Exercise for fall prevention in community-dwelling people aged 60+: more effective in trials with higher fall rates in control groups.

Belinda Y Wang, Catherine Sherrington, Nicola Fairhall, Wing S Kwok, Zoe A Michaleff, Anne Tiedemann, Geraldine Wallbank, Marina B Pinheiro

Journal: Journal of clinical epidemiology 2023;159():116-127

PMID: 37156341

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Plain Language Summary

Exercise is an effective intervention for reducing the rate of falls in trials undertaken in people aged 60 and over, with both higher and lower overall fall rates. The aim of this study was to explore differences in effectiveness of fall prevention exercise according to prospectively measured fall rate. This study was a secondary analysis of a systematic review of 62 trials of which 31 (50%) were classified as having a lower control group fall rate and the other 31 (50%) as higher control group fall rates. Results showed that exercise interventions are effective for reducing the rate of falls in populations with higher and lower prospectively measured fall rates in control groups. However, it appears to be particularly effective for those with higher fall rates. Authors concluded that providing fall prevention exercise programmes to older adults with higher fall rates may be an optimal population level approach. Thus, their findings could be used to target future programme investment and health promotion messages.

Abstract

BACKGROUND AND OBJECTIVES

Exercise is beneficial for fall prevention. Targeting interventions to people who fall more may lead to greater population impacts. As trials have used varying methods to assess participant risk level, prospectively-measured control group fall rates may provide a more accurate and poolable way to understand intervention effects in different subpopulations. We aimed to explore differences in effectiveness of fall prevention exercise according to prospectively-measured fall rate.

METHODS

Secondary analysis of a Cochrane review investigating exercise for fall prevention in peopled aged ≥60 years. Meta-analysis assessed the impact of exercise on fall rate. Studies were dichotomized according to the median control group fall rate (0.87, IQR 0.54-1.37 falls/person-year). Meta-regression explored the effects on falls in trials with higher and lower control group fall rates.

RESULTS

Exercise reduced the rate of falls in trials with higher (rate ratio 0.68, 95% CI 0.61-0.76, 31 studies) and lower control group fall rates (rate ratio 0.88, 95% CI 0.79-0.97, 31 studies, P = 0.006 for difference in effects).

CONCLUSION

Exercise prevents falls, moreso in trials with higher control group fall rates. As past falls strongly predict future falls, targeting interventions to those with more past falls may be more efficient than other falls risk screening methods.

Address: Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia.; Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia; Northern NSW Local Health District, Lismore, New South Wales, Australia; Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.; Sydney Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Camperdown, New South Wales, Australia. Electronic address: [email protected].

DOI: 10.1016/j.jclinepi.2023.05.003