Exercise Prevents Injuries From Falls in Older People

Ricki Lewis, PhD

October 30, 2013

Exercise programs prevent falls among people older than 60 years living in the community. Such programs also reduce the likelihood of injuries when falls do occur, according to results of a meta-analysis published online October 29 in BMJ.

Many older adults who live at home are vulnerable to injuries sustained during falls. Such injuries can cause pain and limit functioning, are costly, and may necessitate placement in a skilled nursing or rehabilitation facility. Even minor injuries can have long-lasting consequences if they lead to loss of mobility or cause depression or other psychological distress. Studies designed to assess the efficacy of exercise programs to prevent falls have not previously assessed prevention of injury from falls.

Fabienne El-Khoury, a PhD candidate in epidemiology from the University Paris-Sud and the Inserm Centre for Research in Epidemiology and Population Health, Villejuif, France, and colleagues compiled data from 17 studies by categorizing types of falls into 4 groups: all falls causing injury, falls requiring medical care, severe falls causing injury, and falls that caused fractures.

The investigators obtained data through June 2013 from the Cochrane Library, Pubmed, EMBASE, and CINAHIL. Among the trial participants, 2195 followed exercise programs and 2110 in the control groups did not. Mean age of the participants was 76 years, and 77% were women.

The studies were heterogeneous. For example, 14 trials administered exercise in groups, with 6 of them adding home-based exercise, whereas the other 3 trials only used individual exercise done at home. Seven studies included high-risk participants (older and with fall history). The studies also differed in the types of exercise: some used only tai chi, whereas others incorporated gait and balance and strength/resistance training to different degrees.

The researchers found that exercise programs had significant effects in all fall categories. Pooled estimates of the rate ratios were 0.63 (95% confidence interval [CI], 0.51 - 0.77; 10 trials) for all injurious falls, 0.70 (95% CI, 0.54 - 0.92; 8 trials) for falls requiring medical care, 0.57 (95% CI, 0.36 - 0.90; 7 trials) for severe falls causing injury, and 0.39 (95% CI, 0.22 - 0.66; 6 trials) for falls causing fractures. However, the researchers observed significant heterogeneity among studies for all falls resulting in injuries (I 2, 50%; P = .04).

The researchers conclude that exercise programs protect against both falls and fall-related injuries, with the most pronounced effect seen on the most severe injuries. They write, "the estimated reduction is 37% for all injurious falls, 43% for severe injurious falls, and 61% for falls resulting in fractures."

Studies would be more valuable, the researchers suggest, if they reported quality-of-life issues, adverse effects of exercise, and intermediate outcomes such as improved balance or cognition.

The researchers have disclosed no relevant financial relationships.

BMJ. Published online October 29, 2013. Full text

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