Balance and functional exercises are recommended to reduce falls.
The recommendation attaches a relatively high value on avoiding the consequences of falls both regarding patient-important outcomes and healthcare costs. Even if the cost of the intervention (implementing exercise programs) may be substantial, the potential savings from avoiding hospitalizations and fractures are probably higher than the cost of the intervention. The intervention (particularly if implemented in groups) is also expected to improve the quality of life.
A Cochrane review [Abstract] 1 including 108 RCTs with 23 407 participants living in the community in 25 countries assessed the effects of exercise on falls prevention in older people. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items.
Eighty-one trials (n=19 684) compared exercise with control intervention not thought to reduce falls. Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 59 studies, n=12 981). Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 63 studies, n=13 518).
Different forms of exercise had different impacts on falls. Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 39 studies, n=7 920) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 37 studies, n=8 288). The effects of resistance training, dance or walking programmes on falls were unclear. No trials compared flexibility or endurance exercise versus control.
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