Summary of randomised controlled falls prevention exercise intervention trials
| Article, study aims, age, number in study, duration | Interventions | Compliance to exercise programmes | Intermediate and other effects | Effect on falls and fall injuries | Comments |
|---|---|---|---|---|---|
| •Reinsch et al18: | •2 × 2 factorial design: | •Not reported | At 1 year: | •No difference between the 4 groups in the number of fallers, time to first fall, fall rate or level of severity of fall-related injury | •No evidence that the exercise programme or cognitive behavioural approach should be implemented to prevent falls in older people |
| •To investigate the effectiveness of exercise and cognitive behavioural programmes compared with a discussion control group in reducing falls and injuries | •Intervention 1: exercise classes (stand-up/step-down procedure) 1 hour 3 days a week for 1 year | •No difference in balance, strength, fear of falling inside the home, self-rated present health | •Analysis compared the 4 groups (rather than each intervention with its control group) and for first fall only | ||
| •>60 years; n=230; 1 year | •Intervention 2: Cognitive behavioural group sessions 1 hour once a week for 1 year (health and safety curriculum to prevent falls, relaxation and video game playing) | ||||
| •Control group: discussion sessions 1 hour once a week for 1 year covering health topics of interest to seniors (and not specifically related to falls) | |||||
| •MacRae et al20: | •Intervention group: exercise classes (stand-up/step-down procedure) 1 hour 3 days a week for 1 year | •Not reported | At 1 year: | •No difference between groups in the number of fallers who completed the study (n=59) | •Small sample size with small number of fall events |
| •To determine the effect of low intensity exercise on falls, fall-related injuries and risk factors for falls in older women | •Control group: health promotion and safety education classes 1 hour a week for 1 year | •Control group declined in knee and ankle strength (p<0.002), both groups declined in hip strength (p<0.002) | •Programme had a maintenance | ||
| •Women >60 years; n=80;1 year | •No difference in balance and gait | •Exercise intervention of insufficient intensity to lower falls riskeffect on muscle strength | |||
| •Mulrow et al21: | •Intervention group: one-on-one 30–45 minute exercise sessions with physical therapist 3 times a week for 4 months | •89% of scheduled physical therapy sessions were attended | At 4 months: | •No difference in proportion of falls compared with hypothesised value (50% of total number of falls experienced by both groups) | •No evidence to support implementation of one-on-one physical therapy in this group of frail long stay nursing home residents to prevent falls |
| :•To investigate the effectiveness of physical therapy on physical function (including falls) and self perceived health in frail long stay nursing home residents | •Control group: one-on-one friendly visits 3 times a week for 4 months | •No improvement in Physical Disability Index, Sickness Impact Profile or activities of daily living | •Short follow up time | ||
| •>60 years; n=194; 4 months | •Improvement in mobility subscale of the Physical Disability Index (15.5%; 95% CI 6.4% to 24.7%)scores | •Falls not reduced but modest improvements in function | |||
| •Physical therapy group less likely to use assistive devices and wheelchairs for locomotion (p<0.005) | |||||
| •Lord et al22: | •Intervention group: exercise classes 1 hour 2 days a week for 4 10–12 week terms for 1 year | •Participants attended 26–82 (32%–100%) classes | At 1 year: | •No difference in the proportion of people falling at least once, or recurrently at 1 year | •Good objective evidence of improvements in physical function risk factors for falls |
| :•To determine whether a 12 month programme of regular exercise would improve physical function and reduce the rate of falling in older women | •Control group: no active intervention | •On average 60 (73%) of classes were attended by the 75 participants who completed the year | •Exercise group improved in reaction time, lower limb muscle strength, neuromuscular control and body sway measures | •Exercise programme may be more effective in higher risk group | |
| •Women ≥60 years; n=197; 1 year | |||||
| •Wolf et al23: | •Intervention group 1: Tai Chi: group classes 2 times a week for 15 weeks; also instructed to practise Tai Chi 2 times daily for 15 minutes | •Participants who missed class were rescheduled for next session or to make them up individually | At 4 months: | •Tai Chi reduced rate of falls by 47.5% (risk ratio = 0.525; p=0.01) | •Programme was most effective in the prevention of recurrent falls |
| •To evaluate the effects of Tai Chi and computerised balance training on specified indicators of frailty and the occurrence of falls | •Intervention group 2: one-on-one computerised balance training 1 day a week for 15 weeks | •Tai Chi home practice sessions not monitored | •Grip strength declined in all groups (p=0.025) | •Tai Chi warrants further investigation | |
| •≥70 years; n=200; up to 20 months | •Control group: 1 hour discussion of topics of interest to older people once a week for 15 weeks | •People in the Tai Chi group were less afraid of falling than control group (p=0.046) | |||
| •Buchner et al24: | •Intervention group 1: strength training using weights machines | •Exercise participants remaining at 6 months (71%) attended 95% of scheduled sessions | At 6 months: | •Exercise increased time to first fall (relative hazard 0.53; 95% CI 0.30 to 0.91) | •Evidence for exercise other than balance to lower falls risk in older people |
| •To determine the effect of strength and endurance training on gait, balance, physical health status, falls risk and use of health services | •Intervention group 2: endurance training using stationary bicycles | •At 9 months 58% of participants reported carrying out the exercises ≥3 times a week, 24% twice a week and 5% not at all | •Improvement in hip and knee strength in strength training group (knee only in combination training group) | •Controls had a higher fall rate (relative risk 0.61; 95% CI 0.39 to 0.93) | •Evidence for lack of improvement in gait and balance with short term strength and endurance training in people with minor deficits in gait and balance |
| •68–85 years with at least mild deficits in strength and balance; n=105; up to 25 months | •Intervention group 3: combination of strength + endurance training | •No effect of exercise on measures of gait, balance or physical health status | |||
| •All interventions: Centre based, supervised 1 hour sessions 3 days a week for 24–26 weeks then self supervised | |||||
| •Control group: instructed to maintain usual activity levels | |||||
| •Campbell et al10: | •Intervention group: home based strength and balance retraining exercises were prescribed and modified over 4 home visits by a physiotherapist | •77% were exercising ≥3 times a week over 2 month supervised period (unpublished) | At 6 months: | •Mean (SD) rate of falls reduced in exercise group (0.87 (1.29) vs 1.34 (1.93) falls per year; difference 0.47; 95% CI 0.04 to 0.90) | •Targeted high risk group for falling |
| •To determine the effectiveness of an individually tailored home based exercise programme in reducing falls and injuries in elderly women | •Control group: equivalent number of social visits by nurse and usual care | •At one year 62.9% were exercising ≥2 times a week (unpublished) and 42% were exercising ≥3 times a week | •Balance score and chair stand test improved in exercise groupAt 1 year: | •Relative hazard for first 4 falls for exercise group 0.68; 95% CI 0.52 to 0.90 | •Programme was most effective in the prevention of recurrent falls |
| •Women ≥80 years; n=233; 1 year | •Exercise group maintained physical activity level and falls self efficacy score (self confidence for daily activities without falling) | •Relative hazard for a fall resulting in moderate or severe injury 0.61; 95% CI 0.39 to 0.97 | •Designed for wider implementation | ||
| •Campbell et al11: | •Intervention group: exercise programme established in year 1; in year 2 participants were phoned every 2 months by the physiotherapist and encouraged to maintain/increase exercise sessions | •31 of 71 (44%) of the exercise participants were carrying out the exercises ≥3 times a week at 2 years | •No intermediate variables assessed | •Relative hazard for all falls for exercise group 0.69; 95% CI 0.49 to 0.97in second year of trial | •Evidence that fall rate reduction was sustained over 2 years |
| •To assess the effectiveness of an individually tailored home based exercise programme over two years (see also Campbell et al10) | •Control group: no active intervention in year 2 | •Relative hazard for a fall resulting in moderate or severe injury 0.63; 95% CI 0.42 to 0.95 | |||
| •Women ≥80 years; n=233 year 1; n=152 year 2; 2 years | |||||
| •Campbell et al25: | •2 × 2 factorial design: | •20 of 32 (63%) of the exercise participants were carrying out the exercises ≥3 times a week at 44 weeks | At 6 months: | •Relative hazard for falling in medication withdrawal group compared with original medication group 0.34; 95% CI 0.16 to 0.74) | •Very large reduction in falls by psychotropic medication withdrawal |
| •To determine the effectiveness of gradual withdrawal of psychotropic medication and a home based exercise programme in reducing falls | •Intervention 1: psychotropic medication withdrawal, active ingredient gradually withdrawn over 14 week period | •23 of 32 (72%) of the exercise participants were walking twice a week at 44 weeks | •Exercise group improved in tests of balance and strength: functional reach (p=0.02), knee extensor strength (p=0.004), chair stand test (p=0.01), time to walk up and down 4 steps (0.02) (unpublished) | •Exercise did not reduce the risk of falling | •Small sample size |
| •≥65 years and currently taking psychotropic medication; n=93; 44 weeks | •Control group for medication withdrawal intervention: continue with original medication | ||||
| •Intervention 2: exercise intervention (see Campbell et al10) | |||||
| •Control group for exercise intervention: no active intervention |