Review
Exercise and Sports Science Australia Position Statement on exercise and falls prevention in older people

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Abstract

Falls affect a significant number of older Australians and present a major challenge to health care providers and health systems. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription of exercise for older community-dwelling people with the goal of preventing falls. Falls in older people are not random events but can be predicted by assessing a number of risk factors. Of particular importance are lower limb muscle strength, gait and balance, all of which can be improved with appropriate exercise. There is now extensive evidence to demonstrate that many falls are preventable, with exercise playing a crucial role in prevention. Research evidence has identified that programs which include exercises that challenge balance are more effective in preventing falls than those which do not challenge balance. It is important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Other (non-exercise) interventions are necessary for certain people with complex medical conditions or recent hospitalisation and risk factors relating to vision and the use of psychotropic medications. Qualified exercise professionals are well placed to implement the research evidence and to prescribe and supervise specific exercise aimed at preventing falls in both healthy older community-dwelling people and those with co-morbidities.

Section snippets

Background

Population ageing and the increased tendency to fall with age, present a major challenge to health care providers and health systems as well as for older people and their carers. Falls affect a significant number of older Australians, with over one-third of community dwelling people aged 65 years and older falling one or more times every year.1 Falls can also result in disability, loss of mobility, reduced quality of life and fear of falling.2 The rate of falling is even higher in residents of

Role of exercise for prevention of falls

The definitions of exercise and physical activity used in the American College of Sports Medicine (ACSM) Position Stand on Exercise and Physical Activity for Older Adults were used in this paper.15 Physical activity refers to body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure. Exercise refers to planned, structured, and repetitive movement to improve or maintain one or more components of physical fitness.

It is known that the function of

Other interventions to prevent falls

Several other single interventions have been found to prevent falls, including home safety interventions in high risk people, psychoactive medication reduction, cataract surgery,18 the use of single lens rather than bi-, tri- or multifocal glasses for outdoor mobility23 and the insertion of cardiac pacemakers for the small proportion of people who experience blackouts and are diagnosed with the cardio-inhibitory form of carotid sinus hypersensitivity.18 Multifactorial interventions include

Guidelines for exercise and physical activity in older people

It is widely acknowledged that physical activity has wide ranging benefits for the health and well-being of people of all ages. Physical activity can reduce the risk of developing certain diseases and can play a role in the management and control of many chronic medical conditions such as arthritis, diabetes, heart and respiratory conditions26 and can slow the decline in mobility in cognitively impaired older people.27

The ACSM and the American Heart Association (AHA) physical activity

Exercise prescription – recommendations

There is now clear evidence that exercise is beneficial for the prevention of falls in older people.18 Exercise programs which include exercises that challenge balance are more effective in preventing falls than programs which do not challenge balance.19 These programs include: exercises conducted while standing in which participants aim to (a) stand with their feet closer together or on one leg, (b) minimise use of their hands to assist balance and (c) practice controlled movements of the

Special considerations

The ACSM states that “virtually all sedentary individuals can begin a moderate exercise program safely”. Regarding pre-exercise screening and medical clearance for older adults, the ACSM recommends that: (1) if an older person wanting to begin moderate exercise is apparently healthy, medical screening is not necessary, and (2) if an older person wanting to begin vigorous exercise is apparently healthy, medical screening is recommended. Additionally, people with known cardiac, pulmonary, or

Adherence with exercise programs

Despite the evidence promoting its benefits, a major limitation of physical activity and exercise as a public health intervention is low rates of participation. In the year 2000 only 57% of the Australian adult population was reported to be participating in the recommended minimum level of physical activity per week.45 In addition, of the people who commence exercise programs, around half dropout within 6–12 months,46 and those who dropout are likely to be those most in need of regular exercise.

Gaps in evidence

Research gaps exist regarding the effects of dance, organised activities (bowls, golf, etc.), walking and strength training as single fall prevention interventions. There are also few direct comparisons of different exercise interventions. It has not been demonstrated prospectively whether mid-life exercise can prevent falls in older age. Similarly more research is needed to definitively determine whether exercise can prevent fall-related fractures in an appropriately designed and powered

Summary

Falls can result in long term disability and impaired quality of life for older people. They also present a major burden to health care providers, health systems and to the wider community. Encouragingly though, there is now extensive evidence to demonstrate that many falls are preventable and that exercise is an effective intervention.

Qualified exercise professionals are well placed to implement the research evidence and to prescribe and supervise specific exercise aimed at preventing falls in

Practical implications

  • Exercise has been established as an effective way of preventing falls in older community-dwelling people.

  • Programs which include exercises that challenge balance are more effective in preventing falls than those which do not challenge balance.

  • Exercise should be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls.

Acknowledgments

Dr Tiedemann is funded by a National Health and Medical Research Council Australian Research Training Fellowship. Professor Lord and Associate Professor Sherrington are supported by Australian National Health and Medical Research Council Fellowships. The funders had no role in study design or execution or in manuscript preparation.

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