Am Fam Physician. 2004;70(2):379-383
There is good evidence that exercise can modify risk factors for falls and prevent them. However, not all types of exercise appear to be beneficial. Programs that include a balance component are more effective than programs using resistance, endurance, and flexibility training. Study results that showed no benefit or minimal benefit might have targeted a population with a low baseline risk for falls. In this study, Lord and colleagues targeted a group at higher risk for falls—elderly persons living in retirement villages—using a weight-bearing exercise program.
Residents 62 to 95 years of age were included in the study. Of 551 participants, 280 were randomized to the group-exercise intervention. The exercise classes were conducted twice weekly for 12 months and were designed to address impaired strength, gait, coordination, balance, and speed, and to improve the patient’s ability to undertake activities of daily living. One control group took part in a flexibility and relaxation program, and another control group did not take part in any group activity. Questionnaires were given to residents every month. In addition, a nurse’s book recorded witnessed falls or falls that resulted in a visit to the nurse’s station. Two functional measures related to stepping and mobility requirements for activities of daily living were primary outcome measures. Secondary outcome measures assessed speed, strength, and balance.
Of the 508 subjects available for analysis, 75 percent completed questionnaires. Combined data from questionnaires and other reporting methods indicated that there were 385 falls, with 282 residents (55.5 percent) never falling, 132 (26.0 percent) falling once, and 94 (18.5 percent) falling at least twice. During the study period, there were 22 percent fewer falls in the exercise group than in the control groups. There were significantly fewer falls in patients who had fallen in the past year but no difference in patients who had not fallen in the year before the study. The difference in fall rate between the two control groups was not significant.
Baseline scores were similar between intervention and control groups; however, the control groups performed better in choice stepping reaction time and six-minute walking distance. At retest, the exercise group performed significantly better than the control groups in these two measures. They also performed better in some, but not all, of the secondary outcome measures.
The findings suggest that a specifically designed program of group exercise can prevent falls and maintain physical function in frail older people, particularly in those who have had previous falls. The fall reduction in this study (22 percent) is lower than the reduction in studies with multiple interventions, but those studies cannot identify the specific components that contribute to fall reduction. Although only one half of eligible participants attended exercise classes, these results show that exercise can prevent falls and maintain physical function.