Exercise and Risk Factors for Falls
Exercise and Risk Factors for Falls
Impact of the backward chaining method on physical and psychological outcome measures in older adults at risk of falling: a systematic review
Leonhardt R, Becker C, Groß M, Mikolaizak AS. Aging Clin. Exp. Res. 2020; ePub(ePub): ePub.
Faculty of Health Sciences, The University of Sydney, Camperdown, Australia.
(Copyright © 2020, Editrice Kurtis)
DOI 10.1007/s40520-019-01459-1 PMID 31939202
BACKGROUND: Being unable to “get up from the floor” is a risk factor and predictor of serious fall-related injuries in older age; however, floor-rise training (FRT) is not widely used. The backward chaining method (BCM) is a success-oriented, step-by-step form of FRT. This systematic review aimed to evaluate the impact of BCM on physical and psychological outcome measures, and its clinical application.
METHODS: Studies were identified through systematic searching of five databases. Criteria for inclusion were: use of BCM as a treatment method, outcome measures related to falls, and participants aged 60 + years. Study quality was evaluated using the Mixed Methods Appraisal Tool and PEDro scale, if applicable.
RESULTS: Seven studies with a total of 446 participants (mean age 82.4 ± 5.3 years) were identified. Emerging evidence shows that BCM significantly improves the ability to get up unassisted from the floor, as well as mobility with reduced fall incidence in older people. Furthermore, it can potentially reduce fear of falling. Reporting on feasibility and acceptance of BCM was limited. Study quality varied widely.
CONCLUSIONS: BCM provides a promising intervention in fall-related recovery strategies for older adults and is most effective when offered to older adults at risk of falling. Considering the small number of included studies and the varying methodological quality, these findings should be evaluated accordingly. The growing evidence regarding the benefits of BCM, yet the lack of adoption into standard care, highlights the need for further research and clinical application of this intervention approach.
Backward chaining method; Fall prevention; Falls; Floor rise training; Older adults
Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review
Ng CACM, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Sherrington C. BMJ Open Sport Exerc. Med. 2019; 5(1): e000663.
Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia.
(Copyright © 2019, British Association of Sport and Exercise Medicine, Publisher BMJ Publishing Group)
DOI 10.1136/bmjsem-2019-000663 PMID 31908838
INTRODUCTION: There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.
METHODS: MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.
RESULTS: 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16-52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15-43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12-52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.
CONCLUSIONS: The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.
evidence-based; exercise; fall; review; senior
Efficacy and generalizability of falls prevention interventions in nursing homes: a systematic review and meta-analysis
Gulka HJ, Patel V, Arora T, McArthur C, Iaboni A. J. Am. Med. Dir. Assoc. 2020; ePub(ePub): ePub.
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: Andrea.Iaboni@uhn.ca.
(Copyright © 2020, Lippincott Williams and Wilkins)
DOI 10.1016/j.jamda.2019.11.012 PMID 31982358
OBJECTIVES: To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia.
DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions.
METHODS: Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers.
RESULTS: Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94).
CONCLUSIONS AND IMPLICATIONS: Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.
Nursing homes; cognitive impairment; dementia; fall prevention; falls; long-term care
Cost-effectiveness of “Tele-Square Step exercise” for falls prevention in fibromyalgia patients: a study protocol
Carlos-Vivas J, Pérez-Gómez J, Delgado-Gil S, Campos-López JC, Granado-Sánchez M, Rojo-Ramos J, Muñoz-Bermejo L, Barrios-Fernandez S, Mendoza-Muñoz M, Prado-Solano A, Garcia-Gordillo MÁ, Adsuar JC. Int. J. Environ. Res. Public Health 2020; 17(3): e695.
Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.
(Copyright © 2020, MDPI: Multidisciplinary Digital Publishing Institute)
DOI 10.3390/ijerph17030695 PMID 31973115
BACKGROUND: Women with fibromyalgia (FM) have 2.5 falls per year compared to the 0.5 falls in people without FM. This fact poses a significant health expense. Square Stepping Exercise (SSE) is a balance training system that has been shown to be effective in preventing falls in the elderly. However, there are neither studies in people with FM nor studies that apply SSE through video-conferencing (Tele-SSE). The objectives of this project are 1) to investigate the applicability, safety, decrease in the number of falls, and incremental cost-effectiveness ratio of prevention of falls program through Tele-SSE in women with FM, and 2) to study the transfer of obtained results to the public and private socio-health economy of Extremadura.
METHODS/Design: A randomized controlled trial with experimental (Tele-SSE) and control (usual treatment) groups will be carried out. The application of Tele-SSE will be performed for 12 months (three times per week) and one additional follow-up month after the intervention. A focus group including agents to identify key points to transfer the findings to the public and private sectors in Extremadura. One-hundred and eighteen women with FM will be recruited and randomly distributed into the two groups: Experimental (Tele-SSE; n = 59) and control group (Usual care; n = 59). Primary outcome measures will be: 1) Applicability; 2) safety; 3) annual number of falls; and 4) incremental cost-effectiveness ratio. Secondary outcomes will be: 1) Balance; 2) fear of falling; 3) socio-demographic and clinical information; 4) body composition; 5) physical fitness; 6) physical activity and sedentary behavior; 7) quality of life-related to health, mental health, and positive health; 8) pain; 9) disability level; 10) cognitive aspects; and 11) depressive symptoms. Regarding the focus group, the acceptability of the Tele-SSE will be evaluated in social-sanitary agents and will include Tele-SSE in their services offer. A statistical analysis will be carried out by treatment intention and protocol. In addition, a cost-effectiveness analysis from the perspective of the health system will be performed.
DISCUSSION: This project aims to improve the efficiency and equity of physical therapy services based on tele-exercise in preventing falls in people with FM. Furthermore, orientations will be given in order to transfer the obtained findings into the social-sanitary system and market.
balance; cognitive aspects; cost-effectiveness; depression; falls prevention; fibromyalgia; happiness; pain; square stepping exercise; strength
Tai Chi for improving balance and reducing falls: an overview of 14 systematic reviews
Zhong D, Xiao Q, Xiao X, Li Y, Ye J, Xia L, Zhang C, Li J, Zheng H, Jin R. Ann. Phys. Rehabil. Med. 2020; ePub(ePub): ePub.
Chengdu University of Traditional Chinese Medicine, Chengdu, P.R, China. Electronic address: firstname.lastname@example.org.
(Copyright © 2020, Elsevier Publishing)
DOI 10.1016/j.rehab.2019.12.008 PMID 31981834
BACKGROUND: Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically.
OBJECTIVE: To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls.
METHODS: We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure.
RESULTS: A total of 14 relevant SRs was included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. 11 (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was “moderate” to “high” for older people and “low” for those with Parkinson disease. The level of evidence of the Berg Balance Scale was “low” to “moderate” for older people and “low” for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias.
CONCLUSIONS: Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions.
AMSTAR 2; GRADE; PRISMA; ROBIS; Tai Chi; balance; falls; overview
Pilates exercise and postural balance in older adults: a systematic review and meta-analysis of randomized controlled trials
Casonatto J, Yamacita CM. Complement. Ther. Med. 2020; 48: e102232.
University of Northern Paraná, Research Group in Physiology and Physical Activity, Brazil.
(Copyright © 2020, Elsevier Publishing)
DOI 10.1016/j.ctim.2019.102232 PMID 31987246
INTRODUCTION: The effects of exercising with the Pilates method on aspects such as balance for the general population have been reported by recent systematic reviews. However, whereas the effects of the Pilates method on improving general balance have been well studied, less is known about postural balance and the respective determinants of Pilates effects.
OBJECTIVES: (1) provide more up-to-date evidence to determine the effects of Pilates on postural balance and (2) examine the effects of length of intervention, Pilates amount per week (times per week X session duration), and study quality (risk of bias) on postural balance in older adults.
METHODS: A systematic electronic search in Medline and Scientific Electronic Library Online (SciELO) was completed in December 2018 identifying randomized controlled trials investigating the effect of a Pilates method on postural balance in healthy older adults. A subsequent meta-analysis was performed.
RESULTS: The meta-analysis involved 6 studies and 261 individuals (128 Pilates and 133 control groups). We observed an overall effect favoring the Pilates group SMD95% = 0.89 [0.29-1.49]. The subgroup mean effects were similar for “length of intervention” (low vs high) [P = 0.557], “Pilates amount per week” (low vs high) [P = 0.565], and “study quality” (low vs high) [P = 0.869].
CONCLUSION: Accordingly, our findings suggest that a Pilates training program can be considered as an effective form of exercise to improve balance in older adults. Additionally, length of intervention, Pilates amount per week, and study quality were not related to the magnitude of effect on postural balance.
Exercise movement techniques; Pilates training; Postural balance
Effect of different forms of physical activity on balance in older women
Filar-Mierzwa K, Długosz-Boś M, Marchewka A, Aleksander-Szymanowicz P. J. Women Aging. 2020; ePub(ePub): ePub.
Department of Occupational Therapy, University of Physical Education in Krakow, Krakow, Poland.
(Copyright © 2020, Informa – Taylor and Francis Group)
DOI 10.1080/08952841.2020.1718579 PMID 31977290
The aim of this study was to analyze the effect of two types of physical activity, dance, and general exercises, on balance in older women. Study participants comprised two groups of women. The participants attended 45-min DMT (n = 20) or GRE sessions (n = 19) three times per week for 12 weeks. Before and after the training, the participants underwent the Postural Stability Test, the Limits of Stability Test, and the Fall Risk Test. Improvement of the balance was confirmed for only one test both for the dance group and the general exercises group.
Dance; fall risk; general exercises; older adults; postural stability