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. 2008 Oct 1;8(2):1–78.
Study Population Intervention and Referent Group Intensity (No. Times/Week) Targeted or Untargeted Follow-Up Outcomes Measured Results
Gillespie: Cochrane Review (2003) (44)

  • Elderly

  • RCTs

  • Community-dwelling

 Exercise alone vs. control Varied

  1. Untargeted

  2. Targeted (strength, balance, training)

  3. Targeted (strength)

 Varied Number of falls Meta-analysis results:

  1. RR, 0.89 (0.79–1.01)

  2. RR, 0.80 (0.66–0.98)

  3. RR, 0.92 (0.73–1.16)
       

  1. Individually targeted

 Varied Number sustaining injury fall Meta-analysis results:

  1. RR, 0.67 (0.51–0.89)
       

  1. Untargeted

  2. Targeted

 Varied Number sustaining 2 or more falls Meta-analysis results:

  1. RR, 0.78 (0.52–1.18)

  2. RR, 0.76 (0.54–1.05)
Barnett (2003) (152)

  • Aged 65+

  • High risk

 Exercise (balance, coordination, strength, tai chi) vs. control 37 classes over 1 year
1 h		 Untargeted, Group and Home 12 months Falls, fear of falling, fall injuries No difference in fear of falling at 6 months Falls:

  • IRR, 0.60 (0.36–0.99)

  • ≥1 fall RR, 0.71 (0.49–1.04)

  • ≥2 fall RR, 0.44 (0.21–0.96)


Fall injuries – no difference:

  • IRR, 0.66 (0.38–1.15)

  • ≥1 fall RR, 0.77 (0.48–1.21)

  • ≥2 fall RR, 0.58 (0.22–1.52)
Day (2002)† (153)

  • Aged 70+

 Strength and balance (n=135) vs. control (n=137) 1x/week for 15 weeks 1h Daily home exercises Untargeted, group and home 18 months Number of falls

  • RR, 0.82 (0.70–0.97)

  • % reduction in annual fall rate: 6.9 (1.1–12.8)
Freiberger (2007) (154)

  • Aged 70+

 Psychomotor intervention vs. fitness intervention (strength, endurance, flexibility) vs. control 2x/week for 16 weeks 1h
Practice at home daily		 Untargeted, Group and home (unsupervised) 12 months Number falls, fallers, multiple fallers Fitness Intervention:

  • No. of fallers: RR, 0.77 (0.60–0.97)

  • Multiple fallers and number falls: RR, not significant


Psychomotor intervention:

  • No outcomes significant


Time to first fall:

  • Psychomotor: 281 ± 16 days

  • Fitness: 337 ± 9 days

  • Control: 216 ± 15 days
Hauer (2001) (155)

  • Women

  • Aged 75–90

  • High risk

  • Past fall

  • Recruited from rehab ward

 Resistance and balance training vs. placebo activity (flexibility, calisthenics, ball games, memory tasks) 3 days/week for 12 weeks 1.5 h resistance 45 min balance Untargeted, Group 6 months falls

  • No difference:

  • RR, 0.75 (0.46–1.25)
Helbostad (2004) (156)

  • Aged 75+

  • High risk (fall or use of walking aid)

 Home-based (HT) exercise vs. group exercise (CT) HT: Daily home exercises + 3 group meetings CT: 2x/wk for 12 weeks (1hr) + same home exercises as HT group daily Targeted vs. untargeted, Group vs. home 1 year Number of falls

  • No significant difference in number of falls (P = .78)
Latham (2003) (157)

  • Frail

  • Mean age 79

 Quadriceps exercise program (home) vs. regular home and telephone support 3/week for 10 weeks Targeted, Home 10-week intervention plus 6-month follow-up Falls, time to first fall Falls outcome:

  • RR, 0.96 (0.67–1.36) Time to first fall:

  • HR, 0.97 (0.68–1.37)
Li (2005) (158)

  • Aged 70+

  • Inactive

 Tai chi intervention vs. stretching control 3x/week for 6 months (both intervention and control) Untargeted, Group After intervention, and 6 months postintervention Number of falls, injurious falls, fear of falling After intervention

  • RR moderate injurious falls, 0.31 (0.12–0.84)

  • RR severe falls, 0.28 (0.09–0.86)

  • Significant increase in time to first fall (P = .007)

  • HR falls, 0.46 (0.26–0.80), P = .006

  • HR multiple falls, 0.45 (0.30– 0.70), P < .001

  • Fear of falling significantly reduced (P = .05)

  • Improvements maintained during the postintervention follow-up
Luukinen (2006) (159)

  • Aged 85+

  • High risk (recurrent falls or other risk factor)

 Individual exercise plan (could be home or group-based) based on risk factors (low-intensity) vs. control (no exercise plan) Varied Targeted, group, and home depending on assessment Median 16 months’ intervention Falls Entire group:

  • HR for first 4 falls and for all falls, not significant


Subgroup: able to move outdoors:

  • HR first 4 falls, 0.72 (0.59–0.88)

  • HR all falls, 0.83 (0.69–1.00)
Means (2005) (160)

  • Mean aged 73.5 years

 Balance training (stretching, postural control, endurance) vs. control (attended seminars on non-health-related topics) 1x/week 6 weeks Untargeted, Group (6–8 people) 6 months postintervention Falls, fall-related injuries

  • Pre/post analysis:

  • Exercise group had fewer falls and fall-related injuries (P = .002 and .034).

  • No difference in control group pre/post
Robertson (2001)† (161)

  • Aged 75+

 Exercise program vs. control Exercise at least 3x/week, walk 2x/week; 30 min For 1 year Targeted, home 1 year Number of falls, number injuries from falls

  • IRR for fall, 0.54 (0.32–0.90), P = .019

  • RR serious injury due to fall (control vs. intervention), 4.6 (1.0–20.7), P = .033

  • Age stratification:

  • 80+: significant fall reduction, P < .001

  • 75–79: no significant reduction
Rubenstein (2000) †(162)

  • Men

  • Aged 70+

  • High risk

 Exercise (strength, endurance and balance) vs. control 3x/week for 12 weeks 1.5 h Untargeted, group 12 weeks Falls, self-rated health

  • Higher self-rated global health (P = .005)

  • 6 falls/1000 h of activity vs. 16.2 falls/1000 h of activity, P = .027
Skelton (2005) (163)

  • Women

  • Aged 65+

  • High risk (≥3 falls in past year)

 Falls management exercise (group and home) vs. regular home exercises 36 weeks of class Group: 1/week for 1 h
Home: 2/week for 30 minutes		 Targeted, Group, and Home (unsupervised) 36-wk intervention plus mean 49.7-wk follow-up Falls, injurious falls, died/LTC home/hospital

  • Whole trial period: IRR, 0.69 (0.50–0.96), P = .029

  • Follow-up only (after intervention completed: IRR, 0.46 (0.34–0.63)

  • No difference for injurious falls (possibly due to lack of power)

  • Significant difference in # deaths or LTC home admission or hospital admission: P = .017
Suzuki (2004) (100)

  • Women

  • Aged 73–90

  • Participants in Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging

 Exercise (tai chi, strength, balance, resistance) vs. control Group: 1 h every 2 weeks for 6 months
Home: 3/wk for ~30 minutes		 Untargeted, Group and Home (unsupervised) 8 and 20 months falls

  • Proportion with fall: 54.5% in controls vs. 13.6% in intervention group, P < .05 at 20-month follow-up

  • No difference at 8-month follow-up
Voukelatos (2007) (164)

  • Aged 60+

  • Recruited in community

 Tai chi vs. control 1 time/week for 16 weeks 1 hour Untargeted, Group 4 and 6 months Falls, ≥1 fall, ≥2 falls

  • IRR # falls, 0.67, P = .02

  • HR ≥1 fall, 0.66, P = .02

  • HR ≥2 falls, 0.27, P = .001
Weerdesteyn (2006) (111)

  • Aged 65+

  • High risk (history of falls)

 Nijmegen Falls Prevention Program: low-intensity exercise vs. control 2x/week for 5 weeks 1.5 h Untargeted, Group Unclear Falls

  • IRR fall incidence rate, 0.54 (0.34–0.86)

  • IRR number falls, 1.26 (0.60–2.64)


*note: not completely randomized
Woo (2007) (165)

  • Aged 65–74

  • Recruited in community

  1. Tai chi

  2. Resistance exercise

  3. Control

 3 times/week for 12 months Untargeted, Group 6 and 12 months Falls

  • No difference
*

HR refers to hazard ratio; IRR, incidence rate ratio; RCT, randomized controlled trial; RR, relative risk.

†

Also identified in Cochrane review