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Exercise decreases falls and injuries in older people
Clinical Question
In older patients, do exercise classes or a prescribed exercise regimen decrease the risk of falls, injuries, or more serious outcomes?
Bottom line
Regular moderate-intensity exercise 2 to 3 times per week can decrease the overall likelihood of falls and resulting injuries in older patients, but does not decrease the overall risk of hospitalization or decrease mortality. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
These investigators searched 5 databases, including the Cochrane Central Register of Controlled Trials, to identify randomized long-term studies that evaluated the effect of exercise programs on important outcomes in patients at least 59 years of age (mean age 73.1 years). They included research in any language. Two researchers independently screened articles, abstracted the data, and assessed the risk of bias. Twenty-nine of the 46 identified studies evaluated multicomponent training (aerobic/strength/balance), though strength training and aerobic exercise alone were also studied. The most common program included moderate-intensity exercise for 50 minutes 3 times per week. Exercise significantly decreased the risk of falls and injurious falls, but did not affect the risk of multiple falls, hospitalization, or mortality. Fractures were less likely in the exercise group but not significantly so. The average attendance at exercise classes was 65%. The quality of the research was not good, with several validity risks and evidence of publication bias. Also, the authors may have combined apples and oranges—the baseline risks of a 59-year-old patient are much different from those of an over-70-year-old, and individual versus group exercise programs might not be equivalent.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Not much of a surprise
The finding of decreased falls risk makes sense. It also makes sense that the risk of multiple falls was not decreased ... in general multi-fallers have several simultaneous pathologies, not necessarily amenable to exercise. I certainly agree that the study compares apples and oranges - the average 60 year old is physiologically quite different from the average over 70 year old ... who may be over 80!