Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T12:42:10.048Z Has data issue: false hasContentIssue false

10 - Exercise interventions to prevent falls

Published online by Cambridge University Press:  03 May 2010

Stephen R. Lord ,
Catherine Sherrington ,
Hylton B. Menz  and
Jacqueline C. T. Close
Stephen R. Lord
Affiliation:
Prince of Wales Medical Research Institute, Sydney
Catherine Sherrington
Affiliation:
University of Sydney
Hylton B. Menz
Affiliation:
Prince of Wales Medical Research Institute, Sydney and La Trobe University, Melbourne
Jacqueline C. T. Close
Affiliation:
Prince of Wales Medical Research Institute, Sydney and Prince of Wales Hospital, Sydney
Get access

Summary

Exercise has a major role to play in preventing falls among older people and is recommended in recent evidence-based guidelines for falls prevention. As acknowledged in these guidelines, there are many different types of exercise, some of which are likely to result in greater reductions in falls than others. It is therefore incumbent upon health professionals to do better than merely suggest that older people should exercise. As Hadley has stated ‘telling an older person that ‘exercise’ can prevent falls is not much better than telling them that ‘antibiotics’ can cure an infection: although true, the advice would be much more useful if it were more specific’.

This chapter aims to assist the health professional to prescribe exercise for falls prevention. The first section reviews the findings of randomized controlled trials into exercise interventions for falls prevention. From this, a synthesis of the findings is undertaken in an effort to delineate the important components for successful exercise interventions.

Analysis of randomized controlled trials (RCTs) investigating exercise and falls

In revising and updating this chapter, a detailed analysis of the specific components of exercise was undertaken. A total of 44 RCTs of exercise interventions for falls prevention written in English were identified via searches of electronic databases (MEDLINE, CINAHL, EMBASE, PEDro), and reference lists of systematic reviews and clinical practice guidelines.

Type
Chapter
Information
Falls in Older People
Risk Factors and Strategies for Prevention
 , pp. 177 - 203
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

NICE, Clinical Guideline 21. Falls: the Assessment and Prevention of Falls in Older People (London: National Institute for Clinical Excellence, 2004).
Moreland, J., Richardson, J., Chan, D. H.et al., Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology, 49(2) (2003), 93–16.CrossRefGoogle ScholarPubMed
Feder, G., Cryer, C., Donovan, S. & Carter, Y., Guidelines for the prevention of falls in people over 65. British Medical Journal, 321 (2000), 1007–11.CrossRefGoogle ScholarPubMed
Hadley, E., The science of the art of geriatric medicine. Journal of the American Medical Association, 273 (1995), 1381–3.CrossRefGoogle ScholarPubMed
Steadman, J., Donaldson, N. & Kalra, L., A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. Journal of the American Geriatrics Society, 51(6) (2003), 847–52.CrossRefGoogle ScholarPubMed
Means, K. M., Rodell, D. E., O'Sullivan, P. S. & Cranford, L. A., Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Archives of Physical Medicine and Rehabilitation, 77 (1996), 1030–6.CrossRefGoogle ScholarPubMed
Pereira, M. A., Kriska, A. M., Day, R. D.et al., A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later. Archives of Internal Medicine, 158(15) (1998), 1695–701.CrossRefGoogle ScholarPubMed
Barnett, A., Smith, B., Lord, S. R., Williams, M. & Baumand, A., Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age and Ageing, 32(4) (2003), 407–14.CrossRefGoogle ScholarPubMed
Buchner, D. M., Cress, M. E., Lateur, B. J.et al., The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 52(4) (1997), M218–24.Google ScholarPubMed
Day, L., Fildes, B., Gordon, I.et al., A randomized factorial trial of falls prevention among older people living in their own homes. British Medical Journal, 325 (2002), 128–33.CrossRefGoogle ScholarPubMed
Means, K. M., Rodell, D. E. & O'Sullivan, P. S., Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. American Journal of Physical Medicine and Rehabilitation, 84(4) (2005), 238–50.CrossRefGoogle ScholarPubMed
Skelton, D., Dinan, S., Campbell, M. & Rutherford, O., Tailored group exercise (FaME) reduces falls in community dwelling older frequent fallers (a RCT) (research letter). Age and Ageing, 34(6) (2005), 636–9.CrossRefGoogle Scholar
Wolf, S. L., Barnhart, H. X., Kutner, N. G.et al., Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and injuries: cooperative studies of intervention techniques. Journal of the American Geriatrics Society, 44(5) (1996), 489–97.CrossRefGoogle ScholarPubMed
Li, F., Harmer, P., Fisher, K. J.et al., Tai Chi and fall reductions in older adults: a randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(2) (2005), 187–94.CrossRefGoogle ScholarPubMed
A. Voukelatos, R. Cumming, S. Lord & C. Rissel, A randomised controlled trial of Tai Chi for prevention of falls: the Central Sydney Tai Chi trial. Manuscript under review.
Lord, S. R., Castell, S., Corcoran, J.et al., The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. Journal of the American Geriatrics Society, 51(12) (2003), 1685–92.CrossRefGoogle ScholarPubMed
Campbell, A. J., Robertson, M. C., Gardner, M. M.et al., Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Medical Journal, 315(7115) (1997), 1065–9.CrossRefGoogle ScholarPubMed
Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N. & Buchner, D. M., Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Ageing, 28(6) (1999), 513–8.CrossRefGoogle ScholarPubMed
Robertson, M. C., Devlin, N., Gardner, M. M. & Campbell, A. J., Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1. Randomised controlled trial. British Medical Journal, 322(7288) (2001), 697–701.CrossRefGoogle ScholarPubMed
Robertson, M. C., Gardner, M. M., Devlin, N., McGee, R. & Campbell, A. J., Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2. Controlled trial in multiple centres. British Medical Journal, 322(7288) (2001), 701–4.Google ScholarPubMed
Schnelle, J. F., Kapur, K., Alessi, C.et al., Does an exercise and incontinence intervention save healthcare costs in a nursing home population?Journal of the American Geriatrics Society, 51(2) (2003), 161–8.CrossRefGoogle Scholar
Ebrahim, S., Thompson, P. W., Baskaran, V. & Evans, K., Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age and Ageing, 26(4) (1997), 253–60.CrossRefGoogle ScholarPubMed
Bunout, D., Barrera, G., Avendaño, M.et al., Results of a community-based weight-bearing resistance training programme for healthy Chilean elderly subjects.. Age and Ageing, 34(1) (2005), 80–3.CrossRefGoogle ScholarPubMed
Carter, N. D., Khan, K. M., McKay, H. A.et al., Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Canadian Medical Association Journal, 167(9) (2002), 997–1004.Google ScholarPubMed
Lord, S., Ward, J., Williams, P. & Strudwick, M., The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 43 (1995), 1198–206.Google ScholarPubMed
McMurdo, M. E., Mole, P. A. & Paterson, C. R., Controlled trial of weight bearing exercise in older women in relation to bone density and falls. British Medical Journal, 314(7080) (1997), 569.CrossRefGoogle ScholarPubMed
Morgan, R. O., Virnig, B. A., Duque, M., Abdel-Moty, E. & DeVito, C. A., Low-intensity exercise and reduction of the risk for falls among at-risk elders. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59(10) (2004), 1062–7.CrossRefGoogle ScholarPubMed
Reinsch, S., MacRae, P., Lachenbruch, P. A. & Tobis, J. S., Attempts to prevent falls and injury: a prospective community study. Gerontologist, 32(4) (1992), 450–6.CrossRefGoogle ScholarPubMed
Steinberg, M., Cartwright, C., Peel, N. & Williams, G., A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial. Journal of Epidemiology and Community Health, 54(3) (2000), 227–32.CrossRefGoogle ScholarPubMed
Wolf, S. L., Sattin, R. W., Kutner, M.et al., Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. Journal of the American Geriatrics Society, 51(12) (2003), 1693–701.CrossRefGoogle ScholarPubMed
Speechley, M. & Tinetti, M., Falls and injuries in frail and vigorous community elderly persons. Journal of the American Geriatrics Society, 39 (1991), 46–52.CrossRefGoogle ScholarPubMed
Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N., Buchner, D. M., Psychotropic medication withdrawal and a home based exercise programme to prevent falls: results of a randomised controlled trial. Journal of the American Geriatrics Society, 47 (1999), 850–3.CrossRefGoogle Scholar
Campbell, A., Robertson, M., Grow, S.et al., Randomised controlled trial of prevention of falls in people aged 75 with severe visual impairment: the VIP trial. British Medical Journal, 331(7520) (2005), 817–925.CrossRefGoogle ScholarPubMed
Latham, N. K., Anderson, C. S., Lee, A.et al., A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). Journal of the American Geriatrics Society, 51(3) (2003), 291–9.CrossRefGoogle Scholar
Mulrow, C. D., Gerety, M. B., Kanten, D.et al., A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA: Journal of the American Medical Association, 271(7) (1994), 519–24.CrossRefGoogle ScholarPubMed
Province, M. A., Hadley, E. C., Hornbrook, M. C.et al., The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. Frailty and injuries: cooperative studies of intervention techniques. JAMA: the Journal of the American Medical Association, 273(17) (1995), 1341–7.CrossRefGoogle ScholarPubMed
Carr, J. & Shepherd, R., Neurological Rehabilitation: Optimizing Motor Performance (Oxford: Butterworth-Heinemann, 1998).Google Scholar
Herbert, R. D. & Gabriel, M., Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. British Medical Journal, 325(7362) (2002), 468–71.CrossRefGoogle ScholarPubMed
Harvey, L. A., Byak, A. J., Ostrovskaya, M., Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries. Australian Journal of Physiotherapy, 49(3) (2003), 176–81.CrossRefGoogle ScholarPubMed
Moseley, A. M., Herbert, R. D., Nightingale, E. J.et al., Passive stretching does not enhance outcomes in patients with plantarflexion contracture after cast immobilization for ankle fracture: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 86(6) (2005), 1118–26.CrossRefGoogle Scholar
Robertson, M. C., Campbell, A. J., Gardner, M. M. & Devlin, N., Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. Journal of the American Geriatrics Society, 50(5) (2002), 905–11.CrossRefGoogle ScholarPubMed
Alexander, N. B., Bentur, N., Strasburg, D. & Nyquist, L. V., Fall risk reduction in Israeli day care centre attendees using exercise and behavior strategies [abstract]. Journal of the American Geriatrics Society, 51(Suppl 4) (2003), S117.Google Scholar
Buettner, L. L., Focus on caregiving. Falls prevention in dementia populations: following a trial program of recreation therapy, falls were reduced by 164 percent. Provider, 28(2) (2002), 41–3.Google Scholar
Cerny, K., Blanks, R., Mohamed, O.et al., The effect of a multidimensional exercise program on strength, range of motion, balance and gait in the well elderly [abstract]. Gait and Posture, 7(2) (1998), 185–6.CrossRefGoogle Scholar
Fiatarone, M., O'Neill, E., Doyle, R. & Clements, K., Efficacy of Home-Based Resistance Training in Frail Elders. Abstracts of the 16th Congress of the International Association of Gerontology. (Bedford Park, South Australia, 1997).Google Scholar
Hauer, K., Rost, B., Rutschle, K.et al., Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Journal of the American Geriatrics Society, 49 (2001), 10–20.CrossRefGoogle ScholarPubMed
Helbostad, J. L., Sletvold, O. & Moe-Nilssen, R., Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study. Aging – Clinical and Experimental Research, 16(2) (2004), 113–21.CrossRefGoogle ScholarPubMed
Liu-Ambrose, T., Khan, K. M., Eng, J. J.et al., Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. Journal of the American Geriatrics Society, 52(5) (2004), 657–65.CrossRefGoogle ScholarPubMed
MacRae, P., Feltner, M. & Reinsch, S., A 1-year exercise program for older women: Effects on falls, injuries and physical performance. Journal of Aging and Physical Activity, 2 (1994), 127–42.CrossRefGoogle Scholar
Nitz, J. C. & Choy, N. L., The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial. Age and Ageing, 33(1) (2004), 52–8.CrossRefGoogle ScholarPubMed
Resnick, B., Testing the effect of the WALC intervention on exercise adherence in older adults. Journal of Gerontological Nursing, 28(6) (2002), 40–9.CrossRefGoogle ScholarPubMed
Rubenstein, L., Josephson, K., Trueblood, P.et al., Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 55A(6) (2000), M317–21.CrossRefGoogle Scholar
Schoenfelder, D. P., A fall prevention program for elderly individuals. Exercise in long-term care settings. Journal of Gerontological Nursing, 26(3) (2000), 43–51.CrossRefGoogle ScholarPubMed
Sherrington, C., Lord, S. R. & Herbert, R. D., A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medical Rehabilitation, 85(2004), 710–6.CrossRefGoogle ScholarPubMed
Shimada, H., Obuchi, S., Furuna, T. & Suzuki, T., New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill. American Journal of Physical Medicine and Rehabilitation, 83(7) (2004), 493–9.CrossRefGoogle ScholarPubMed
Toulotte, C., Fabre, C., Dangremont, B., Lensel, G. & Thevenon, A., Effects of physical training on the physical capacity of frail, demented patients with a history of falling: a randomised controlled trial. Age and Ageing, 32(1) (2003), 67–73.CrossRefGoogle ScholarPubMed
Nowalk, M. P., Prendergast,, J. M.Bayles, C. M., D'Amico, F. J. & Colvin, G. C., A randomized trial of exercise programs among older Individuals living in two long-term care facilities: the Falls FREE program. Journal of the American Geriatrics Society, 49(7) (2001), 859–65.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×