Exercise is an essential part of falls prevention

Falling and fall-induced injuries are a major public health problem. For example, in Finland the number of deaths due to falls (1971-2009)3 and the age-adjusted and age-specific incidence of fall-induced severe cervical spine injuries (1971-2011)4 have increased in adults aged 50 and older in both men and women. Usually the risk of falling increases with age3 and generally women are at more risk of falling6. Surprisingly it was noticed that in Finland in men the age-adjusted incidence increased from 43 to 57 per 100 000 persons, but in women the age-adjusted incidence decreased from 77 to 353.

Factors that predispose falls
Risk factors for falls can be non-modifiable or modifiable and usually falls occur as a result of an interaction of multiple risk factors. The risk factors can be categorised into four main categories:

  1. behavioural (e.g. multiple medications, footwear, alcohol abuse, inactivity)
  2. environmental (e.g. accessibility),
  3. biological (e.g. age, gender, race, illnesses and physical/cognitive and affective decline incapacity)
  4. socioeconomic (e.g. low income, low education level, lack of social interactions, limited access to health and social services and lack of community resources)6.

Scientific evidence behind falls prevention
There is strong evidence that supports multicomponent and multifactorial approach in falls prevention interventions1. However, there has been a lack of evidence on if falls prevention programmes are also effective in preventing fall-induced injuries in addition to preventing falls.

In a very recent Finnish study a multifactorial centre-based Chaos Clinic Falls Prevention Programme was effective in decreasing falls as well as fall-induced injuries of home-dwelling older adults by up to 30% (n=1314)5. For the intervention group the multifactorial Chaos falls prevention programme included individually tailored measures such as strength and balance training, medical review and referrals, medication review, proper nutrition (calcium, vitamin D), and home hazard assessment and modification. The control group received a general injury prevention brochure5.

Because of the multifactorial setting it is not possible to draw conclusions on which components were the most important in preventing falls and fall induced injuries5. Though, it has been established that exercise interventions can prevent falls in community-dwelling elderly2, it also seems likely that at least exercise interventions could prevent fall-induced fractures2. In the Chaos Clinic study no statistically significant difference was seen in number of fractures in the intervention and control groups, however a trend was seen favouring the multifactorial prevention programme5.

Recommended contents of falls prevention
Attention in falls prevention programmes should be directed especially to environmental adaptation and modification, physical training as well as management of other medical problems like visual deficits, postural hypotension and reduction of medications1. The exercise component of the prevention program should include resistance (strength), balance, coordination, gait and transfer training. Endurance and flexibility training can be recommended, but only as part of more extensive program1. It was also concluded in the Updated Clinical Practice Guidelines for Prevention of Falls in Older Persons that the most positive trials had used exercise programs that lasted three months or longer and the training frequency varying between 1-3 times a week1.

PhysioTools is a valuable tool in falls prevention
PhysioTools offers exercise modules that are specifically for falls and fracture prevention. There is also several other modules that are extremely useful when putting together individual programmes aiming at fall and fall-induced injury prevention. PhysioTools modules include all exercise aspects advised for a falls prevention programmes. Suggested modules are:

–          Balance & Falls Prevention by Gerd Laxåback
–          Falls Prevention with Pulley Equipment by HUR Ltd
–          Fitness Training for Falls Prevention by Gerd Laxåback
–          Fracture Prevention by Oulu Deaconess Institute
–          Rollator Walker – Functional and Balance Exercises by PhysioTools
–          55+ Gym Training by UKK Instituutti
–          55+ Motor Control & Balance by UKK Instituutti
–          Managing at Home by PhysioTools
–          There are also several aquatic therapy modules

References
1)     American Geriatrics Society and British Geriatrics Society. Summary of the Updated Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc 2010 Available: http://www.ncbi.nlm.nih.gov/pubmed/21226685, Accessed 12.8.2014.
2)     Franco, Pereira, Ferreira. Exercise Interventions for preventing falls in older people living in the community. Br J Sports Med 2014 48: 867-868.
3)     Korhonen, Kannus, Niemi, Palvanen, Parkkari. Fall-induced deaths among older adults: Nationwide statistics in Finland between 1971 and 2009 and prediction for the future. Injury, Int J Care Injured 2013 44: 867–871.
4)     Korhonen, Kannus, Niemi, Parkkari, Sievänen. Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011. Age and Ageing 2014; 43: 567–571.
5)     Palvanen, Kannus, Piirtola, Niemi, Parkkari, Järvinen. Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomised controlled trial. Injury, Int. J. Care Injured 2014: 45; 265–271.
6)     World Health Organization. WHO global report on falls prevention in older age. Ageing and Life Course, Family and Community Health. WHO 2007 Available: www.who.int/ageing/publications/Falls_prevention7March.pdf, Accessed 12.8.2014.

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