The Strength of Falls Prevention

Approximately 30% of adults over 65 years of age living in the community fall each year (Gillespie et al. 2012). Falls in care facilities and hospitals are common events that can cause serious injury and death, imposing a significant social and economic burden on individuals, their families, community health services and the economy. As the proportion of older adults continues to increase globally, the financial costs associated with falls will increase worldwide (Burns et al. 2016). Therefore, prevention of falls is an urgent public health challenge. 

The risk of falling may be predicted from many risk factors. Accidents and environment-related reasons are the most commonly recognized events leading to falls. Most of such falls are associated with one or more identifiable risk factors, e.g. reduced muscle strength, gait or balance disorders, confusion, postural hypotension, visual disorders and certain medications. Large body of research has shown that attention to these risk factors can significantly reduce rates of falling. (Rubenstein et al. 2006). In fact, the latest meta-analysis published in JAMA (Tricco et al. 2017) showed that in a network meta-analysis including 54 studies and 41,596 participants (mean age 78 years; 74% wom-en), exercise alone and various combinations of interventions including exercise, vision assessment and treatment, and environmental assessment and modification were associated with markedly lower risk of injurious falls (about 50%) compared with usual care. These results highlight the message encouraging aging adults to exercise.

A large body of previous evidence also supports the recommendation that balance, strength, gait, and coordination training is effective in reducing falls, and therefore it should be included as part of a multi-component intervention to prevent falls in older adults, and may be considered as a single intervention. In most scientific trials, the exercise program has been longer than 12 weeks (1 to 3 times per week) with variable intensity. According to a recent meta-analysis (Sherrington et al. 2016), exercise reduced fall rates in community-dwelling older people by 21%. Greater fall prevention effects (rate reductions of 39%) were seen from exercise programs that challenge balance and involve 3 or more hours of weekly exercise.

"The rate of falls was reduced by 55% in the exercise group compared to the usual care group, and the exercise group also showed an improvement in physical performance without serious adverse events. "

In addition to increased muscle strength, strength training offers numerous other benefits for older adults. It has been clearly shown to lead to improvements in balance, functional mobility, stability limits, quality of life and falls prevention. A cluster randomized controlled trial of 16 residential aged care facilities and 221 participants (mean age 86 years; 72%women) showed important reduction in falls rate (Hewitt et al. 2018). In this study, the exercise group participated in progressive strength training using HUR intelligent technology plus balance exercises 2 times per week for 25 weeks, followed by a 6-month maintenance program performed similarly 2 times per week. The rate of falls was reduced by 55% in the exercise group compared to the usual care group, and the exercise group also showed an improvement in physical performance without serious adverse events.

To summarize, the research findings described above emphasize regular exercise — especially strength and balance training — as one of the key determinants in preventing falls in the elderly pop-ulation. Exercise intervention is relatively simple to roll out widely and it provides an opportunity for improved resident outcomes and cost savings, and hopefully contributes to the debate for policy decision-making when planning optimal utilization of resources in health care.

1.    Gillespie LD et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012.
2.    Burns ER et al. The direct costs of fatal and non-fatal falls among older adults - United States. J Safety Res. 2016.
3.    Rubenstein LZ et al. Falls in older people: epidemiology, risk factors and strategies for pre-vention. Age Ageing 2006.
4.    Tricco AC et al. Comparisons of Interventions for Preventing Falls in Older Adults. A sys-tematic A Systematic Review and Meta-analysis. JAMA 2017.
5.    Sherrington C et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 2016.
6.    Hewitt J et al. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. JAMDA 2018.

Arto Hautala, PhD

• Adjunct Professor of Physiotherapy
• HUR, Director of Research and Education
• Physical Activity Guidelines Expert appointed by the
  Finnish Medical Society Duodecim and the Executive Board of Current Care Chair
• Editor in the working group planning Finnish Current Care Guideline for
  exercise-based cardiac rehabilitation appointed by the Finnish Association of Physiotherapists