CRD summary

This review assessed the effectiveness of exercise programmes in preventing falls and improving balance and muscle strength in older people. The authors concluded that there is an overall, marginally significant, benefit of exercise, but further studies are recommended. The limited search and lack of a quality assessment of the included studies make it difficult to assess the reliability of the results.

Authors' objectives

To assess the effectiveness of exercise programmes in preventing falls and improving balance and muscle strength in older people.

Searching

MEDLINE and CINAHL were searched from inception to 2003; the search terms were reported. The authors also checked the reference lists of retrieved articles and review articles. Studies published in English after 1990 were included in the review.

Study selection

Assessment of study quality

The authors stated that validity was assessed, but did not state what criteria were used.

The authors stated that two reviewers independently evaluated the validity of the studies.

Data extraction

Two reviewers independently extracted the data. The reviewers calculated the fall rate in the intervention and control groups using data on the numbers of participants who had and had not fallen in each group. They then calculated the difference in fall rate by subtracting the fall rate of the exercise group from the fall rate of the control group. The odds ratio (OR), risk difference and relative risk were also calculated, along with their 95% confidence interval (CI) or standard error (SE).

The standardised net increase in balance and muscle strength was calculated as the mean difference (exercise minus control) of the change (post-measurement minus pre-measurement) divided by the standard deviation. The associated 95% CI or SE was also presented.

Methods of synthesis

Results of the review

Eight trials (n=843) were included in the review: 6 randomised controlled trials (RCTs) and 2 quasi-experimental studies in which the treatment centre, rather than the patient, was randomly assigned.

Five trials assessed compliance with the exercise programme. The proportion of patients who adhered to the entire programme ranged from 42 to 93% (4 trials), while the proportion of sessions that the participants attended ranged from 73 to 95% (4 trials).

Exercise had a marginally significant effect on fall rate, reducing it by 6.2% (95% CI: 0, 12.7, P=0.06) with no evidence of significant heterogeneity (Q=6.11, P=0.53). The pooled OR was not statistically significant (0.79, 95% CI: 0.59, 1.05, P=0.10).

There was a statistically significant improvement in balance after exercise therapy (7 studies: effect size 0.32, 95% CI: 0.17, 0.47, P<0.0001). However, there was evidence of statistically significant heterogeneity between the studies (P<0.0001).

There were statistically significant improvements in ankle muscle strength (effect size 0.42, 95% CI: 0.25, 0.59, P<0.0001) and knee muscle strength (effect size 1.11, 95% CI: 0.90, 1.32, P<0.0001) after exercise therapy. However, there was evidence of statistically significant heterogeneity between the studies (P<0.001 for both).

There was no significant association between post-intervention fall risk and compliance rate, or between post-intervention fall rate and baseline fall rate.

Authors' conclusions

There is an overall, marginally significant, benefit of exercise in preventing falls and improving balance and muscle strength in older people. The authors made recommendations for future research.

CRD commentary

The review question was clear in terms of the study designs, participants, interventions and outcomes of interest. The authors searched two relevant electronic databases for studies. However, they only included studies published in English and made no attempts to identify unpublished studies, thereby increasing the potential for publication and language biases. Two reviewers undertook the data extraction and validity assessment processes, but the authors did not state how any disagreements were resolved. The authors did not state how studies were selected for the review, thus the potential for reviewer bias and error cannot be assessed. Whilst the authors stated that the validity of the studies was assessed, the criteria used and the results of the assessment were not reported. Although appropriate measures of effect were calculated and heterogeneity was assessed, the authors did not report the methods used to pool the data.

The authors' conclusions appear to be supported by the review findings. However, given that other relevant studies might have been missed and details of the validity assessment were lacking, the reliability of the included studies, and thus the review, cannot be assured.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that as additional studies are published, a meta-analysis should be carried out in the future. They recommended that, in future, researchers should provide detailed descriptions of exercise programmes, participants' health and functional conditions, medications and activity levels in order to examine fall reduction after adjusting for activity level and individual characteristics related to fall risk.

Bibliographic details

Sohng K Y, Choi J H, Song H H, Moon J S. A meta-analysis of exercise programmes for preventing falls in older people. Asian Journal of Nursing Studies 2005; 8(1): 3-15.

Indexing Status

Subject indexing assigned by CRD

MeSH

Accidental Falls; Aged

AccessionNumber

12005005338

Database entry date

31/01/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.