An Updated Cochrane Review: Can Exercise Reduce Falls in Our Elderly Population? Which Exercises Show Proof?

An Updated Cochrane Review: Can Exercise Reduce Falls in Our Elderly Population? Which Exercises Show Proof?
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We all know how devastating falls can be in our older patients. I send many to physical therapy specifically for fall prevention. Most have osteoporosis, and although I believe this is the right thing to do, I am not sure how effective a prescription for "gait and balance training/muscle strengthening" is for preventing falls.

Cochrane researchers reviewed 108 randomized, controlled trials, and their conclusion was that there is a "high-certainty of evidence" that exercises involving balance and functional exercise training reduce falls. They included 23,407 participants from 25 countries. On average, participants were 76 years old and 77% were women. All trials consisted of participants over the age of 60. Stroke trials were not included.

The group looked at falls from two different points of view. In the first evaluation they found that exercise reduces the number of falls over time by 23%. For example, if there were 850 falls among 1000 older people with no fall-prevention exercises in one year, there would be 195 fewer falls among those who were in exercise classes. The second analysis was in a cohort of fallers, and they found that exercise reduces the number of people experiencing one or more falls by about 15%. For example, if 480 out of 1000 people had fallen at least once in the past year, participating in exercise would reduce the number of falls by 72. The effects were even greater when resistance exercises were added to the mix; drops in fall rates and the number of people experiencing falls were 34% and 22%, respectively.

Different forms of exercise had different impacts on falls. The term "functional exercise" was defined as exercises that mimic everyday activities with the goal of improving performance. As an example, multidirectional lunges are a functional exercise that helps the body prepare for vacuuming, yard work, and other common activities. Exercises were mostly done while standing, and aided balance in activities such as getting up from a chair, and climbing stairs. According to a press release from the Cochrane Group: "Exercise programs carried out in group classes or done at home prescribed by a health professional and directed by a trained exercise leader were effective."

Interestingly, there were uncertain effects from dance, walking, and resistance training by themselves. There was no evidence to determine the effects of flexibility or endurance exercises. However, the researchers did note that Tai chi showed some evidence that it may also prevent falls.

It is well known that keeping active in older years promotes good health, but with this review we can now pinpoint which type of exercises are more specific to preventing falls. This is a welcome piece of information for providers and their older, frailer patients at risk for falling.

References
  • Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community.Cochrane Database Syst Rev. 2019;1:CD012424.

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Filed under: Miscellaneous , Orthopedics

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