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|Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review [with consumer summary]|
|Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb S|
|British Journal of Sports Medicine 2020 Aug;54(15):885-891|
OBJECTIVES: To assess the effects of exercise interventions for preventing falls in older people living in the community. SELECTION CRITERIA: We included randomised controlled trials evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. RESULTS: Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% CI 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Subgroup analyses showed no evidence of a difference in effect on falls on the basis of risk of falling as a trial inclusion criterion, participant age 75 years+ or group versus individual exercise but revealed a larger effect of exercise in trials where interventions were delivered by a health professional (usually a physiotherapist). Different forms of exercise had different impacts on falls. Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7,920 participants, 39 studies; high-certainty evidence). Multiple types of exercise (commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1,374 participants, 11 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2,655 participants, 7 studies; low-certainty evidence). We are uncertain of the effects of programmes that primarily involve resistance training, dance or walking. CONCLUSIONS AND IMPLICATIONS: Given the certainty of evidence, effective programmes should now be implemented.