At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have previously been found to prevent falls in these people.
To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community.
We searched the healthcare literature for reports of randomised controlled trials relevant to this review up to 2 May 2018. In such studies, people are allocated at random to receive one of two or more interventions being compared in the study. Leaving group allocation to chance helps ensure the participant populations are similar in the intervention groups.
This review includes 108 randomised controlled trials with 23,407 participants. These were carried out in 25 countries. On average, participants were 76 years old and 77% were women.
Certainty of the evidence
The majority of trials had unclear or high risk of bias, mainly reflecting lack of blinding of trial participants and personnel to the interventions. This could have influenced how the trial was conducted and outcome assessment. The certainty of the evidence for the overall effect of exercise on falls was high. Risk of fracture, hospitalisation, medical attention and adverse events were not well reported and, where reported, the evidence was low- to very low-certainty. This leads to uncertainty regarding drawing conclusions from the evidence for these outcomes.
Eighty-one trials compared exercise (all types) versus a control intervention that is not thought to reduce falls in people living in the community (who also had not recently been discharged from hospital). Exercise reduces the number of falls over time by around one-quarter (23% reduction). By way of an example, these data indicate that if there were 850 falls in 1000 people followed over one year, exercise would result in 195 fewer falls. Exercise also reduces the number of people experiencing one or more falls (number of fallers) by around one-sixth (15%) compared with control. For example, if there were 480 fallers who fell in 1000 people followed over one year, exercise would result in 72 fewer fallers. The effects on falls were similar whether the trials selected people who were at an increased risk of falling or not.
We found exercise that mainly involved balance and functional training reduced falls compared with an inactive control group. Programmes involving multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduced falls, and Tai Chi may also reduce falls. We did not find enough evidence to determine the effects of exercise programmes classified as being mainly resistance exercises, dance, or walking programmes. We found no evidence to determine the effects of programmes that were mainly flexibility or endurance exercise.
There was considerably less evidence for non-fall outcomes. Exercise may reduce the number of people experiencing fractures by over one-quarter (27%) compared with control. However, more studies are needed to confirm this. Exercise may also reduce the risk of a fall requiring medical attention. We did not find enough evidence to determine the effects of exercise on the risk of a fall requiring hospital admission. Exercise may make very little difference to health-related quality of life. The evidence for adverse events related to exercise was also limited. Where reported, adverse events were usually non-serious events of a musculoskeletal nature; exceptionally one trial reported a pelvic stress fracture and a hernia.
Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.
Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.