The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials

Zhao, Rongsheng; Bu, Wenqian; Chen, Xianghe

doi:10.1186/s12877-019-1359-9

Cited by 38 publications

(27 citation statements)

References 48 publications

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“…The observed reduction in fall rate is comparable to that reported in previous studies—21% reduction with individually delivered exercise programmes over 12 months and 14% over 24 months 234. However, the 20% reduction in the proportion of people who had injurious falls over 24 months seems to be higher than the 12% reduction previously reported in other studies 35. These findings indicate that technology can be used to deliver an e-health balance exercise programme to older people that is effective at reducing fall rates and the proportion of injurious falls over 24 months.…”

Section: Discussionsupporting

confidence: 84%

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

Delbaere

Valenzuela

Lord

et al. 2021

BMJ

135

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Objective To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people. Design Assessor blinded, randomised controlled trial. Setting Older people living independently in the community in Sydney, Australia. Participants 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise. Interventions Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years. Main outcome measures The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number who had an injurious fall (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months. Results The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.84, 95% confidence interval 0.62 to 1.13, P=0.071). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.67 to 1.20, P=0.461). However, the intervention group had a 16% lower rate of falls over 24 months compared with the control group (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.68 to 1.10, P=0.239), but the proportion of people who had an injurious fall over 24 months was 20% lower in the intervention group compared with the control group (relative risk 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred. Conclusions The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and the number of injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies. Trial registration ACTRN12615000138583

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Section: Discussionsupporting

confidence: 84%

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

Delbaere

Valenzuela

Lord

et al. 2021

BMJ

135

View full text Add to dashboard Cite

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“…Subgroup analyses were stratified for age group (<65 years vs. ≥65 years; commonly considered as the age for elderly adults), 40 sex (male vs. female), baseline BMI (<35 kg/m 2 vs. ≥35 kg/m 2 ; cut‐off point for WHO Class II obesity), 1 length of follow‐up (<12 months vs. ≥12 months), 41 and dietary co‐intervention (present vs. absent). Sensitivity analyses were run by excluding studies with a high risk of bias and by splitting control and minimal intervention as separate nodes.…”

Section: Resultsmentioning

confidence: 99%

Impact of different training modalities on anthropometric outcomes in patients with obesity: A systematic review and network meta‐analysis

et al. 2021

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Summary Obesity management guidelines consistently advise aerobic training for weight loss, whereas recommendations for other training modalities are sparse. This systematic review and network meta‐analysis (NMA) aimed to compare the long‐term effects of different training modalities on anthropometric outcomes in patients with obesity. MEDLINE, Cochrane CENTRAL, and Web of Science were searched to identify the following: (1) randomized controlled trials (RCTs); (2) conducted in adults with a mean body mass index (BMI) ≥30 kg/m2; (3) comparing aerobic, resistance, combined, or high‐intensity interval training head‐to‐head or to control for ≥6 months; and (4) reporting changes in body weight (BW), BMI, waist circumference (WC), fat mass (FM), or fat‐free mass (FFM). Random‐effects NMA models were fitted in a frequentist approach. GRADE framework was used to assess certainty of evidence. Thirty‐two RCTs with 4774 participants with obesity were included in this review. Aerobic training was ranked as best for improving BW, BMI, and WC and combined training for improving FM, as well as equally with resistance training most effective for improving FFM. Low to moderate certainty of evidence supports use of aerobic training to improve anthropometric outcomes in obesity, and its combination with resistance training provides additional benefit for reducing FM and increasing FFM.

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“…Fall-related injury emerges as an important cause of morbidity and mortality in the elderly (29). Damages caused by falling lead to an increase in nursing home admission and dependence (30).…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status Might Be Related to Physical Performance and Functionality in Older Adults

Koçyiğit¹,

Aydın²,

Işık³

2021

Osmangazi̇ Journal of Medicine

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It was aimed to investigate the effect of malnutrition with and the risk of malnutrition in elderly individuals with regards to other geriatric syndromes and comprehensive geriatric assessment (CGA) parameters. Patients who applied to the geriatric outpatient clinic between January 2019 and June 2020 were included in the study. 460 patients were examined. The patients were divided into three groups according to malnutrition, malnutrition-risk, and normal nutritional status. These three groups were compared in terms of geriatric syndromes and CGA parameters. The well-nourished group and the risk of malnutrition and malnutrition group were compared in terms of geriatric syndromes and CGA parameters adjusted for age and gender. Of 460 patients, 64.5% of these patients were female, and the mean age was 77.75±8.12, 65 had malnutrition, and 141 had malnutrition-risk. When the well-nourished group was compared with the malnutrition and malnutrition-risk group, age, education year, frequency of cerebrovascular disease were statistically different. The frequency of falls, dementia, sleep disturbance, urinary incontinence, orthostatic hypotension, polypharmacy, sarcopenia, and frailty was higher in groups with malnutrition and malnutrition-risk than in the normal group (p<0.05). Also, activities of daily living (ADLs) and gait and balance scores were lower in the group with malnutrition and malnutrition risk (p<0.05). In the regression analysis adjusted for age and gender, geriatric depression, urinary incontinence, dementia, orthostatic hypotension, sarcopenia, and frailty were increased in the group with malnutrition and malnutrition risk compared to the normal group (p<0.05). Malnutrition and risk of malnutrition is associated with other geriatric syndromes and deterioration in ADLs. Therefore, nutritional evaluation must be included in the assessment of older adults, and necessary interventions should be made to optimize the nutritional status.

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The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials

Cited by 38 publications

References 48 publications

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

Impact of different training modalities on anthropometric outcomes in patients with obesity: A systematic review and network meta‐analysis

Nutritional Status Might Be Related to Physical Performance and Functionality in Older Adults

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