The prevention of falls and mobility-related disability among older people is an urgent public health challenge, with one third of people aged 65 and over falling once or more annually. Due to increasing proportions of older people in the population, the impact of falls on older individuals, their carers and health services will continue to grow into the future. Trials and systematic reviews have provided clear evidence that falls in older people can be prevented with appropriately designed interventions. This systematic review update includes 54 randomised controlled trials, including 10 additional eligible trials, and focuses on exercise as a single falls prevention intervention. The findings of the meta-analysis remained unchanged, confirming that that exercise as a single intervention can prevent falls (RR 0.84, 95% CI: 0.77 to 0.91). Programs that included balance training, contained a higher dose of exercise and did not include walking training had the greatest effect on reducing falls. However trials with and without walking training led to a reduction in falls if they also included balance training and a high dose of exercise. An exploratory meta-analysis from trials conducted in residential care settings found that exercise resulted in a 7% reduction in fall rates (RR 0.93, 95% CI: 0.78 to 1.11). The authors recommend that exercise for falls prevention should provide a moderate or high challenge to balance, must be of a sufficient dose to have an effect and be undertaken for at least 2 hours per week on an ongoing basis. Additionally it is recommended that falls prevention exercise should be targeted at the general community as well as those at high risk for falls, and that walking training may be included in addition to balance training, but high risk individuals should not be prescribed brisk walking programs. The authors suggest that the above recommendations also apply to people in residential aged care and to people with cognitive impairment, however modification of implementation approaches are required to ensure safety and efficacy of exercise interventions in residential care settings and for those with cognitive impairment.
Sherrington C, Tiedemann A, et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin 2011;22(4):78-83.