Exercise for the prevention of falls in elderly people

Conclusion: Convincing evidence for effectiveness

Interventions based on balance and strength training and Tai Chi for elderly living in the community can reduce the risk of falls by 15-50%. This type of exercise can improve many risk factors of falling, such as muscle strength, gait, proprioception, balance, flexibility, coordination and fear of falling.
Exercise may be less effective when there are other risk factors for falls present that are not influenced by the intervention. This might be the reason for the limited effectiveness of exercise in frail, institutionalised elderly
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.
A home based exercise program is more effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.

Recommendations (for research & practice)

Exercise programmes with the appropriate components can be carried out safely by older people if prescribed and supervised by a trained instructor. A non-specific approach to exercise may encourage higher activity levels and therefore results in more, rather than fewer, falls and injuries.
Exercise is effective as a single measure or prescribed as a part of a multifactorial program
There is a need for research on exercise programs to reduce falls in nursing care facilities and research to establish whether exercise programmes reduce fall related injuries.

Review Date: 17/11/2008
Version: 1.2
Status: Publish

Procedure
First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Recent reviews and meta-analyses, were selected and scrutinised. In the end, the selection was completed with articles of later date and background documents were created. The resulting evidence statements were subjected to expert review and if necessary adapted.

Background documents

Effective exercise for the prevention of falls: a systematic review and meta-analysis (version 1)
C. Sherrington, J.C. Whitney, S.R. Lord ... [et al.] (2008)

Interventions for preventing falls in older people living in the community (version 1)
L.D. Gillespie, M.C. Robertson, W.J. Gillespie ... [et al.] (2009)

Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons : a systematic review (version 1)
K. Hauer, C. Becker, U. Lindemann...[et al] (2006)

A randomized, controlled trial of tai chi for the prevention of falls : the central Sydney tai chi trial (version 1)
A. Voukelatos, R.G. Cumming, S.R.Lord ... [et al.] (2007)

Randomised factorial trial of falls prevention among older people living in their own homes (version 1)
Lesley Day, Brian Fildes, Ian Gordon, ...[et al.] (2002)

A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly (version 1)
Vivian Weerdesteyn, Hennie Rijken, Alexander C. Geurts...[et al] (2006)

Preventing injuries in older people by preventing falls : a meta-analysis of individual-level data (version 1)
M. Clare Robertson, A. John Campbell, Melinda M. Gardner ...[et al.] (2002)