As fall prevention programming becomes embedded in more community sites, as well as health care settings, it is useful to find a statistical analysis of the evidence regarding the most effective types of exercise programming. A meta-analysis was conducted to establish the effect of exercise on falls rates and to determine the particular features of effective fall prevention exercise programs. After identifying 1,107 relevant studies, the authors applied strict inclusion standards resulting in a final sample of 44 randomized clinical trials where it was possible to discern the specific exercise intervention and falls were measured as the outcome. Combined, these trials involved a total of 9,603 older adults, the majority of which were community dwelling. However, 6 studies involved older adult nursing home patients. Estimates of the effects of exercise were statistically extracted from each study.
Results: This review suggests that among older adults, exercise programs can reduce fall rates by as much as 17%. Sub-analysis excluding nursing home residents did not change the results. The greatest effects of exercise on falls were obtained from programs that:
Challenge balance to a high extent—starting at an appropriate level and individualizing the program to gradually increase the challenge to standing balance. The authors suggest that Tai Chi is effective for fall prevention because it meets these criteria.
Include a higher total dose of exercise—the minimum effective dose equates to a twice-weekly program lasting 25 weeks. It is suggested that supervised sessions that gradually increase intensity, should be interspersed with instructions to practice between classes at home. The typical 10 week courses are too short.
(Having both of the above was particularly effective.)
Did not include a walking program—The authors speculate that this unexpected finding may be due to:
a) time spent walking may reduce the amount of time spent practicing balance, for example in a timed center-based class, or
b) an increase in activity, such as walking, could precipitate more falls among frail people.
They observed that walking programs were often offered to more high risk populations. *The authors note that walking offers many health benefits and that it is to be encouraged. But if the goal is fall prevention, time is better spent practicing balance.
Strength training was not shown to be effective in reducing falls. The authors speculate that increasing strength in the absence of improving balance may account for this finding. Strength training increases strength, whereas standing balance exercises improve balance and because they include maneuvers that involve maintaining control of body weight-against-gravity, to some extent they simultaneously improve strength.
Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close CT. (2008). Effective exercise for the prevention of falls: A systematic review and meta-analysis. JAGS 56: 2234.