Summary of findings 6. Summary of findings: walking programme (general physical activity) versus control (e.g. usual activities).

General physical activity (including walking) training versus control (e.g. usual activities) for preventing falls in older people in the community
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 = general physical activity (including walking) 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 (general physical activity [including walking])
Rate of falls (falls per person‐years) Follow‐up: range 12 to 24 months	All studies population		Rate ratio 1.14 (0.66 to 1.97)	441 (2 RCTs)	⊕⊝⊝⊝d very low	The evidence is of very low certainty, hence we are uncertain of the findings of an increase of 14% (95% CI 34% reduction to 97% increase) 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 may be 969 (95% CI 561 to 1675) compared with 850 in the group receiving usual care or attention control
	850 per 1000c	969 per 1000 (561 to 1675)
	Specific exercise population
	670 per 1000c	764 per 1000 (443 to 1320)
Number of people who experienced one or more falls Follow‐up: range 12 to 24 months	All studies population		RR 1.05 (0.71 to 1.54)	441 (2 RCTs)	⊕⊝⊝⊝f very low	The evidence is of very low certainty, hence we are uncertain of the findings of an increase of 5% (95% CI 29% reduction to 54% increase) 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 may be 504 (95% CI 341 to 740) compared with 480 in the group receiving usual care or attention control
	480 per 1000e	504 per 1000 (341 to 740)
	Specific exercise population
	374 per 1000e	393 per 1000 (266 to 576)
Number of people who experienced one or more fall‐related fractures	All studies population		RR 0.66 (0.11 to 3.76)	97 (1 RCT)	⊕⊝⊝⊝h very low	The evidence is of very low certainty, hence we are uncertain of the findings of a reduction of 34% (95% CI 89% reduction to 276% increase) 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 43 (95% CI 7 to 241) compared with 64 in the group receiving usual care or attention control
	64 per 1000g	43 per 1000 (7 to 241)
Adverse events	See comment		Not estimable	See comment	‐	This outcome was not reported
*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, physical activity is any movement of the body, produced by skeletal muscle, that causes energy expenditure to be substantially increased. Recommendations regarding intensity, frequency and duration are required in order to increase performance. Exercise programmes included in this analysis had general physical activity (including walking) training as the single primary exercise category; these exercise programmes 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.
 ^cThe 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 in the two RCTs.
 ^dDowngraded by three levels due to inconsistency (there was substantial heterogeneity (I² = 67%)), imprecision (wide CI), and risk of bias (removing studies with high risk of bias on one or more items had a marked impact on results).
 ^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 in the two RCTs.
 ^fDowngraded by three levels due to inconsistency (there was moderate heterogeneity (I² = 50%), imprecision (wide CI), and risk of bias (removing studies with high risk of bias on one or more items had a marked impact on results).
 ^gThe 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 in the only RCT, the assumed risk in the control group was 84 per 1000.

^hDowngraded three levels due to risk of bias and imprecision (single study, wide CI).