Lower limb muscle strengthening exercises can reduce the risk of falls in older adults.

Ishigaki EY, Ramos LG, Carvalho ES, et al. Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: A systematic review Braz J Phys Ther. 2014;18(2):111-118.

Review question

Do lower limb muscle strengthening exercises help to reduce the risk of falls in the elderly?

Background

Falls are a serious health and safety concern for the elderly, and lead to an estimated 424,000 deaths around the world each year. Recent research suggests that balance training exercises and lower limb muscle strengthening exercises can reduce the risk of falls, and improve mobility and functioning in everyday activities. It is difficult to find specific guidelines that provide detailed instructions for balance and lower limb muscle strengthening exercises aimed at preventing falls.

How the review was done

The researchers did a systematic review of 12 randomized and controlled clinical trials published between 2002 and 2012.

A total of 3795 elderly adults were included in the studies (3260 from the community, 96 from hospitals, and 439 from aged-care facilities).  Participants were placed in exercise or control groups.

Key features of the studies were:

• Studies lasted on average 6 months and exercise sessions occurred on average two and a half times per week
• Participants self-reported their falls. 75% of the studies used a monthly calendar to record any falls, and 25% reported any falls directly to a nurse or study researchers
• Two different types of lower limb muscle strengthening exercises were studied: 4 studies focused on muscle load training exercises (e.g using ankle weights); 8 studies focused on functional exercises (e.g. repeating sit-to-stand movements, or climbing up-and-down steps)
• Studies compared the number of falls of participants in the exercise groups to people in the control groups

What the researchers found

All four of the studies assessing muscle load training exercises reported decreases in the number of falls, ranging from 25% to 75% fewer falls compared to the control groups. As well, 6 out of the 8 studies assessing functional exercises reported a reduction in falls while two did not.

Many of the studies combined muscle load training exercises with functional exercises, balance training, activities of daily living exercises, gait training and muscle stretching, so it is unknown what the independent effect of muscle load exercises and/or functional exercises have on falls prevention. It may be that strategies that impact multiple components associated with falls prevention are needed to reduce the risk of falls. Future studies describing how often a muscle load activity should be repeated in a week, and how long each exercise session should be done are recommended.

Conclusion

Lower limb muscle strengthening exercises can reduce the number of falls in the elderly.