August 8, 2012 — Embedding balance and strength movements into everyday activities such as "carrying the groceries from the car to the porch while walking sideways" may help older people prevent falls and improve overall strength and balance, according to a study published online August 7 in the British Medical Journal.
Lindy Clemson, PhD, head of occupational therapy in the Faculty of Health Sciences, University of Sydney, New South Wales, Australia, and colleagues conducted a 3-group randomized trial in which residents of Sydney older than 70 years who had 2 or more falls or 1 injurious fall within the previous year were recruited and randomly assigned to one of the following interventions: a novel activity-integrated exercise program called Lifestyle integrated Functional Exercise (LiFE), a structured exercise program, or a gentle exercise control program. Exclusion criteria included "moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises."
The researchers recruited 317 people in Sydney between February 2006 and December 2007 and then randomly assigned 107 participants to the LiFE program, 105 to the structured program, and 105 to the gentle exercise program. They performed follow-up at 6 months and 12 months after study participants started their programs. Participants reported any falls they experienced on daily calendars that were mailed monthly to the researchers; weekly exercise logs to assess adherence were also mailed in each month.
"The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group," the researchers write.
"We recorded a clinically important reduction of 31% in the rate of falls for participants in the LiFE programme compared with the control programme (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99), n=212)." They did not find a significant reduction in falls between the structured and the control group.
During the trial, as recorded at the 12-month follow-up, participants in the LiFE group experienced 172 falls, participants in the structured group experienced 193 falls, and participants in the control group experienced 224 falls. LiFE participants also showed improvements in balance, ankle strength, daily activity measures, and adherence rates.
Rather than a structured program, LiFE movements can occur at any time and be incorporated into normal daily activities such as "ironing while standing on one leg, talking on the phone while heel standing...[and] squatting in the supermarket to select an item from a lower shelf rather than bending," the researchers write. During the trial, LiFE and structured groups received 5 instructional sessions with 2 booster visits, plus 2 telephone calls during a 6-month time frame and a program manual. The control group received 3 visits and 2 calls.
The control group receiving less visit time could be a limitation to the study, the researchers write, and the number of participants was less than they preferred. Nonetheless, "The LiFE program provides an additional choice to traditional exercise and another fall prevention programme that could work for some people."
In addition, the researchers conclude, "[I]t challenges allied health professionals to expand their focus when working with older people to find opportunities to incorporate balance and strength training into daily life."
In an accompanying editorial, Meg E. Morris, PhD, from the Department of Physiotherapy at the University of Melbourne, Victoria, Australia, writes, "The current trial suggests that for fall prevention programmes in older people to be effective, therapeutic exercises, education, and physical activities need to be sustainable, enjoyable, and effective over the long term. … The belief that falls should be accepted and tolerated as part of the ageing process is a myth that needs dispelling. Many falls can and should be prevented."
This study was supported by a grant from the National Health and Medical Research Council. The authors and the editorialist have disclosed no relevant financial relationships.
BMJ. Published online August 7, 2012. Article full text, Editorial extract
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