Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review

Abstract

Purpose: To review and update the evidence of the relationship between physical activity, risk of fall-related injury, and physical function in community-dwelling older people that was presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (PAGAC Report).

Methods: Duplicate independent screenings of 1415 systematic reviews and meta-analyses published between 2006 and 2016 identified from PubMed®, Cochrane Library, and CINAHL databases yielded 111 articles used for the PAGAC Report. The PAGAC Aging Subcommittee members graded scientific evidence strength based upon a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. An updated search of 368 articles published between January 2017 and March 2018 yielded 35 additional pertinent articles.

Results: Strong evidence demonstrated that physical activity reduced the risk of fall-related injuries by 32% to 40%, including severe falls requiring medical care or hospitalization. Strong evidence also supported that physical activity improved physical function and reduced the risk of age-related loss of physical function in an inverse graded manner among the general aging population, and improved physical function in older people with frailty and with Parkinson's disease. Aerobic, muscle-strengthening, and/or multicomponent physical activity programs elicited the largest improvements in physical function in these same populations. Moderate evidence indicated that for older adults who sustained a hip fracture or stroke, extended exercise programs and mobility-oriented physical activity improved physical function.

Conclusions: Regular physical activity effectively helps older adults improve or delay the loss of physical function and mobility while reducing the risk of fall-related injuries. These important public health benefits underscore the importance of physical activity among older adults, especially those living with declining physical function and chronic health conditions.

Figure 1.

Risk of injuries from falls: systematic reviews, meta-analyses, pooled analyses, and report flow diagram of search strategy and study selection from the updated search, March 2018.

Figure 2.

Physical function systematic review, meta-analyses, pooled analysis, and report flow diagram of search strategy and study selection from the updated search, March 2018.

Figure 3.

Results of a systematic review of the inverse dose-response relationship between volume of aerobic physical activity and risk of physical functional limitations in the general aging population. Categories of physical activity level were derived from prospective cohort studies with covariate adjustment: 0)=no activity; 1) = light activities only occasion walking or gardening; 2) = moderate level of activity (volume = 3-5 days/week for 30 min/day; and 3) = vigorous activities and/or high volume of systematic activity. The odds ratio is the odds of disability in the physical activity group relative to a comparison group. ADL=activities of daily living; IADL=instrumental activities of daily living; QOL=quality of life score. Figure reproduced with permission from Paterson & Warburton, 2010.