Abstract
Previous meta-analyses have found exercise as a single intervention prevents falls in older people. This updated systematic review with random effects meta-analysis and meta-regression aimed to test whether this effect is still present when new trials are added and explore trial characteristics associated with greater fall prevention effects. One hundred comparisons from 89 randomised trials with 19,869 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I2 47%, 67 comparisons) with greater effects seen from exercise programs that challenged balance and involved more than three hours per week of exercise. Together these variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (IRR 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson’s disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I2 21%, 3 comparisons) but not in residential care settings or among stroke survivors, people with severe visual impairment or people recently discharged from hospital. Exercise as a single intervention can prevent falls in community dwelling older people, promising results are seen in people with Parkinson’s disease or cognitive impairment but its impact in other clinical groups and aged care facility residents requires further investigation.