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Meta-Analysis
. 2023 Dec 1;52(12):afad217.
doi: 10.1093/ageing/afad217.

Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses

Suzanne M Dyer  1 , Jenni Suen  1 , Wing S Kwok  2 , Rik Dawson  2 , Charlotte McLennan  2 , Ian D Cameron  3   4 , Keith D Hill  5 , Catherine Sherrington  2
Affiliations
Meta-Analysis

Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses

Suzanne M Dyer et al. Age Ageing. .

Abstract

Background: There is strong evidence that exercise reduces falls in older people living in the community, but its effectiveness in residential aged care is less clear. This systematic review examines the effectiveness of exercise for falls prevention in residential aged care, meta-analysing outcomes measured immediately after exercise or after post-intervention follow-up.

Methods: Systematic review and meta-analysis, including randomised controlled trials from a Cochrane review and additional trials, published to December 2022. Trials of exercise as a single intervention compared to usual care, reporting data suitable for meta-analysis of rate or risk of falls, were included. Meta-analyses were conducted according to Cochrane Collaboration methods and quality of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: 12 trials from the Cochrane review plus 7 new trials were included. At the end of the intervention period, exercise probably reduces the number of falls (13 trials, rate ratio [RaR] = 0.68, 95% confidence interval [CI] = 0.49-0.95), but after post-intervention follow-up exercise had little or no effect (8 trials, RaR = 1.01, 95% CI = 0.80-1.28). The effect on the risk of falling was similar (end of intervention risk ratio (RR) = 0.84, 95% CI = 0.72-0.98, 12 trials; post-intervention follow-up RR = 1.05, 95% CI = 0.92-1.20, 8 trials). There were no significant subgroup differences according to cognitive impairment.

Conclusions: Exercise is recommended as a fall prevention strategy for older people living in aged care who are willing and able to participate (moderate certainty evidence), but exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).

Keywords: aged; exercise; falls; meta-analysis; nursing homes; older people; systematic review.

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Conflict of interest statement

Rik Dawson, Catherine Sherrington and Keith Hill are authors of trials of exercise in older people, which are funded by national grant agencies.

Figures

Figure 1
Figure 1
Meta-analyses of rate of falls of exercise interventions compared to usual care in included randomised controlled trials in care facilities at (a) the end of the intervention period or (b) after a period of post-intervention follow-up
Figure 2
Figure 2
Meta-analyses of the risk of falling of exercise interventions compared to usual care in included randomised controlled trials in care facilities at (a) the end of the intervention period or (b) after a period of post-intervention follow-up
Figure 3
Figure 3
Subgroup analyses by type of exercise (according to the ProFaNE taxonomy) of the (a) rate of falls and (b) risk of falling for exercise interventions to reduce falls compared to usual care in randomised controlled trials in care facilities as measured at the end of the intervention period.
See this image and copyright information in PMC

References

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