Article first published online: 31 OCT 2008
DOI: 10.1111/j.1532-5415.2008.02014.x
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
ABSTRACT
OBJECTIVES: To determine
the effects of exercise on falls prevention in older people and
establish whether particular trial characteristics or components of
exercise programs are associated with larger reductions in falls.
DESIGN:
Systematic review with meta-analysis. Randomized controlled trials that
compared fall rates in older people who undertook exercise programs
with fall rates in those who did not exercise were included.
SETTING: Older people.
PARTICIPANTS: General community and residential care.
MEASUREMENTS: Fall rates.
RESULTS:
The pooled estimate of the effect of exercise was that it reduced the
rate of falling by 17% (44 trials with 9,603 participants, rate ratio
(RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I2=62%).
The greatest relative effects of exercise on fall rates (RR=0.58, 95%
CI=0.48–0.69, 68% of between-study variability explained) were seen in
programs that included a combination of a higher total dose of exercise
(>50 hours over the trial period) and challenging balance exercises
(exercises conducted while standing in which people aimed to stand with
their feet closer together or on one leg, minimize use of their hands to
assist, and practice controlled movements of the center of mass) and
did not include a walking program.
CONCLUSION:
Exercise can prevent falls in older people. Greater relative effects
are seen in programs that include exercises that challenge balance, use a
higher dose of exercise, and do not include a walking program. Service
providers can use these findings to design and implement exercise
programs for falls prevention.
The
development and implementation of effective and cost-efficient
strategies to prevent falls in older people is an urgent global health
challenge. In developed countries, life expectancy for people aged 65
years old is approximately 17 years for men and 21 years for women. At
least one-third of people aged 65 and older fall at least once annually,1 and falls account for more than half of the injury-related hospitalizations for older people.2 Fall rates in the general older population are reported to be 1.2 falls per person year.3
Falls in older people are not purely random events but can be predicted by assessing a number of risk factors.4,5
Some of these risk factors (e.g., reduced muscle strength and impaired
balance and gait) can be modified using exercise, whereas others (e.g.,
poor vision, psychoactive medication use) require different intervention
approaches. Exercise can be used as a stand-alone falls prevention
intervention or as a component of a multifaceted program. Multifaceted
interventions can prevent falls in the general community, in those at
greater risk of falls, and in residential care facilities.4,6
Many
trials have sought to establish the specific effect of exercise on fall
rates, but a large proportion of these trials have been underpowered.
The best way to interpret these trials may be to pool their data in a
meta-analysis, but trials of the effects of exercise on fall rates vary
in their quality, have been conducted on a range of populations, and
employ exercise programs that differ greatly in their aims and content.
Meta-analysis should therefore involve exploration of whether these
factors “explain” (are associated with) estimates of the effect of
exercise programs.7,8
A Cochrane review of fall prevention strategies6
conducted separate meta-analyses on different forms of exercise and
concluded that some exercise programs can prevent falls in community
dwellers (e.g., home exercise program of balance and strength training, a
Tai Chi group program) but that others are unlikely to be beneficial
(brisk walking in women with an upper limb fracture in the previous 2
years) or require further investigation (untargeted group-based exercise
interventions and individual lower-limb strength training).
A limitation to this approach is that it combines programs that may be different (e.g., group programs that are of low and high intensity) and separates programs that share key features (e.g., balance training).
A limitation to this approach is that it combines programs that may be different (e.g., group programs that are of low and high intensity) and separates programs that share key features (e.g., balance training).
This
study sought to establish the effect of exercise on fall rates, with a
major aim of explaining between-trial variability. Meta-regression
methods were used to investigate whether particular features of study
populations, exercise programs, and study design were associated with
the size of estimates of effects of exercise on fall rates.
Quelle: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full?globalMessage=0
Quelle: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full?globalMessage=0
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/pdf
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