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

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Falls are leading cause of injury and death in older Americans

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

British Journal of Sports Medicine, 02/02/2017

Sherrington C, et al. – This study was performed to test whether this impact is still present when new trials are included, and it investigates whether qualities of the trial design, sample or intervention are related to greater fall prevention impacts. This work suggested that the 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 impacts. The effect of exercise as a single intervention in clinical groups and aged care facility residents requires advance examination, however, promising results are evident for people with Parkinson's disease and cognitive impairment.

Methods

• Update of a systematic review with random effects meta-analysis and meta-regression.
• From January 2010 to January 2016, Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched.
• Inclusion of randomised controlled trials were performed to compare 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 19478 members were available for meta-analysis.
• Exercise lessened 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 impacts observed from exercise programmes that challenged balance and included more than 3 hours/week of exercise.
• These variables explained 76% of the between-trial heterogeneity in association with a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001).
• Exercise had a fall prevention impact 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, I²21%, 3 comparisons).
• No evidence was suggestive of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital.

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