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Sherrington C.1, Michaleff Z.1,2, Fairhall N.1, Paul S.1, Tiedemann A.1, Whitney J.3, Cumming R.4, Herbert R.5, Close J.5,6, Lord S.5
1University of Sydney, George Institute for Global Health, Sydney, Australia, 2Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele, United Kingdom, 3Clinical Age Research Unit, King's College Hospital, London, United Kingdom, 4University of Sydney, School of Public Health, Sydney Medical School, Sydney, Australia, 5University of New South Wales, Neuroscience Research Australia, Sydney, Australia, 6University of New South Wales, Prince of Wales Clinical School, Sydney, Australia
Background: Previous meta-analyses have found exercise as a single intervention prevents falls in older people.
Purpose: To update our previously-developed guidelines on the basis of our recently-updated systematic review (Br J Sports Med, 2016).
Methods: This systematic review with random effects meta-analysis and meta-regression aimed to test whether fall prevention effects are still present when new trials are added and explore trial characteristics associated with greater fall prevention effects.
Results: Meta-analysis found that 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 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 Parkinsons 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.
Conclusion(s): Our updated guidelines are:
1. Exercise programmes should aim to provide a high challenge to balance. Choose exercises that involve safely: A. reducing the base of support (eg, standing with two legs
close together, standing with one foot directly in front of the other, standing on one leg);
B. moving the centre of gravity and controlling body position while standing (eg, reaching, transferring body weight from one leg to another, stepping up onto a higher surface); and C. standing without using the arms for support, or if this is not possible then aim to reduce reliance on the upper limbs (eg, hold onto a surface with one hand rather than two, or one finger instead of the whole hand);
2. At least 3 hours of exercise should be undertaken each week;
3. Ongoing participation in exercise is necessary or benefits will be lost;
4. Fall prevention exercise should be targeted at the general community as well as community-dwellers with an increased risk of falls;
5. Fall prevention exercise may be undertaken in a group or home-based setting;
6. Walking training may be included in addition to balance training but high-risk individuals should not be prescribed brisk walking programs;
7. Strength training may be included in addition to balance training;
8. Exercise providers should make referrals for other risk factors to be addressed;
9. Exercise as a single intervention may prevent falls in people with Parkinsons disease or cognitive impairment. There is currently no evidence that exercise as a single intervention prevents falls in stroke survivors or people recently discharged from hospital. Exercise should be delivered to these groups by providers with particular expertise.
Implications: These guidelines can be used to guide clinical practice and policy.
Funding acknowledgements: CS, AT, RDH and SRL receive salary funding from the Australian National Health and Medical Research Council.
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval: Ethics approval not required.
All authors, affiliations and abstracts have been published as submitted.
