Summary of randomised controlled falls prevention multiple intervention trials with an exercise component
| Article, study aims, age, number in study, duration | Interventions | Compliance to exercise components | Intermediate and other effects | Effect on falls and fall injuries | Comments |
|---|---|---|---|---|---|
| •Hornbrook et al26: | •Intervention group: informed about potential home hazards and encouraged to make changes; 4 weekly 90 minute group meetings, instruction on environmental, behavioural and physical falls risk factors, 20 minutes of supervised exercise, participants were given a manual and instructed to walk 3 times a week; quarterly maintenance sessions | •Participants monitored their exercises and walking sessions using a monthly checklist, but compliance rates not reported | •No intermediate variables assessed | •Intervention decreased odds of falling by 0.85 | •Analysis by individual although randomisation was by household |
| •To prevent falls with a programme addressing home safety, exercise and behavioural risks | •Control group: informed about potential home hazards, but no repair advice or assistance was given | •Average number of falls among those who fell reduced by 7% (NS) | •Exercise programme not sufficiently supervised and too general | ||
| •≥65 years; n=3182; 2 years | •No difference in time to first injurious fall (medical care, fracture, hospitalised) | •Minimal evidence to recommend this intervention for a falls prevention programme | |||
| •Tinetti et al27: | •Intervention group: specific interventions based on baseline assessment of risk factors for falling (sedative medications, ≥4 prescription medications, postural hypotension, environmental hazards, gait impairments, balance or transfer impairments, leg or arm muscle strength or range of movement impairments) | •65% of the participants took part in at least 70% of the exercise sessions, 85% took part in over half the recommended sessions | •At reassessment the percentage of intervention participants with risk factors still present decreased for 3 risk factors: ≥4 prescription medications (p=0.009), balance impairment (p=0.001), impairment in toilet transfer skills (p=0.05) | •Reduction in proportion of fallers (p=0.04) | •Good evidence to support the use of a targeted multifactorial approach for the prevention of falls |
| •To investigate whether the risk of falling could be reduced by modifying known risk factors | •Primary physician adjusted medications; physiotherapist prescribed individually tailored home based exercise programme to be carried out twice daily for 15–20 minutes | •Improved self confidence for performing daily activities without falling (p=0.02) | •Adjusted incidence-rate ratio for falling lower in the intervention group (0.69; 95% CI 0.52 to 0.90) | ||
| •≥70 years, with at least 1 of the 8 targeted risk factors for falling; n=301; 1 year | •Control group: equivalent number of home visits by social work students | ||||
| •McMurdo et al28: | •Exercise intervention group: exercise classes 3 times weekly for each of three 10 week terms a year for 2 years + 1000 mg calcium supplementation daily | •46–100% attendance at exercise classes | •Increase in ultradistal forearm bone mineral density in the calcium + exercise group versus calcium only group (p=0.009) | •Fewer women in the exercise + calcium group fell during the 2 years (NS, but significant between 12 and 18 months, p=0.011) | •Young sample (age range 60–73 years) may explain non significant effect of programme on number of fallers at two years |
| •To investigate the effect of weight bearing exercise on bone density and falls | •Calcium group: 1000 mg calcium supplementation daily | •Mean of 76% classes attended | |||
| •Women ≥60 years; n=118; 2 years |