“Falls in older adults are the third leading cause of chronic disability.” This month's Journal of the American Medical Society reports on a study undertaken to determine if an exercise program in adults who have already sustained a fall would prevent future falls.
We already know that 94% of women who break a hip have fallen as the cause of the fracture. Of these women, 25% will not survive one year, and 50% never achieve the mobility and quality of life they enjoyed prior to the accident.
The study, performed in Canada, assigned adults who had already fallen to two groups. In both groups the participants received routine care after a fall was sustained. These measures included adjusting medications, making lifestyle recommendations such as reducing alcohol intake, referral to health care providers such as a cardiologist who could monitor for arrhythmias, or an ophthalmologist who would check vision. Then the group was divided into two subsets. In the study group, they were assigned to an exercise program called the Otago Exercise Program. The other group did not have an assigned exercise routine.
The Otago exercise program included 5 strengthening exercise for the knee, ankle and hips, 11 balance exercises, and walking 30 minutes twice per week. Initially a physical therapist administered the exercise regime, but then the participant was given an exercise manual and cuff weights, and asked to perform the exercises 3 times per week, increasing weights or resistance over time.
At the end of the year the data was analyzed. Adherence to the exercise routine was about 63%, and adherence to the walking regime was 127% as many participants walked more than twice a week. In each group there were 172 participants, and 236 self-reported falls in the exercise group vs. 366 in the usual care group, a decrease of about one-third. As the study progressed over the year, the difference is the number of falls increased. This leads us to extrapolate that the longer one exercises, additional benefits can be seen.
This study helps us to understand the importance strength and balance training have in preventing falls in older adults. The exercise regime requires no gym or special equipment and can be done at home by almost anyone. Here is another excellent reason to exercise as we age, and may extend our active years and independence.
Marilyn C. Jerome, MD
Foxhall Ob-Gyn Associates
Effect of Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial, Ambrose, et al.
Journal of the American Medical Society, June 4, 2019. Volume 321, Number 21, pp. 2092-2100.