As the Olympics draw to a close, I’m turning my attention from amazing sporting feats by those at the peak of fitness to the health and wellbeing of older people, and in particular what can be done to reduce the rate of falls amongst this large sector of society.
The BMJ has published the results of a randomised controlled trial, conducted in Australia, which explored whether a programme integrating balance and strength training into daily activities (the LiFE programme) could reduce the rate of falls in older, high risk people living at home.
This involves performing exercises whenever the opportunity arises during the day, as part of normal activities. An activity incorporating the strategy of ‘bend knees’ might involve squatting to close a drawer or, at a harder level, to pick things up from the floor, for example.
The researchers recruited 327 people aged 70 and over (mean age 83.4 years) who had multiple falls or a fall resulting in injury during the previous year and randomly allocated them to three groups: a LiFE group, a structured programme group (who did balance and lower limb strengthening exercise three times a week) and a sham control group (who did gentle exercise). Assessments were made at baseline and after six and twelve months. Here’s what they found:
- A significant reduction of 31% in the rate of falls in the LiFE group compared to the control group (incidence rate ratio 0.69; 95% confidence interval 0.48 to 0.99); the difference between the structured group and controls was non-significant
- Overall incidence of falls per person years was 1.66 in the LiFE group, 1.90 in the structured group and 2.28 in the control group
- Static balance, ankle strength, function and participation were significantly better in the LiFE group than in controls
- LiFE and structured groups had a significant and moderate improvement in dynamic balance compared with controls
- LiFE participants reported a significantly better health status at 12 months
- Two people reported severe adverse effects which they attributed to the programme, one in the structured group and one in the LiFE group
- Adherence was significantly better in the LiFE and control groups than the structured group
The authors concluded:
The LiFE programme provides an additional choice to traditional exercise and another fall prevention programme that could work for some people. Functional based exercise should be a focus for protection from falling and for improving and maintaining functional capacity for older people at risk.
Next month, the Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group will be publishing the results of a large systematic review on falls prevention and I’ll be blogging about that here. Meanwhile, we have a new friend in the woodland, the Musculoskeletal Elf, who is sure to be interested in this new trial. If you want to keep up to date with research on musculosketal conditions you’d do well to hurry along to check out her blogs here.
Clemson L; Fiatarone Singh MA; Bundy A; Cumming RG; Manollaras K; O’Loughlin P; Black D. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012;345:e4547