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Am Fam Physician. 2009;80(5):512

Background: Falls affect at least one third of adults 65 years and older every year, accounting for more than one half of injury-related hospitalizations in this age group. Exercise programs can reduce fall risk by modifying some risk factors, such as poor muscle strength and impaired balance. However, it is unclear whether exercise in general or specific exercise components reduce the likelihood of falling.

The Study: Sherrington and colleagues conducted a meta-analysis of randomized trials that examined different types of exercise on fall frequency in older persons. To be included, studies had to focus on exercise as the primary intervention. Data were extracted from each trial to calculate a pooled incidence rate ratio of the effect of exercise on fall rates.

Results: Forty-four trials including 9,603 participants were reviewed. Thirty-nine trials had a follow-up period of at least six months, with 25 of those trials having follow-up of 12 months or longer. Overall, exercise in general significantly reduced the risk of falls by 17 percent (relative risk [RR] = 0.83). Fall risk was further reduced with programs that had more than 50 hours of exercise during the trial period (RR = 0.80) or that emphasized balance training (RR = 0.76). The greatest reduction in falls occurred with exercise programs that included challenging balance exercises and higher total amount of exercise (more than 50 hours over the trial period), and did not include a walking program (RR = 0.58). Similar results were noted among persons living independently and in nursing homes, although a lesser effect of exercise occurred in participants who initially had two or more annual falls.

Conclusion: The authors concluded that exercise can reduce fall risk in older persons, with the greatest reduction in programs that combine longer exercise programs and challenging balance exercises, and that do not include a walking program. It was proposed that not including walking in these times allowed for more focus on balance exercises. The estimated minimally effective amount of exercise to achieve this benefit equated to two exercise sessions weekly for 25 weeks.

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