This study evaluated the fall-prevention effects of exercise intervention in a service-based fall-prevention program.
Community-dwelling older fallers aged 60 years or above were included. After a multidimensional assessment, recommendations on lifestyle modification, fall-prevention exercise and referral to doctor consultations as indicated were given. Therapists-led fall-prevention exercise, either in groups receiving conventional balance and strengthening exercises (group exercise) or in individuals receiving exercises based on the Lifestyle-Integrated Functional Exercise plus a home safety assessment (mLiFE), was provided to participants assessed to have moderate or above fall risk by the Physiological Profile Assessment (PPA). All participants received 1-year tri-monthly phone follow-up for fall incidents. Cox regression analysis for one-year hazard ratio (HR) was performed for participants who received exercise intervention compared to those who did not with age, sex, self-reported fall history, and multi-comorbidities adjusted. As the therapist-led exercise intervention was provided mainly to participants assessed to have moderate or above fall risk, sensitivity analysis was performed, including only these participants. Different risks of falling were reported in people who had a fall history and those who did not. Subgroup analyses were thus performed for participants who had a fall history before joining the program and those who did not.
Among 4136 participants (70% female, mean age±SD=72.2±5.0 years), 643 participants (16%) fell once or more [531 reported one fall (12.8%) and 112 reported more than one fall (2.7%)] in the one-year follow-up. Significant reduction in falls was shown in participants who received mLiFE (n=173, fallers=24, adjusted HR=0.59, 95%CI=0.39-0.90) or group exercise (n=1694, fallers=269, adjusted HR=0.73, 95%CI=0.62-0.86) compared to those received no exercise intervention. Sensitivity analyses including only participants with moderate or above fall risk (i.e., PPA z-score >1, n=2812, fallers=459) showed similar results in the pooled and subgroup analyses (mLiFE: n=140, fallers=19, adjusted HR=0.56, 95%CI=0.35-0.89; Group exercise: n=1346, fallers=219, adjusted HR=0.72, 95%CI=0.59-0.87).
Subgroup analyses in participants without a history of fall (n=3205, fallers=470, PPA z-score >1=2156, fallers=336) showed a significant reduction in fall risk in participants received either mLiFE (n=131, fallers=15, adjusted HR=0.54-0.57, 95%CI=0.32-0.98) or group exercise (n=1303, fallers=195, adjusted HR=0.73-74, 95%CI=0.58-0.91) compared to those received no exercise intervention. In participants with fall history (n=932, fallers=173, PPA z-score >1=656, fallers=123), significant reduction in fall risk was found only in those received group exercise in the pooled analysis (n=391, fallers=74, adjusted HR=0.72, 95%CI=0. 52-0.99; sensitivity analysis: n=313, fallers=61, adjusted HR=0.70, 95%CI=0.48-1.02; mLiFE: n=31-42, fallers=5-9, adjusted HR=0.50-0.69, 95%CI=0.20-1.38).
Exercise intervention, either in the group or individual format, was effective in preventing falls among community-dwelling older fallers in real-life implementation, especially in those without a fall history.
To mitigate the fall-related adverse sequelae to individuals and direct and indirect sociomedical costs to society, greater efforts in providing and promoting balance and strengthening exercise in community-based settings are encouraged.
older adults
training
