Extensive Cochrane review shows: fall prevention works

...but which exercise modalities work best?

  • Less people falling and less falling incidents
  • Balance training and functional training work best
  • Better results with supervision from health care providers

Community dwelling elderly fall less if they follow a fall prevention program, particularly if it includes balance exercises and functional training. Even if they fall, it may lead less often to fractures or medical care. Researchers concluded this after an extensive meta-analysis of 108 effect studies from 25 countries including 23,407 community dwelling elderly. 

Other outcome measures

Besides less falling, fall prevention training could reduce the risk of fall related medical care and fractures in elderly. However, this was not commonly reported, so the authors could not confirm this. The effect on hospital admissions or quality of life remains unclear. Although fall prevention training seems to have little unwanted effects, researchers warn for underreporting: only a quarter of the effect studies reported about this. 

Training parameters

The programs differed too much to make a statement about the optimal training dosage. Researchers did notice that most training programs had a duration of at least three months; almost a third had a duration of a year or longer.

Participants

The 23,407 investigated elderly had a mean age of 76 years and more than three quarters was female. They lived independently in the community and had no diseases that could lead to a higher risk of falling, such as a stroke, Parkinson’s disease, MS or dementia.

> From: Sherrington et al., Cochrane Database Syst Rev (2019) CD012424. All rights reserved to John Wiley & Sons, Inc. Click here for the online summary.

Expert opinion by Ellen Smulders

Cochrane reviews are very extensive reviews that have to meet a lot of criteria. They are qualitatively well-designed studies, which findings can be valued highly.

The current Cochrane study again shows that exercise therapy is effective for reducing fall incidents in community dwelling older people. Moreover, it demonstrates a reduction in the number of fallers. It is less clear if exercise therapy also leads to less injury and fractures. This is only logical: approximately 10 percent of the falls leads to injuries, of which approximately half are fractures. To specifically investigate the reduction of fractures, the study should be 20 times as large as when only the effects of falling incidents are investigated. These studies are extremely difficult to set up and execute. 

The Cochrane review shows that ‘single’ interventions such as dance and walking programs are less effective. Especially the programs with balance and functional exercises, combined with resistance training, show positive effects. Functional exercises are very important for elderly, because these are easier translated to a specific situation and therefore are better implemented in their daily activities of older people. 

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