A multicentre randomised controlled trial found that a two-year balance training programme reduced the risk of falls in older women
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Exercise programmes that emphasise balance training are effective at reducing falls among older people in the community (Gillespie et al, 2012). The National Institute for Health and Care Excellence (2013) recommends that all older people who have fallen, or are at risk of falling, should be offered a muscle-strengthening and balance programme as a component of an individualised multifactorial intervention.
El-Khoury et al (2015) conducted a randomised controlled trial to assess whether a two-year balance retraining programme reduced injurious falls among older women living in the community. Voter registration lists were used to recruit women aged 75–85 in 16 cities in France. These women were invited by letter to attend a free balance and health examination. Women were eligible to participate in the study if they were assessed as having poor balance or gait.
A total of 4,221 women attended the baseline balance and health examination (11% of those invited) and 706 agreed to be randomised to the intervention group (n = 352) or the control group (n = 354). The intervention comprised two years of free weekly supervised exercise sessions, supplemented by individually prescribed home exercises (the Ossébo balance training programme). The intervention was delivered by a network of community-based instructors with moderate levels of training and expertise.
Over the two-year study period, 397 injurious falls were reported in the control group (in 189 women), and 305 falls in the intervention group (in 170 women). The rate of injurious falls was 19% lower in the intervention group than in the control group. Women in the intervention group were statistically significantly better than those in the control group in a range of measures of balance and gait, such as time taken to walk six metres. When questioned about health-related quality of life, women in the intervention group reported statistically significantly better physical function throughout the study and better general health and vitality at one year.
Limitations of this study include the low recruitment rate (11%) as well as the high dropout rates (16% in the intervention group and 14% in the control group).
In addition, participation in the intervention programme was inconsistent, with most participants missing some of the sessions.
- Study sponsorship: Assistance Publique – Hôpitaux de Paris, the French Ministry of Health, the French National Research Agency, the National Institute of Health Prevention and Education, and the Council of the Ile-de-France region.
- Reproduced with permission; adapted from National Institute for Health and Care Excellence (2016) Balance training to prevent injuries from falls in older people. Eyes on Evidence; Issue 85.
Box 1. Commentary
Given that reduction in injurious falls was the primary outcome measure in this study, it is surprising that neither the total number of previous falls, nor the number of injurious falls, was recorded before the intervention. Randomisation was stratified for weight and study centre, although not for history of falls. As a result, the control and intervention group had a different proportion of people with a history of falls – 45% and 39% respectively – this meant there were 15% more people with a history of falls in the control group. The 19% difference in injurious falls between the two groups during the intervention period should be interpreted in this context.
There was no economic assessment of this intervention and, in the absence of follow-up data, it is not possible to comment on any lasting benefit.
Despite these caveats, this is a useful study proving the feasibility of delivering a long-term, progressive strength and balance programme requiring weekly attendance by participants and using normal facilities. It has greatly added to our knowledge of the practical challenges and barriers to providing a large-scale, population-level, single intervention to reduce falls in a moderately at-risk older population. Health professionals should continue to follow the advice of the National Institute for Health and Care Excellence, and offer individualised muscle-strengthening and balance interventions to people at risk of falling.
Alison Shepherd, speciality trainee in geriatric medicine and Damien Reid, consultant in medicine for the elderly, Hairmyres Hospital, NHS Lanarkshire
Helen Jaques is medical writer, National Institute for Health and Care Excellence
El-Khoury F et al (2015) Effectiveness of two year balance training programme on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossébo randomised controlled trial. British Medical Journal; 351: h3830.
Gillespie LD et al (2012) Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews; 9: CD007146.
National Institute for Health and Care Excellence (2013) Falls in Older People: Assessing Risk and Prevention.