Exercise and Falls Prevention A Review of the Current Evidence

1. Exercise and Falls PreventionA Review of the Current Evidence March 24, 2008 Christian Thompson, Ph.D. Department of Exercise & Sport Science University of San Francisco

2. The Older Adult Continuum

3. This Can Happen to Both of Them!

4. Too Bad It’s Not Funny… • Over 1/3 of people aged of 65+ fall each year • In 2004, over 1.8 million seniors were treated for fall-related injuries at emergency rooms • Approx. 400,000 fractures per year due to falls • Over 20% of hip fractures result in death in 1 yr • Problem will only continue to increase with changing demographics Sources: CDC, 2007; Kannus et al., 2005; Ngyuen et al., 2007

5. Extrinsic Factors External Issues Weather or outdoor conditions House clutter and obstacles Poor lighting Lack of adaptive devices in the home Inappropriate footwear/clothing Intrinsic Factors Internal Issues History of Falling Chronic Diseases & Medical Conditions Sensory/Vestibular Impairments Medication Effects Functional Level (Strength, Posture, Gait) Factors Affecting Falls Risk linearly with number of risk factors present Sources: (Rose, 2003; Tinetti et al., 1988; Carter, 2001; Lehtola et al., 2006)

6. Multifactorial Address both I&E risks Environmental hazards Medication modification Sensory deficits Disease management Exercise Education Exercise-Only Address modifiable functional limitations Lower body strength Static/Dynamic balance Flexibility Gait modification Cardiovascular Group vs. Individual Supervised vs. Unsupervised Regularly ImplementedIntervention Strategies Sources: Lord et al., 1995; Province et al., 1995; Tinetti et al., 1994

7. Evidence-Based Review Strategy • Online manuscript database search • PubMed & SportDiscus • Keywords: Exercise, Falls Prevention, Balance Training, Fall Risk, Resistance Training, Gait Training • Inclusion Criteria • Community-dwelling older adults • Randomized controlled trials • Intervention study • Studies in last 10 years (since 1998) • Falls as an outcome measure

8. Intervention Characteristics Exercise (6) Home Hazard Reduction (3) Day et al., 2002, Sjosten et al., 2007; Steinberg et al., 2000) Medical/Medication Intervention (5) Day et al., 2002; Steinberg et al., 2000; Shumway-Cook et al., 2007; Campbell et al., 1999; Sjosten et al., 2007 Vision (2) Day et al., 2002; Shumway-Cook et al., 2007 Education (2) Shumway-Cook et al., 2007; Sjosten et al., 2007 Nutrition (1) Swanenburg et al., 2007 Randomized Controlled TrialsMultifactorial Interventions – 6 Studies

9. Relevant Findings Falls Reduction Significant reduction in falls in 3 of 6 studies Day et al., 2002; Steinberg et al., 2000; Swanenburg et al., 2007 Fall Risk Reduction Improvement in some/all fall risk factors in 5 of 6 studies Measured by Balance assessment inventories, Strength, Gait Analysis, Agility/Dynamic Balance Assessments, Balance Confidence/Fear of Falling scales Only Sjosten, et al., 2007 did not report improvement Limitations Variability in participant selection, exercise dose, exercise program content, program duration Questionable statistical analyses Randomized Controlled TrialsMultifactorial Interventions

10. Included Exercise Program Characteristics Resistance Training (7) – Barnett et al., 2003; Freiberger et al., 2007; Woo et al., 2007; Suzuki et al., 2004; Luukinen et al., 2007; Rubenstein et al., 2000; Lin et al., 2006 Static Balance Training (5) – Barnett et al., 2003; Freiberger et al., 2007; Madureira et al., 2007; Suzuki et al., 2004; Rubenstein et al., 2000 Agility/Dynamic Balance Training (8) Gait Enhancement Training (4) – Barnett et al., 2003; Madureira et al., 2007; Suzuki et al., 2004; Rubenstein et al., 2000 Aerobic/Cardiovascular Training (4) – Barnett et al., 2003; Freiberger et al., 2007; Luukinen et al., 2007; Rubenstein et al., 2000 Flexibility Training (6) – All except Madureira 2007 & Suzuki 2004 Tai Chi (4) – Barnett et al., 2003; Woo et al., 2007; Li et al., 2005, Lin et al., 2006 Supervised Group Exercise (4), Home-based Exercise (1), Combination (4) Randomized Controlled TrialsExercise-Only Interventions – 9 Studies

11. Relevant Findings Falls Reduction Significant reduction in falls in 6 of 9 studies Barnett et al., 2003; Freiberger et al., 2007; Li et al., 2005; Madureira et al., 2007; Suzuki et al., 2004; Rubenstein et al., 2000 Fall Risk Reduction Improvement in some/all fall risk factors in 5 of 6 studies Measured by Balance assessment inventories, Strength, Gait Analysis, Agility/Dynamic Balance Assessments, Balance Confidence/Fear of Falling scales Only Woo, et al., 2007 did not report improvement Limitations Variability in participant selection, exercise dose, exercise program content, program duration Questionable statistical analyses Randomized Controlled Trials Exercise-Only Interventions

12. Conclusions Concerning Exercise for Falls Prevention • Exercise has been shown to exert a strong effect on functional level and modifiable intrinsic falls risk factors • Exercise has been shown in several studies to reduce future falls • Dose-response studies are needed to determine optimal training recommendations

13. Recommendations for the Fitness Professional • Understand your older clients • Recommend clients to undergo multifactorial risk assessment • Progress clients safely but steadily • Include multiple modes of exercise to address modifiable physical characteristics

14. Dr. Christian Thompson Department of Exercise & Sport Science University of San Francisco 2130 Fulton Street San Francisco, CA 94118 cjthompson@usfca.edu (415) 422-5270

15. Multifactorial Interventions Campbell et al., 1999 Day et al., 2002 Shumway-Cook et al., 2007 Sjosten et al., 2007 Steinberg et al., 2002 Swanenburg et al., 2007 Exercise-Only Interventions Barnett et al., 2003 Freiberger et al., 2007 Luukinen et al., 2007 Li et al., 2005 Lin et al., 2006 Madureira et al., 2007 Rubenstein et al., 2000 Suzuki et al., 2004 Woo et al., 2007 Reference List