Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis

Authors

  • Catherine Sherrington PhD,

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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  • Julie C. Whitney MSc,

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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  • Stephen R. Lord DSc,

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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  • Robert D. Herbert PhD,

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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  • Robert G. Cumming PhD,

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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  • Jacqueline C. T. Close MD

    1. From the *Musculoskeletal Division, The George Institute for International Health and School of Public Health, University of Sydney, Sydney, AustraliaFalls and Balance Research Group, Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia§Clinical Age Research Unit, Kings College Hospital, London, United Kingdom; and Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia.
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Address correspondence to Dr. Catherine Sherrington, The George Institute for International Health, PO Box M201, Missenden Road, Sydney NSW 2050, Australia. E-mail: csherrington@george.org.au

Abstract

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.

DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included.

SETTING: Older people.

PARTICIPANTS: General community and residential care.

MEASUREMENTS: Fall rates.

RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I2=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48–0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program.

CONCLUSION: Exercise can prevent falls in older people. 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. Service providers can use these findings to design and implement exercise programs for falls prevention.

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