Effect of eHealth-delivered exercise programmes on balance in people aged 65 years and over living in the community: a systematic review and meta-analysis of randomised controlled trials

Abstract

IntroductionExercise that challenges balance is proven to prevent falls in community-dwelling older people, yet widespread implementation and uptake of effective programmes is low. This systematic review and meta-analysis synthesised the evidence and evaluated the effect of eHealth-delivered exercise programmes compared with control on balance in community-dwelling people aged ≥65 years.MethodsNine databases including MEDLINE, CINAHL and Embase, were searched from inception to January 2022 to identify randomised controlled trials evaluating eHealth-delivered exercise programmes for community-dwelling people aged ≥65 years, published in English that included a balance outcome. Primary outcomes were static and dynamic balance. Secondary outcomes included fall risk and fear of falling. We calculated standardised mean differences (SMDs, Hedges’ g) with 95% CIs from random effects meta-analyses.ResultsWe identified 14 eligible studies that included 1180 participants. Methodological quality ranged from 3 to 8 (mean, 5). The pooled effect indicated that eHealth-delivered exercise programmes have a medium significant effect on static balance (11 studies; SMD=0.62, 95% CI 0.27 to 0.72) with very low-quality evidence. There was small statistically significant effect on dynamic balance (14 studies; SMD=0.42, 95% CI 0.11 to 0.73) with very low-quality evidence, and fall risk (5 studies; SMD=0.32, 95% CI 0.00 to 0.64) with moderate-quality evidence. No significant effect of eHealth programmes on fear of falling was found (four studies; SMD=0.10, 95% CI −0.05 to 0.24; high-quality evidence).ConclusionThis review provides preliminary evidence that eHealth-delivered exercise programmes improved balance and reduced fall risk in people aged ≥65 years. There is still uncertainty regarding the effect of eHealth delivered exercise programmes on fear of falling.PROSPERO registration numberCRD42018115098.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

“…However, the recent study by Gani et al [ 193 ] underlined that telemedicine might improve the compliance rate to osteoporosis pharmacological therapies and prevent hip fractures in the elderly. However, growing evidence is supporting the positive effects of telemedicine in lifestyle approach, a widely accepted key component of the therapeutic management of osteoporosis [ 194 ].…”

Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol

“… 19 22 However, community programmes including group exercise interventions were largely halted or reduced because of social distancing measures, 18 which has necessitated the urgent synthesis of best practices and evidence to inform the development of individualised, home-based falls prevention programmes. 23 …”

“…Two recent systematic reviews examined eHealth interventions and exergaming for older adults, but their primary outcomes were focused on static and dynamic balance. 23 32 While important, surrogate markers including tests of hand-grip strength and balance are indirect measures of patient-important endpoints such as falls and fractures. 33 34 Furthermore, a number of falls prevention trials have recently been completed among older adults with conditions such as Parkinson’s disease, 28 cardiopulmonary disease 35 and chronic kidney disease, 36 which have not been included in previous reviews.…”

“…A Cochrane review found that supervised group-based exercises reduced the risk of falls by 23%,21 while other systematic reviews found that community fall prevention programmes with longer durations reduced the risk of injurious falls and fractures but not hospitalisations and mortality 19 22. However, community programmes including group exercise interventions were largely halted or reduced because of social distancing measures,18 which has necessitated the urgent synthesis of best practices and evidence to inform the development of individualised, home-based falls prevention programmes 23…”

“…To our knowledge, few systematic reviews have examined the risks and benefits of home-based fall prevention programmes using telehealth for community-dwelling older adults. Two recent systematic reviews examined eHealth interventions and exergaming for older adults, but their primary outcomes were focused on static and dynamic balance 23 32. While important, surrogate markers including tests of hand-grip strength and balance are indirect measures of patient-important endpoints such as falls and fractures 33 34.…”