Table 1

Summary of randomised controlled falls prevention exercise intervention trials

Article, study aims, age, number in study, durationInterventionsCompliance to exercise programmesIntermediate and other effectsEffect on falls and fall injuriesComments
•Reinsch et al18:•2 × 2 factorial design:•Not reportedAt 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 reportedAt 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 attendedAt 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%) classesAt 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 individuallyAt 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 sessionsAt 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 weeksAt 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