Effect of exercise on fall prevention of community-dwelling elderly

Abstract

Objective: To evaluate the effectiveness of exercises on fall prevention among community-dwelling elderly. Design: Systematic review of randomized controlled trials. Method: The literature search of articles was conducted through the electronic databases of PubMed, Medline and EMBASE and manual search, and was confined to articles in English language with full text and publications from 2002 to 2012. Randomized controlled trials with exercise as the only intervention which aimed at reducing falls in older people aged 60 or above in community i.e. community-dwelling elderly were included. The primary outcomes were number of fallers, fall rate, time to the first and subsequent falls. Data Extraction: A total of 145 articles were retrieved through the electronic data bases (137 articles) and manual search (8 articles) of which 10 were selected after applying the inclusion criteria. According to the checklist developed by National Institute for Health and Clinical Excellence (NICE) for randomized controlled trials, the overall methodological quality of the 10 studies was rated as good as they had fulfilled 79%-93% of the assessment criteria in the NICE checklist. Results: The studies involved a sample size of 3,138 at the median age of 69 to 83. All the subjects were ambulatory and able to mobilize independently. The duration of exercise interventions ranged from 1.5 months to 12 months at a total of 11-156 hours. Eight studies showed that exercises were effective in fall prevention whereas two studies found no evidence of such effectiveness. The effect of exercises on fall prevention was multifactorial including the duration, frequency and continuity of the exercise programs, the health status of the target population and the individuals’ adherence to the exercise programs. Shorter exercise programs and make-up class arrangement resulted in higher adherence rate. Tailor-made (based on the functional capabilities of the subjects) and progressive (gradual increase of the intensity and challenge of the exercises during the intervention period) nature of the exercise programs also enhanced their effectiveness on the elderly. For the studies in which exercise did not have any positive effect on fall prevention, the subjects were generally older (median age at 81) and frailer (with 3-7 frail attributes). Conclusions: This review suggests exercise may be an effective intervention for fall prevention among community-dwelling elderly. Different types of exercise including strengthening, balance, endurance and weight-bearing exercises as well as Tai Chi may prevent falls. The elderly’s age and health status must be taken into consideration when designing exercise intervention programs for the elderly. Further researches are recommended to determine the optimal type, intensity, frequency and duration of exercises in fall prevention. Observations from the studies provide insights for future researches, such as the fall prevention effect of group and home exercises, tailor-made and progressive exercise programs. In Hong Kong, no randomized controlled trial studies have been conducted to examine different intervention programs on fall prevention. To achieve generalizabilty of the studies in the review, further local researches, particularly well designed and powered randomized controlled trials have to be conducted to assess the effect of different kinds of exercise interventions on fall prevention among the community-dwelling elderly.