External validity of physical activity interventions for community-dwelling older adults with fall risk: a quantitative systematic literature review (original) (raw)
Related papers
Journal of Aging and Health, 2009
Objective: This study examines the 9-month impact of a 12-week falls prevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three indicators. Program effects were examined using linear and logistic regression procedures. Results: Both groups showed similar increases in weekly frequency of exercise at the 9-month posttest. However, the program's participants showed higher increases in their variety of exercises at the 9-month posttest (especially among those with greater baseline scores). Among seniors reporting lower levels of energy expenditure at baseline, the program's participants showed significantly greater increases in energy expenditure than control participants. Discussion: These preliminary findings suggest that programs such as Stand Up! have the potential to stimulate continued involvement in physical activity.
Journal of Frailty, Sarcopenia and Falls
Falls are significant concern to many older adults 1. To facilitate greater resilience against falls, their agency to prevent and manage falls should be adequately addressed. According to Bandura 2 , the key factor of agency is the belief in personal efficacy. Perceived self-efficacy is not a global trait but a differentiated set of self-beliefs linked to distinct realms of functioning 3. Viewing it as a single domain of functional capability risks overlooking its potential effectiveness in particular aspects of perceived capabilities. Falls efficacy has been equated with balance confidence 4 , but this could foreground one domain of the perceived capacity to cope with falls (the ability to perform activities without losing balance) at the expense of others, such as the perceived ability to manage a fall if one occurs. Falls efficacy has been recently posited as a series of perceived capabilities needed to overcome varying fall-related demands across different domains of a fall (pre-fall, near-fall, fall-landing and completed fall) 5. Consideration of a person's abilities to act in prospective fall-related situations would facilitate planning and tailoring of empowering interventions for older adults. It has been proposed that falls efficacy encompasses a Abstract Falls efficacy has been defined as perceived self-belief in the prevention and management of falls. In the case of community-dwelling older adults, it is essential that interventions should address the different aspects of falls efficacy in terms of balance confidence, balance recovery confidence, safe landing confidence and post-fall recovery confidence to improve their agency to deal with falls. This review aims to provide the current landscape of falls efficacy interventions and measurement instruments. A literature search of five electronic databases was conducted to extract relevant trials from January 2010 to September 2021, and the CASP tool for critical appraisal was applied to assess the quality and applicability of the studies. Eligibility criteria included randomised controlled trials evaluating falls efficacy as a primary or secondary outcome for community-dwelling older adults. A total of 302 full texts were reviewed, with 47 selected for inclusion involving 7,259 participants across 14 countries. A total of 63 interventions were identified, using exercise and other components to target different aspects of falls efficacy. The novel contribution of this article is to highlight that those interventions were applied to address the different fallrelated self-efficacies across pre-fall, near-fall, fall landing and completed fall stages. Appropriate measurement instruments need to be used to support empirical evidence of clinical effectiveness.
Age and ageing, 2018
exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control...
Sports Medicine - Open
Background: The risk of falling and associated injuries increases with age. Therefore, the prevention of falls is a key priority in geriatrics and is particularly based on physical exercising, aiming to improve the age-related decline in motor performance, which is crucial in response to postural threats. Although the benefits and specifications of effective exercise programs have been well documented in pre-post design studies, that is during the treatment, the definitive retention and transfer of these fall-related exercise benefits to the daily life fall risk during follow-up periods remains largely unclear. Accordingly, this meta-analysis investigates the efficacy of exercise interventions on the follow-up risk of falling. Methods: A systematic database search was conducted. A study was considered eligible if it examined the number of falls (fall rate) and fallers (fall risk) of healthy older adults (≥ 65 years) during a follow-up period after participating in a randomized controlled physical exercise intervention. The pooled estimates of the fall rate and fall risk ratios were calculated using a random-effects meta-analysis. Furthermore, the methodological quality and the risk of bias were assessed. Results: Twenty-six studies with 31 different intervention groups were included (4739 participants). The number of falls was significantly (p <0.001) reduced by 32% (rate ratio 0.68, 95% confidence interval 0.58 to 0.80) and the number of fallers by 22% (risk ratio 0.78, 95% confidence interval 0.68 to 0.89) following exercising when compared with controls. Interventions that applied posture-challenging exercises showed the highest effects. The methodological quality score was acceptable (73 ± 11%) and risk of bias low. Conclusions: The present review and meta-analysis provide evidence that physical exercise interventions have the potential to significantly reduce fall rate and risk in healthy older adults. Posture-challenging exercises might be particularly considered when designing fall prevention interventions.
Physiotherapy
Background Fall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise. Objectives To assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults. Data Sources Searches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017. Study selection Randomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12 months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group. Data extraction/Data synthesis Pairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR). Results Twenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years postintervention. Conclusions Falls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention. Contribution of the paper: There is a shortage of data relating to the possible long-lasting effects of falls prevention exercise interventions for older adults. Previous systematic reviews have assessed the effect of falls prevention exercise programmes for up to 12-months; this review evaluates the sustained effect of falls prevention exercise programmes beyond a year. This review provides evidence of the long-term effect of certain falls prevention exercise interventions.
Preventing falls among older adults: no "one size suits all" intervention strategy
Journal of rehabilitation research and development, 2008
Physical activity (exercise) serves primary, secondary, and tertiary roles in the prevention of falls among older adults. In its primary role, physical activity can prevent the onset of pathology and system impairments that lead to disability and increased risk for falls. Slowing the progression of disease and system impairments is its secondary role, while its tertiary role lies in the restoration of function to a level that allows for more autonomy in the performance of essential activities of daily living. Whether used as a stand-alone strategy or a core component of a multifactorial intervention approach, exercise constitutes an effective means by which to reduce fall risk and/or fall incidence rates. At low levels of risk, many exercise choices are available to older adults. As the level of risk increases, however, more tailored and progressive exercise programs that target the physical risk factors associated with falls are more effective in lowering fall risk. Adopting a mult...
2019
Background: The risk of falling and associated injuries increases with age. Therefore, the prevention of falls is a key priority in geriatrics and is particularly based on physical exercising, aiming to improve the age-related decline in motor performance, which is crucial in response to postural threats. Although the benefits and specifications of effective exercise programs have been well documented in pre-post design studies, that is during the treatment, the definitive retention and transfer of these fall-related exercise benefits to the daily life fall risk during follow-up periods remains largely unclear. Accordingly, this meta-analysis investigates the efficacy of exercise interventions on the follow-up risk of falling. Methods: A systematic database search was conducted. A study was considered eligible if it examined the number of falls (fall rate) and fallers (fall risk) of healthy older adults (≥ 65 years) during a follow-up period after participating in a randomized contr...