Exercise prescription for falls prevention A/Prof Cathie Sherrington

Transcription

1 Exercise prescription for falls prevention A/Prof Cathie Sherrington Affiliated with the University of Sydney 1

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3 ProFaNE taxonomy for exercise Gait, balance, and functional training Strength/resistance Flexibility Correction of walking technique, transfer of body weight, challenges balance systems, functional activities Contracting the muscles against resistance to overload Stretching exercises 3 D forward/ back, side to side, up/down General physical activity Endurance Tai Chi, Qi Gong dance Occupational, transportation and recreational components Cardiovascular conditioning 3

4 Group exercise multiple categories reduces fall rates 4

5 Group Tai Chi and gait/ balance/functional training reduce fall rates 5

6 Some individual exercise programs reduce fall rates 6

7 Group exercise reduces number of fallers 7

8 Tai Chi reduces number of fallers 8

9 Group exercise reduces fall rates in those selected for higher risk of falling and in the general community 9

10 Tai Chi has a greater impact on falls in the general community that for those selected for higher risk of falling 10

11 Exercise may reduce the number of fractures 11

12 Cochrane review summary We included 159 trials with 79,193 participants. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; 7 trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; 6 trials; 714 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; 5 trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; 6 trials; 1625 participants). Overall, exercise interventions significantly reduced the risk of sustaining a fall-related fracture (RR 0.34, 95% CI 0.18 to 0.63; 6 trials; 810 participants). 12

13 A complementary approach NSW Public Health Bulletin. 22 (3-4);78-83 (2011). 13

14 Sherrington et al 2011 A broader view of balance control over movements of the body s centre of mass Tai Chi, group exercise and Otago classified as challenging balance Pooled exercise program and established features associated with bigger effects balance challenge ongoing exercise 14

15 Relative versus absolute effects Skelton (2005) 1 31% reduction in the rate of falls control group rate of 3.2 falls/person year 100 falls prevented per 100 person years Woo (2007) 2 51% reduction in the rate of falls control group rate of 0.52 falls/person year 27 falls prevented per 100 person years 1. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age & Ageing. 2005;34: Woo J, Hong A, Lau E, Lynn H. A randomized controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age and Ageing. 2007;36:

16 Recommendations for exercise to prevent falls in older adults 1. Exercise must provide a moderate or high challenge to balance 2. Exercise must be of sufficient dose to have an effect 3. Ongoing exercise is necessary 4. Fall prevention exercise should be targeted at the general community as well as those at high risk for falls 5. Fall prevention exercise may be undertaken in a group or home-based setting Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated metaanalysis and best practice recommendations. NSW Public Health Bulletin. 22 (3-4);78-83 (2011).

17 Recommendations for exercise to prevent falls in older adults 6. Walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs 7. Strength training may be included in addition to balance training 8. Exercise providers should make referrals for other risk factors to be addressed Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated metaanalysis and best practice recommendations. NSW Public Health Bulletin. 22 (3-4);78-83 (2011). 17

18 No exercise in past 2 weeks 1 1. Australian Institute of Health and Welfare. Australia s Health Australia s Health series no.13. Cat. no. AUS 156. Canberra: AIHW (2012)

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21 Conclusions Strong evidence that exercise can prevent falls Widespread implementation of preventive strategies is urgently needed