Exercise in the Prevention of Falls in Older People

A Systematic Literature Review Examining the Rationale and the Evidence

Authors: Carter N.D.; Kannus P; Khan K.M.
 
Source: Sports Medicine, Volume 31, Number 6, 1 June 2001 , pp. 427-438(12)

Abstract:

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults. 

 

These changes coupled with age-related changes in muscle and bone are likely to contribute to an increased risk of falls in this population. The integrated rehabilitation-based model of fall risk factors reveals multiple sites for interventions that may reverse fall risk factors. Regular exercise may be one way of preventing falls and fall-related fractures. 

 

The evidence for this contention comes from a variety of sources. On the basis of 9 randomised controlled studies conducted since 1996, exercise appears to be a useful tool in fall prevention in older adults, significantly reducing the incidence of falls compared with control groups. 

 

However, current limitations such as inconsistencies in the measurement of key dependent and independent variables do not, at present, permit a meta-analysis of intervention trials. Further investigation, using trials designed with the current limitations in mind, is necessary to establish the optimum exercise programme to maximise fall prevention in older adults. 

 

Keywords: Elderly; Exercise therapy
 
Document Type: Review article

Quelle:  http://www.ingentaconnect.com/content/adis/smd/2001/00000031/00000006/art00003


Exercise in the prevention of falls in oder people:  Full Text / pdf

http://resources.glos.ac.uk/shareddata/dms/0EEB551FBCD42A0394BE4E0235DC08D2.pdf

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Systematic Review of Progressive Resistance Strength Training in Older Adults

systematic review von:

1. Nancy K. Latham 
2. Derrick A. Bennett ,
3. Caroline M. Stretton  and
4. Craig S. Anderson

Abstract

Background. The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to reduce physical disability in older people. 

Methods. Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest. 

Results. 62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI −0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored. 

Conclusions. PRT results in improvements to muscle strength and some aspects of functional limitation, such as gait speed, in older adults. However, based on current data, the effect of PRT on physical disability remains unclear. Further, due to the poor reporting of adverse events in trials, it is difficult to evaluate the risks associated with PRT.

Quelle:  http://biomedgerontology.oxfordjournals.org/content/59/1/M48.short

Download Full Text / Google Scholar / Ähnliche Artikel:   latham_et_al._2004_-_prt_in_older_adults-1.pdf

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Implementation of multifactorial interventions for fall and fracture prevention

1. A. John Campbell ¹ and
2. M. Clare Robertson

Abstract

Over 60% of falls experienced by older people result from multiple aetiological factors. Preventing falls in individual patients requires the identification and treatment of these interacting factors. Multifactorial interventions have been successful in some, but not all, fall prevention trials. 

Preventing falls in populations requires selection of the population most likely to benefit, and selection of the particular interventions shown to have been effective in this group. The implementation of preventive measures has been low despite strong evidence that fall and fractures can be reduced. 

Misconceptions about the potential for prevention in old age, the time to effect improvement, resource issues and the nature of the interventions contribute to the low uptake. An improved system of delivery of proven preventive measures is needed. 

Quelle:  http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.short

Full Text / pdf:  http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.full.pdf+html

Keywords Google Scholar:  exercise and fall-prevention



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A Review of Exercise Interventions for Fall Prevention in the Elderly

Gu MO, Jeon MY, Kim HJ, Eun Y.  /  Department of Nursing, Gyeong Sang National University: Gerontological Health Research Center, Gyeongsang Institute of Health Science. mogu@nongae.gsnu.ac.kr
Department of Nursing, Kuekdong College.
Department of Nursing, Chong Ju National College of Science and Technology.

Abstract

PURPOSE: This study was done to suggest directions for developing exercise interventions for fall prevention in the elderly in Korea in the future.

METHOD: Twenty five articles for fall prevention exercises were reviewed and analyzed.

RESULT: 84.0% of subjects were older adults age 65 and older living in the community. The most frequently performed interventions were lower limb strength and balance exercises together 43.3%, group exercise 70.0%, exercise 3 times/week 60.0%, 60 min per session 36.7%, duration of 12 weeks and 1 year 23.3% each. The most frequently used outcome variables were static balance 84.0%, lower limb muscle strength 72.0%, dynamic balance 56.0 %, and falls 56.0 %. The effect of exercise interventions on fall prevention was inconclusive. Lower limb strength exercises with resistance were effective for increasing muscle strength. Balance exercises with various movements for balance were effective for increasing balance.

CONCLUSION: Exercise interventions for fall prevention is recommended for older adults with risk factors of falling. The desirable type of exercise intervention is lower limb strength and balance exercise together.

Quelle:   http://www.koreamed.org/SearchBasic.php?RID=1006JKAN/2005.35.6.1101&DT=1



Sturzprävention für Kleingruppen und Privatpersonen in Baden-Württemberg und nach Vereinbarung

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Tai Chi: Improving functional balance and predicting subsequent falls in older persons

Résumé / Abstract

Purpose: To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons.

Methods: Two hundred fifty-six healthy, physically inactive older adults aged 70-92 (mean age ± SD = 77.48 ± 4.95), recruited from a local health system in Portland, OR, participated in a 6-month randomized controlled trial, with allocation to Tai Chi or exercise stretching control, followed by a 6-month postintervention follow-up. Functional balance measures included Berg balance scale, dynamic gait index, and functional reach, assessed during the 6-month intervention period (baseline, 3-month, and 6-month intervention endpoint) and again at the 6-month postintervention follow-up. Fall counts were recorded during the 6-month postintervention follow-up period. Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures.

Results: Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period, compared with those in the control condition (odds ratio (OR), 0.27, 95% confidence interval (CI), 0.07-0.96 for Berg balance scale; OR, 0.27, 95% CI, 0.09-0.87 for dynamic gait index; OR, 0.20, 95% CI, 0.05-0.82 for functional reach).

Conclusions: Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons.

Quelle:   http://cat.inist.fr/?aModele=afficheN&cpsidt=16330923


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Effects of a fall prevention program

Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities.

Abstract

BACKGROUND AND AIMS:

Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling.

METHODS:

187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering.

RESULTS:

At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. No association was found between improved mobility and reduced risk of falling.

CONCLUSIONS:

Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling.

Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/15575122

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Effect of Age and Activity Level on Lower Extremity Gait Dynamics: 

An Introductory Study.

ABSTRACT:  

Elderly adults should perform exercises that maintain or improve balance in order to reduce risk of injury from falls. Bone fractures secondary to falls in the elderly, particularly sedentary females, continue to pose a major health and economic problem.

A greater understanding of the processes that contribute to the propensity for falling may be obtained by considering changes in gait biodynamics with age and activity level.

Therefore, the purpose of this study was to quantify the relationships between age/activity level and selected biodynamic parameters of the lower extremity during normal gait. Seventeen healthy women, nine young and eight elderly, were divided into groups of nine active and eight sedentary subjects. Three dimensional (3-D) video motion and force platform kinematic and kinetic data were collected from the hip, knee, and ankle of the right lower extremity as the subjects walked at self-selected speeds. Data were analyzed as functions of age and activity level by using a two-way analysis of variance. As expected, our results show that the elderly group had significantly greater (p<0.05) functional and mobility limitations in their lower extremity joints than did the younger group. Significant age-related lower-limb gait alterations were manifested primarily at the ankle, whereas activity-related alterations were manifested most prominently at the hip.

The knee showed the fewest changes accompanying age or activity level. Thus, age and activity level affect gait, which may have a role in the subsequent development of a predisposition to gait-related imbalances and resultant falling and increased hip fracture risk.

Strength and conditioning professionals may consider these age- and activity-level-related factors when individualizing exercise regimens for their older, or sedentary, clients.

Prophylactic physical activities involving specific, controlled three-dimensional body movements may help prevent abnormal lower limb joint kinematics (and their hypothetically-coupled intrinsic postural control strategies), thereby reducing fall and fracture propensity


Quelle:  http://www.ncbi.nlm.nih.gov/pubmed/22964857



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Sturzrisiko

Ältere Menschen, die an einer Demenz leiden, haben ein erhöhtes Sturzrisiko. Dies gab Anlass den State-oft-he-Science und den State-of-the-Art zur Sturzprävention bei Demenzkranken zu untersuchen.

Bei einer systematischen Literaturrecherche konnten keine effektiven Interventionen gefunden werden. Mittels Focus-Group-Interviews wurde untersucht, welche Interventionen erfahrene Altenpflegerinnen zur Sturzprävention bei Demenzkranken anwenden.

In der Praxis der Altenpflege gibt es Überlegungen, wie die bisherigen Maßnahmen der Sturzprävention an die Situation Demenzkranker angepasst werden können.

Zudem gehen die Pflegefachkräfte davon aus, dass Maßnahmen, welche die kognitiven Störungen positiv beeinflussen sollen, auch das Sturzrisiko reduzieren.

Über die Effektivität der geschilderten Interventionen können keine Aussagen gemacht werden. Auf wissenschaftlicher Ebene sollte weiter an einer theoretisch und empirisch begründeten Anpassung der Sturzpräventionsmaßnahmen bei dieser Patientengruppe gearbeitet werden.


Quelle: www.springerlink.com/content/806ml6732g420jx6/



JÖRG LINDER AKTIV-TRAINING
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JÖRG LINDER AKTIV-TRAINING

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Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

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