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Am Fam Physician. 2020;101(1):42-43

Author disclosure: No relevant financial affiliations.

Clinical Question

Do exercise interventions in community-dwelling older adults reduce the incidence of falls?

Evidence-Based Answer

Exercise programs should be recommended for community-dwelling adults 60 years and older because they lead to fewer falls. (Strength of Recommendation [SOR]: A, based on meta-analyses of randomized controlled trials [RCTs].) Community-dwelling adults 50 years and older should participate in exercise programs to decrease their rate of falls resulting in fractures. (SOR: B, based on meta-analyses of RCTs with heterogeneity and low-quality evidence.) Balance training, functional exercise, and resistance training are the most effective types of exercise to reduce the risk of falls. (SOR: B, based on meta-analyses of moderate- to high-certainty evidence.)

Summary

RISK OF FALLS

A 2019 Cochrane systematic review and meta-analysis of 63 trials (N = 13,518) found that exercise reduced the risk of falls by 15% in community-dwelling adults 60 years and older compared with a control intervention (rate ratio = 0.85; 95% CI, 0.81 to 0.89).1 The control intervention varied between trials but was broadly defined as standard care, which was not thought to decrease falls. A 2018 meta-analysis of RCTs (N = 4,926) showed that exercise reduced the number of community-dwelling adults 65 years and older who experienced a fall by 11% (relative risk [RR] = 0.89; 95% CI, 0.81 to 0.97).2 Similarly, another 2018 systematic review and meta-analysis of RCTs (N = 4,420) found that exercise decreased the risk of falls by 12% in adults 60 years and older (RR = 0.88; 95% CI, 0.79 to 0.98; P = .005; number of trials = 20).3

RISK OF FALL-RELATED FRACTURES

A 2017 meta-analysis of RCTs (N = 3,136) showed that multiple types of exercise reduced the risk of fall-related fractures by 40% in adults 50 years and older (RR = 0.60; 95% CI, 0.45 to 0.84; P = .003).4 Variations in exercise duration and setting contributed to heterogeneity. The 2019 Cochrane meta-analysis discussed above showed that exercise reduced the number of adults 60 years and older who experienced fall-related fractures by 27% (RR = 0.73; 95% CI, 0.56 to 0.95; number of trials = 10; n = 4,047), although the studies were lower quality.1

EXERCISE INTERVENTIONS

Exercise interventions in the included studies varied in types of exercise, group vs. individual exercise, and duration of exercise programs (six months to four years) and follow-up (six months to five years). The 2017 meta-analysis found that falls decreased by 14% (rate ratio = 0.86; 95% CI, 0.78 to 0.94) in patients who improved their leg strength through resistance and strength training (standardized mean difference = 0.61; 95% CI, 0.12 to 1.11).4 The 2019 Cochrane review found that functional task training (including balance, gait, coordination, and functional exercises for activities of daily living) reduced the rate of falls by 24% (rate ratio = 0.76; 95% CI, 0.70 to 0.81; number of trials = 39; n = 7,920; high-certainty evidence).1 The addition of resistance exercises probably reduces the rate of falls by 34% (rate ratio = 0.66; 95% CI, 0.50 to 0.88; number of trials = 11; n = 1,374; moderate-certainty evidence). Tai chi was found to reduce the rate of falls by 19% (rate ratio = 0.81; 95% CI, 0.67 to 0.99; low-certainty evidence).1

Recommendations from Others

The U.S. Preventive Services Task Force recommends exercise interventions to prevent falls in community-dwelling adults 65 years and older who are at increased risk (B recommendation).5 The American Academy of Family Physicians recommends exercise or physical therapy to prevent falls in community-dwelling older adults who are at increased risk.6

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