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Prescribe exercise for falls prevention in community settings

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Falls in older people living in the community can successfully be prevented by prescribing exercise, according to a major new review of the research evidence.

The Cochrane Review, undertaken by researchers from the University of Oxford and University of Sydney, brings together results from more than 100 trials from across the globe.

“This evidence helps build an even stronger picture that exercise can help prevent older people having falls”

Cathie Sherrington

It found exercise programmes supported by health professionals including nurses reduced the number of falls by nearly a quarter, with strong evidence regimes that help improve balance and function have a positive impact.

In all, the review brings together the findings from 108 randomised controlled trials involving more than 23,400 participants across 25 countries.

All the trials included in the review specifically looked at the impact of exercise on falls among over-60s in the community – living independently at home, in retirement complexes or sheltered housing.

The majority – 81 of the trials – compared the impact of doing little or no exercise with following a prescribed exercise regime, which could include doing group classes or exercising at home.

Interventions featured in the review included nurse-led schemes, such as a programme in New Zealand looking at the impact of home exercises, and walking plans prescribed by a nurse while a study in London explored the impact of a “brisk walking” scheme supported by nurses.

The analysis found that overall doing fall-prevention exercises of any type reduced the number of falls over time by 23%, as well as cutting the number of people experiencing one or more falls by around a fifth or 15%.

When it came to the most effective type of exercise, the researchers found strong evidence that programmes that focus on improving balance and function helped reduce falls.

The evidence was less clear when it came to regimes involving a range of different types of exercise – usually a mix of balance, function and resistance exercises, such as using weights and elastic bands.

However, the analysis suggests that such programmes “probably” help to reduce the rate of falls by more than a third or 34% and the number of people experiencing one or two falls by 22%.

The review found Tai Chai may also help in falls prevention but the evidence was uncertain when it came to schemes primarily focused on resistance training, or dancing or walking programmes.

The impact of exercise when it came to reducing fractures and the need for medical attention was also less clear – partly because only a small number of studies looked at those outcomes.

When side effects of exercises were recorded, they were usually not serious, such as joint or muscle pain, but a pelvic stress fracture was reported in one trial.

“This review pinpoints which types of exercise are more likely to be effective for preventing falls”

Cathie Sherrington

Lead author Professor Cathie Sherrington, from the University of Sydney’s Institute for Musculoskeletal Health, said the findings backed the theory that exercise could help prevent falls.

“This evidence helps build an even stronger picture that exercise can help prevent older people having falls,” she said. “It also illustrates which types of exercise can be beneficial.

“It is well known that keeping active promotes good health but this review pinpoints which types of exercise are more likely to be effective for preventing falls,” she said.

However, she said more work was needed to establish the impact of exercises on fall-related fractures and falls that required medical attention, because “such falls have major impacts for the individual and are particularly costly to health systems”.

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