis.

Sherrington C
Michaleff ZA
Fairhall N
Paul SS
Tiedemann A
Whitney J, et al.

Br J Sports Med. 2017 Dec;51(24):1750-1758. doi: 10.1136/bjsports-2016-096547. Epub 2016 Oct 4. (Review)
PMID: 27707740

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Disciplines

Internal Medicine

Relevance - 6/7
Newsworthiness - 6/7
Family Medicine (FM)/General Practice (GP)

Relevance - 6/7
Newsworthiness - 5/7
General Internal Medicine-Primary Care(US)

Relevance - 6/7
Newsworthiness - 5/7
Geriatrics

Relevance - 6/7
Newsworthiness - 5/7
Physical Medicine and Rehabilitation

Relevance - 6/7
Newsworthiness - 5/7
Neurology

Relevance - 5/7
Newsworthiness - 5/7
Public Health

Relevance - 5/7
Newsworthiness - 4/7

Abstract

OBJECTIVE: Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects.

DESIGN: Update of a systematic review with random effects meta-analysis and meta-regression.

DATA SOURCES: Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016.

STUDY ELIGIBILITY CRITERIA: We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group.

RESULTS: 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital.

SUMMARY/CONCLUSIONS: Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.

Clinical Comments

Family Medicine (FM)/General Practice (GP)

This is not a conclusive but useful review. My own unreliable observation is that exercise benefits the elderly more than the young. I like studies which agree with me but have tried to be dispassionate in reading this. If this is correct, the reduction in fractures and falls and gains in cardiovascular performance and mental health are worth more study.

General Internal Medicine-Primary Care(US)

This review of the impact of exercise on fall risk clarifies several aspects of specific requirements to achieve benefits. The benefits seem limited to community dwelling elderly and is not clearly of value in those in residence facilities. As clinicians, we often suggest that simply walking is of benefit. However even in community dwelling elderly, that simple form of exercise alone was not useful in reducing falls. Indeed, there was a trend towards harm. Supporting that conclusion was the finding that there was greater fall reduction with more extensive (> 3 hours per week) programs that included specific exercises which required balance challenging components. The authors rightly point out that there may be value to any exercise in all these groups, but to specifically reduce risk of falling requires a more regimented approach as they found in this review.

Internal Medicine

It is well known that exercise prevents falls in older people. What this study adds is that it works well in patients with Parkinson disease and cognitive impairment, and it is not so clear in stroke survivors. The updated recommendation for exercise practices to prevent falls given by authors is a good starting point.

Public Health

This meta analysis confirms with including the results of newer study the benefit of exercise in preventing falls in the elderly: Therefore, there is no new news but reinforcement and strengthening of previous findings.

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