New research Exercise and Falls

Falls are a problem for seniors and those who love them. On December 28, 2018, a review was published of the research that looked at the impact of exercise on falls among seniors. The research was a Meta-analysis called Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults and it was written by Philipe de Souto Barreto, Ph.D.

Dr. Barreto, asked the question “What is the association of long-term (≥1 year) exercise with the risk of falls, fractures, hospitalizations and death in older adults?”

In this meta-analysis of 40 long-term randomized clinical trials of 21 868 participants, exercise significantly decreased the risk of being a faller and injurious faller but did not significantly reduce the risk of fractures. Long-term exercise, particularly moderate intensity, multi-component training with balance exercises, performed 2 to 3 times per week, appears to be a safe and effective intervention for reducing the risk of being a faller/injurious faller in seniors. Exercise did not, however, diminish the risk of multiple falls, hospitalization, and mortality

This meta-analysis showed that long-term exercise had modest but significant association with reduced risk of becoming a faller and an injurious faller, but not a faller with multiple falls, in older adults. Moreover, exercise was associated with a nonsignificant reduction in the risk of sustaining a fracture. Exercise benefits occurred without increasing the risk of mortality and hospitalization.

Furthermore, this study further extends current knowledge by examining for the first time the association of exercise with the risk of being a faller with multiple falls. However, multiple falls were not reported in some of the largest, well-conducted original studies.

The study consistently found that exercise decreased the risk of injurious falls by about 26%. Regarding fractures, the study contributes to this still not well-established field by showing that exercise seems to protect against fractures; although the primary finding was not statistically significant. The positive results suggest that long-term exercise might lead to a reduction in the risk of fractures.

The study found that vigorous-intensity is as safe as moderate-intensity exercise. Exercise frequency of between twice and thrice a week was associated with decreased mortality, whereas more than 3 times per week was associated with increased risk of being a faller; therefore, the best exercise frequency seems to be 2 to 3 times per week.

The association between exercise frequency and risk of becoming faller might be dependent on the fall-related vulnerability of the population, with higher risks in more vulnerable participants; indeed, among studies with exercise frequency of 4 or more times per week. It is possible that the dose-response idea implying that “more exercise is always better” might not fully apply for the most vulnerable older adults. The potential mechanisms involved require further investigation, but it could be related to overtraining: excessive exercise leads to diminished immunity and energy metabolism according to animal models and is associated with reduced calorie intake, worse sleep, and negative psychological patterns in young and middle-aged adults.

The findings on the best exercise frequency, suggests that the best exercise regimen for protecting older people against diverse adverse events would be moderate-intensity, multi-component training comprising balance exercises, performed 2 to 3 times per week; a session duration of 30 to 60 minutes (average of 50 minutes, according to studies on injurious falls analysis) should be safe and effective. Exercise is associated with a modest decrease in the risk of becoming a faller, an injurious faller, and potentially sustaining a fracture in older adults.