Exercise to prevent falls in older adults: An updated systematic review and meta-analysis

Catherine Sherrington, Zoe A. Michaleff, Nicola Fairhall, Serene S. Paul, Anne Tiedemann, Julie Whitney, Robert G. Cumming, Robert D. Herbert, Jacqueline C.T. Close, Stephen R. Lord

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137 Citations (Scopus)

Abstract

Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I 2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I 2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I 2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.

Original languageEnglish
Pages (from-to)1749-1757
Number of pages9
JournalBritish Journal of Sports Medicine
Volume51
Issue number24
DOIs
Publication statusPublished - 1 Dec 2017
Externally publishedYes

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Meta-Analysis
Exercise
Independent Living
Parkinson Disease
Information Storage and Retrieval
PubMed
MEDLINE
Libraries
Survivors
Randomized Controlled Trials
Stroke
Control Groups

Cite this

Sherrington, Catherine ; Michaleff, Zoe A. ; Fairhall, Nicola ; Paul, Serene S. ; Tiedemann, Anne ; Whitney, Julie ; Cumming, Robert G. ; Herbert, Robert D. ; Close, Jacqueline C.T. ; Lord, Stephen R. / Exercise to prevent falls in older adults : An updated systematic review and meta-analysis. In: British Journal of Sports Medicine. 2017 ; Vol. 51, No. 24. pp. 1749-1757.
@article{3878559fe450434e954832ed7bd98e11,
title = "Exercise to prevent falls in older adults: An updated systematic review and meta-analysis",
abstract = "Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21{\%} (pooled rate ratio 0.79, 95{\%} CI 0.73 to 0.85, p<0.001, I 2 47{\%}, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76{\%} of the between-trial heterogeneity and in combination led to a 39{\%} reduction in falls (incident rate ratio 0.61, 95{\%} CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95{\%} CI 0.30 to 0.73, p=0.001, I 2 65{\%}, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95{\%} CI 0.37 to 0.83, p=0.004, I 2 21{\%}, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.",
author = "Catherine Sherrington and Michaleff, {Zoe A.} and Nicola Fairhall and Paul, {Serene S.} and Anne Tiedemann and Julie Whitney and Cumming, {Robert G.} and Herbert, {Robert D.} and Close, {Jacqueline C.T.} and Lord, {Stephen R.}",
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Sherrington, C, Michaleff, ZA, Fairhall, N, Paul, SS, Tiedemann, A, Whitney, J, Cumming, RG, Herbert, RD, Close, JCT & Lord, SR 2017, 'Exercise to prevent falls in older adults: An updated systematic review and meta-analysis' British Journal of Sports Medicine, vol. 51, no. 24, pp. 1749-1757. https://doi.org/10.1136/bjsports-2016-096547

Exercise to prevent falls in older adults : An updated systematic review and meta-analysis. / Sherrington, Catherine; Michaleff, Zoe A.; Fairhall, Nicola; Paul, Serene S.; Tiedemann, Anne; Whitney, Julie; Cumming, Robert G.; Herbert, Robert D.; Close, Jacqueline C.T.; Lord, Stephen R.

In: British Journal of Sports Medicine, Vol. 51, No. 24, 01.12.2017, p. 1749-1757.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Exercise to prevent falls in older adults

T2 - An updated systematic review and meta-analysis

AU - Sherrington, Catherine

AU - Michaleff, Zoe A.

AU - Fairhall, Nicola

AU - Paul, Serene S.

AU - Tiedemann, Anne

AU - Whitney, Julie

AU - Cumming, Robert G.

AU - Herbert, Robert D.

AU - Close, Jacqueline C.T.

AU - Lord, Stephen R.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I 2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I 2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I 2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.

AB - Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I 2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I 2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I 2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.

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U2 - 10.1136/bjsports-2016-096547

DO - 10.1136/bjsports-2016-096547

M3 - Review article

VL - 51

SP - 1749

EP - 1757

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

SN - 0306-3674

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