Rose, E, Thomas, M, Riordan, M, Gwyer, J; Duke University, Durham, NC, USA.

PURPOSE: Recent meta-analyses have examined the relationship between exercise and falls prevention in older adults but none have examined the specific exercise interventions that have been successful. The purpose of this systematic review was to combine data from existing literature and identify the exercise interventions shown to reduce falls. METHODS: A systematic review was conducted of published and unpublished literature. Manual and computerized searches were used to obtain all falls prevention reports that met the following criteria: 1) randomized controlled trial (RCT), 2) participants at least 65 years of age, 3) exercise intervention, and 4) direct measure of frequency of falls. The quality of evidence of each included study was assessed using a quality rating scale developed for this project. Extensive descriptive data related to exercise (category, frequency, intensity and duration) were extracted from each included study. ANALYSES: Two primary investigators independently identified reports that met all selection criteria. Descriptive statistics were used to summarize the data extracted from the reports. RESULTS: The search produced 581 articles published between 1964-2001 on falls prevention and exercise. Twenty-one RCTs met all selection criteria. Sixty-seven percent of the 21 studies showed a reduction in falls but only five studies reported a statistically significant reduction in falls. Despite not showing a decrease in falls, in the remaining 9 studies, the interventions did not significantly increase falls. The five successful interventions were performed on community dwelling adults over 70. Three of the five studies used exercise as a sole intervention. The other two used a combination of interventions. The most commonly used exercise interventions in the five studies include: moderate intensity hip, knee and ankle strengthening and dynamic balance training performed two or three days per week. CONCLUSIONS: Moderate intensity lower extremity strengthening and dynamic balance exercises can reduce the risk of falls in those 70 years and older. Clinical trials in this area can be strengthened by studying age and ability appropriate exercise programs and by including assessments of impairment that may predict functional performance. FUNDING SOURCE: None.

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