History of Falls Should Guide Exercise Prescription for Seniors

Fran Lowry

June 07, 2021

Past falls predict future falls and are a crucial factor to consider when prescribing exercise for seniors, according to new research.

In a study presented at the virtual American College of Sports Medicine (ACSM) 2021 Annual Meeting, investigators assessed the effect of past falls on the likelihood of future falls. The study, which included more than 600 older adults, indicated that each fall experienced in the past 5 years was associated with an almost fourfold increase in the odds of falling again sometime in the next several months.

The ACSM's Guidelines of Exercise Testing and Prescription recommend that older adults perform aerobic exercise 5 days a week and that they supplement this with 2 days of flexibility and resistance training.

But some researchers believe the recommendations should take into account adults who have previously experienced a fall.

Marie Acosta

"I watched way too many adults in my community suffer from falls, and then I watched how dire the consequences often were," first author Marie R. Acosta, a former undergraduate student at the University of the Pacific, Stockton, California, told Medscape Medical News.

"I realized that getting older adults to engage in physical activities was not a simple go-do-it prescription. It's not prophylactic, because it increases their fall risk. Shedding more light on that risk to see what the effect of past falls could be on the likelihood and incidence of future falls was our aim in this study," Acosta said.

She and her group evaluated 615 patients (mean age, 80 years; range, 71 to 89 years; 72% women) who were admitted to a level 1 trauma center for a fall-related injury over a 1-year period.

The researchers analyzed the patients' records to determine any admissions for fall-related injuries within the past 5 years. They then tracked these patients going forward for another 8 months to record any additional falls.

They found that past falls increased the liklihood that patients would fall again. This held true after controlling for factors such as cognitive decline and balance problems caused by certain medications.

Overall, the patients in the study experienced a mean of 1.9 (±1.3) previous fall-related injuries, and they sustained 0.5 ± 0.9 falls during the 8-month tracking period.

The researchers found that each additional previous fall was associated with a 3.9-fold increase in the odds of experiencing a future fall (95% CI, 3.131 – 4.961; P < .001).

Another analysis of the data revealed that each additional previous fall was associated with nearly a 95% increased risk for future falls.

"Our findings highlight the importance of asking older adults about their history of falls before you prescribe an exercise regimen for them," Acosta said.

"Saying to older adults, 'Go exercise,' is not helpful or beneficial if they have fallen in the past. My take-home message is for clinicians, personal trainers, exercise coaches, and fitness specialists to include questions about fall propensity for every client who is middle aged or older," she said.

Screening for Falls a Must

"This analysis emphasizes that fall risk screening is a critical component of pre-exercise evaluation and should be considered a primary risk factor in the development of a patient's exercise program," commented Amanda L. Zaleski, PhD, director of exercise physiology research at Hartford Hospital, Hartford, Connecticut.

Dr Amanda Zaleski

"Patients who are at risk for falls should be recommended to engage in neuromotor exercise training 2 to 3 days per week as the foundation of their exercise program," Zaleski, who was not part of the study, told Medscape Medical News.

"The good news is that there are various multimodal forms of exercise, such as Tai Chi, that are widely accessible, engaging, and equally effective at reducing fall risk and other comorbid risk factors likely to cluster in older adults, such as hypertension," she said. "This is where exercise prescription becomes more of an art vs prescriptive."

You're Never Too Old to Get Stronger

Summer Cook, PhD, an associate professor of kinesiology at the University of New Hampshire, Durham, New Hampshire, agrees that adding to the ACSM guidelines for exercise a recommendation to screen for falls among seniors is a good idea.

Dr Summer Cook

Cook regularly works with older adults and recommends specific exercise interventions for them. Her experience has taught her that every older adult is different, and they have very diverse physical function and abilities.

"The exercise prescriptions were tailored to each person's physical needs as well as their goals. It's never too late to build muscle and strength. You're never too old to get stronger," she said.

Acosta, Zaleski, and Cook report no relevant financial relationships.

American College of Sports Medicine (ACSM) 2021 Annual Meeting: Abstract 1184. Presented June 1, 2021.

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