Summary of findings 2. Summary of findings: balance and functional exercises versus control (e.g. usual activities).
| Balance, and functional exercises versus control (e.g. usual activities) for preventing falls in older people in the community | ||||||
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Patient or population: Older people living in the community (trials focusing on people recently discharged from hospital were not included) Settings: Community, either at home or in places of residence that, on the whole, do not provide residential health‐related care Intervention: Exercise, type = gait, balance, and functional (task) traininga Comparison: Usual care (no change in usual activities) or a control (non‐active) interventionb | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Exercise (gait, balance, and functional [task] training) | |||||
| Rate of falls (falls per person‐years) Follow‐up: range 3 to 30 months | All studies population | Rate ratio 0.76 (0.70 to 0.81) | 7920 (39 RCTs) |
⊕⊕⊕⊕d high | Overall, there is a reduction of 24% (95% CI 19% to 30%) in the number of falls Guide to the data based on the all‐studies estimate. If 1000 people were followed over 1 year, the number of falls would be 646 (95% CI 595 to 689) compared with 850 in the group receiving usual care or attention control |
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| 850 per 1000c | 646 per 1000 (595 to 689) | |||||
| Specific exercise population | ||||||
| 930 per 1000c | 707 per 1000 (651 to 754) | |||||
| Number of people who experienced one of more falls Follow‐up: range 3 to 24 months |
All studies population | RR 0.87 (0.82 to 0.91) | 8288 (37 RCTs) |
⊕⊕⊕⊕d high | Overall, there is a reduction of 13% (95% CI 9% to 18%) in the number of people who experienced one or more falls. Guide to the data based on the all‐studies estimate. If 1000 people were followed over 1 year, the number of people who experienced one or more falls would be 418 (95% CI 394 to 437) compared with 480 in the group receiving usual care or attention control |
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| 480 per 1000e |
418 per 1000 (394 to 437) |
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| Specific exercise population | ||||||
| 549 per 1000e | 478 per 1000 (451 to 500) | |||||
| Number of people who experienced one or more fall‐related fractures. Follow‐up: range 6 to 30 months |
All studies population | RR 0.44 (0.25 to 0.76) | 2139 (7 RCTs) |
⊕⊕⊝⊝g low | Overall, there may be a reduction of 56% (95% CI 24% to 75%) in the number of people who experienced one or more fall‐related fractures Guide to the data. If 1000 people were followed over 1 year, the number of people who experienced one or more fall‐related fractures may be 29 (95% CI 16 to 49) compared with 64 in the group receiving usual care or attention control |
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| 64 per 1000f | 29 per 1000 (16 to 49) | |||||
| Adverse events | See comment | Not estimable | 4167 (15 RCTs) |
⊕⊝⊝⊝h very low | Adverse events were reported on in 15 of the 48 trials with gait, balance, and functional (task) training as the primary intervention in exercise versus control analyses in trials. Adverse events were reported for both intervention and control groups (11 trials) or just the intervention group (4 trials). 200 adverse events were reported; most were non‐serious adverse events of a musculoskeletal nature; 173 were in a single study including 2 intervention groups. Other adverse events included shortness of breath in 4 participants; and 1 participant with palpitations. One study reported a pelvic stress fracture in an intervention group | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aUsing Prevention of Falls Network Europe (ProFaNE) taxonomy, gait, balance, and functional [task] training is: gait training = specific correction of walking technique, and changes of pace, level and direction; balance training = transferring bodyweight from one part of the body to another or challenging specific aspects of the balance systems; functional training = functional activities, based on the concept of task specificity. Training is assessment‐based, tailored and progressed. Exercise programs included in this analysis contained a single primary exercise category (gait, balance, and functional [task] training); these exercise programs may also include secondary categories of exercise. bA control intervention is one that is not thought to reduce falls, such as general health education, social visits, very gentle exercise, or 'sham' exercise not expected to impact on falls. c The all‐studies population risk was based on the number of events and the number of participants in the control group for this outcome over the 59 all‐exercise types RCTs. The specific exercise population risk was based on the number of events and the number of participants in the control group for this outcome over the 39 RCTs. dWe did not downgrade for risk of bias, as results were essentially unchanged with the removal of the trials with a high risk of bias in one or more items. eThe all‐studies population risk was based on the number of events and the number of participants in the control group for this outcome over the 63 all‐exercise types RCTs. The specific exercise population risk was based on the number of events and the number of participants in the control group for this outcome over the 37 RCTs.
fThe all‐studies population risk was based on the number of events and the number of participants in the control group for this outcome over the 10 all‐exercise types RCTs. Based on the number of events and the number of participants in the control group for this outcome over the seven RCTs, the assumed risk in the control group was 43 per 1000. gDowngraded by two levels due to risk of bias (removing studies with high risk of bias on one or more items had a marked impact on results), and imprecision (few events and wide CI due to small sample size). hDowngraded by three levels due to limitations in design of studies, suggesting a high likelihood of bias (no trials in this analysis measured the number of participants experiencing adverse events in both groups throughout the trial period).