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Falls and Frailty – Reduces falls related injuries

Evidence summary (Updated 2022)
Exercise interventions tend to reduce injurious falls in all categories. Ten trials provided figures for all injurious falls. The pooled estimated rate ratio was 0.63 (0.51 to 0.77). The pooled estimate for falls resulting in medical care was 0.70 (0.54 to 0.92) and for falls resulting in serious injuries was 0.57 (0.36 to 0.90). Exercise seemed to significantly decrease the rate of falls resulting in fractures as well, with a pooled effect of 0.39 (0.23 to 0.66). The protective effect seems most pronounced for the most severe fall related injuries [1].
Updated review since 2018 confirms that physical activity is safe and can reduce the severity of injuries related to falls. Most types of exercise reduce falls rate, especially 3D exercise, strength/resistance training, and mixed exercises. Taken together (more power), exercise interventions reduce fall-related fracture risk. Fear of falling was slightly decreased with endurance exercises [2].

Exercise resulted in: 12% risk reduction in fall-related injuries (RR 0.88, CI 0.83-0.93); 32% reduction in injuries requiring medical care (RR 0.68, CI 0.56-0.82); 44% reduction in fall-related fractures (RR 0.56, CI 0.37-0.86). Exercise interventions were safe and compliance was high [3]

An update of the previous Cochrane review in 2019 To assess the effects of exercise intervention on incident fragility fractures among adults with a history of vertebral fracture commented that for this population (post-vertebral fracture): “We do not have sufficient evidence to determine the effects of exercise on incident fractures, falls or adverse events.” [4]

A very large SR (>35000 people) showed exercise significantly reduced number of fallers (RR 0.89, CI 0.81-0.97) and injurious falls (IRR 0.81, CI 0.73-0.90); it caused a nonsignificant reduction in falls incidence (IRR 0.87; CI 0.75-1.00); no association with mortality [5]. Few exercise trials reported fall-related fractures.

Quality of evidence
B – Studies with large numbers but with heterogeneity in the studies.

Strength of recommendation
1 Strong

Exercise exerts a positive effect on injurious falls, including the most severe falls and those that result in medical care, meaning that those falls with the greatest consequences for people’s health and use of resources are reduced.
Physical activity can be recommended for the prevention of falls-related injuries in most circumstances.

[1] El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMj. 2013 Oct 29;347:f6234.
[2] Caristia S, Campani D, Cannici C, Frontera E, Giarda G, Pisterzi S, Terranova L, Payedimarri AB, Faggiano F, Dal Molin A. Physical exercise and fall prevention: A systematic review and meta-analysis of experimental studies included in Cochrane reviews. Geriatr Nurs. 2021 Nov-Dec;42(6):1275-1286. doi: 10.1016/j.gerinurse.2021.06.001. Epub 2021 Sep 21. PMID: 34555570.

[3] Zhao R, Bu W, Chen X. The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr. 2019 Dec 3;19(1):341. doi: 10.1186/s12877-019-1359-9. PMID: 31795944; PMCID: PMC6892137.

[4] Gibbs JC, MacIntyre NJ, Ponzano M, Templeton JA, Thabane L, Papaioannou A, Giangregorio LM. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev. 2019 Jul 5;7(7):CD008618. doi: 10.1002/14651858.CD008618.pub3. PMID: 31273764; PMCID: PMC6609547.

[5] Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Apr 24;319(16):1705-1716. doi: 10.1001/jama.2017.21962. PMID: 29710140.