Published: Oct 30, 2013 | Updated: Oct 31, 2013

By Chris Kaiser
Full Story:  http://www.medpagetoday.com/PrimaryCare/Geriatrics/42592

Fall-prevention exercise programs for older people seem to lower the risk of injuries when falls do occur, a review of randomized controlled trials found.

Pooled data found that exercise was associated with an overall 37% reduction in all injurious falls in older community-dwelling adults (95% CI 0.51-0.77, 10 trials), Fabienne El Khoury, PhD, from the University of Paris-Sud in France, and colleagues, wrote online in BMJ.

When researchers broke down the data into separate categories, they found that exercise programs were associated with reductions in:

• Falls resulting in medical care (rate ratio [RR] 0.70, 95% CI 0.54-0.92, eight trials)
• Falls resulting in severe injuries (RR 0.57, 95% CI 0.36-0.90, seven trials)
• Falls resulting in fractures (RR 0.39, 95% CI 0.22-0.66, six trials)

A 2012 Cochrane review of randomized trials concluded that exercise programs reduce the rate of falls (up to 29%) and the risk of falling (up to 32%), and also reduced the risk of fractures by 66%. But there are no data on other types of injuries due to falls.

To explore the issue further, the authors reviewed 17 trials conducted through June 2013 with a total of 2,195 participants in the exercise groups and 2,110 in the control groups. The mean age was 76, and 77% were women.

Tai Chi was the exercise in two of the trials, but the rest consisted of gait, balance, and functional training for activities performed in daily life. Most trials also included strength/resistance training exercises.

Most of the studies were judged to have a low risk of bias and most used the preferred method for recording falls: daily calendars returned monthly. But only six of the 11 trials that had data on serious injuries actually confirmed the injury with medical records.

The authors of the study also noted the significant heterogeneity between the 10 studies for all injurious falls. Another limitation was the substantial variations in the definition and classification of injurious falls — and most trials did not provide a reference for their definition.

“Injurious falls usually included very diverse consequences ranging from relatively minor injuries such as bruises, to fractures and other serious injuries requiring hospitalizations,” the authors wrote.

They therefore distinguished four categories for falls: falls resulting in any reported consequences including bruises, cuts or fractures; falls resulting in medical care; falls resulting in severe injuries such as fractures, head trauma, or soft tissue injury; and falls resulting in fractures.

All the exercises that proved to be effective for fall prevention emphasized balance training, which the researchers said is “ample evidence that this type of program improves balance ability.”

But beyond the improving balance and overall physical functioning, exercise has been shown to improve cognitive functioning, which most likely contributes to the overall lower risk of falling, they said.

The results provide useful additional evidence for healthcare providers to encourage patients to take part in exercise fall-prevention programs, the researchers said.

However, the results should be interpreted with caution because of the heterogeneity of the studies, including diverse intervention components and inclusion criteria.

They suggested that future trials should aim to address some of the limitations by providing data on quality of life, as well as on intermediate outcomes, which would help elucidate “how exercise works and design optimum programs.”