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Review
. 2019 Dec 16;5(1):e000663.
doi: 10.1136/bmjsem-2019-000663. eCollection 2019.

Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review

Christopher A C M Ng  1   2 , Nicola Fairhall  3 , Geraldine Wallbank  3 , Anne Tiedemann  3 , Zoe A Michaleff  3   4 , Catherine Sherrington  3
Affiliations
Review

Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review

Christopher A C M Ng et al. BMJ Open Sport Exerc Med. .

Abstract

Introduction: There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.

Methods: MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.

Results: 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16-52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15-43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12-52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.

Conclusions: The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.

Keywords: evidence-based; exercise; fall; review; senior.

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Conflict of interest statement

Competing interests: CS and AT are currently running trials of fall prevention interventions, funded by national grant agencies, which are not included in this review. CS is an author of several trials considered in this review, including four included trials (Merom et al (2016); Sherrington et al (2014); Vogler et al (2009); Voukelatos et al (2015)). CN, NF, GW, AT and ZAM have no known conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram summarising the study selection process. RCT, randomised controlled trial.
Figure 2
Figure 2
Number of trials by country. Note: There are three multinational trials not included on the map: Australia and New Zealand by Latham et al; Australia, Spain and Germany by Gschwind et al; Belgium, Israel, Italy, the Netherlands and the UK by Mirelman et al.
See this image and copyright information in PMC

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