Emerging concept: 'central benefit model' of exercise in falls prevention

Abstract

Falls are a common geriatric syndrome and are the third leading cause of chonic disability worldwide. Falls are not random events and occur, at least in part, due to impaired physiological function, such as impaired balance, and cognitive impairment. The clinical syndrome of falls is important for Sports and Exercise Medicine Clinicians as there is Level 1 evidence that targeted exercise prescription is an effective intervention strategy. The widely accepted dogma is that improved physical function, balance and muscle strength, underlies the effectiveness of the exercise in reducing falls. However, findings from randomised controlled trials suggest that exercise reduce falls via mechanisms other than improved physiological function. The authors propose that improved cognitive function - specifically, executive functions - and associated functional plasticity may be an important yet underappreciated mechanism by which the exercise reduces falls in older adults.

Figure 1. Conceptual Framework for the Central Benefit Model

Arrows indicate direct consequence. T-bar indicates prevention. This framework highlights that reduced executive functions may increase the propensity to fall via various pathways including impaired balance [11] and gait [12] secondary to reduced attentional capacity, impaired central processing and integration, and impaired execution of postural responses. Reduced executive functions may also increase falls risk via decreased judgment and diminished self-regulation,[7] or indirectly increase falls risk via secondary disruptions in executive functions-related behaviour, such as a loss in motivation and initiation.[13] Conversely, impaired balance and gait and loss of motivation and initiation may lead to further reductions in executive functions (i.e., feedback loop). Notably, targeted exercise training reduces falls risk in older adults by maintaining or promoting executive functions.