Preventing falls in elderly: Exercise is the first line of defense

The decrease in muscle strength and coordination of the lower limbs is a result of natural wear and tear on our bodies, which is accompanied by reduced balance control in walking. Degenerative processes in the nervous and muscular systems lead to instability, and together with age-related losses in cognitive functions, these impairments lead to a higher risk of falls in the elderly. The further consequences of such events are often severe for the individual’s health^1,2.

Immobility is identified as a factor that accelerates the decline of bodily functions, with a negative impact on balance control. Therefore, physical activity has been shown to counteract this effect. Higher levels of physical activity reduce overall morbidity and mortality and fall risk by between 30% and 50%. Leg strength training and balance training in particular have been identified as suitable methods to reduce the risk of falls.

The aim of a systematic review study¹ was to analyze different types of exercise aimed at increasing static balance in older adults and to try to understand which forms of exercise are most beneficial to prevent the risk of falling. Of the studies analyzed, all showed improvements in balance ability after the intervention period with various forms of exercise and have linked increases in muscle strength with increases in balance ability in older adults.

• In research by Lacroix et al (2016), a 6-week resistance exercise protocol in healthy older adults was able to increase balance by up to 68%. Supervision can help older adults perform the exercises with higher quality.
• Another study proposed by Marques et al in 2017 provided both resistance and aerobic exercise to 2 groups of elderly people and found that after the 32-week intervention, both groups increased their ability to balance. The resistance exercise group increased their balance ability during one-leg stand by 25%, while the aerobic group increased balance by about 31%.

81 studies compared the effect of several types of exercise on the number of falls and found that exercise reduced falls over time by 23%.

The effects on falls were similar whether the trials selected people who were at increased risk of falling (eg the elderly, people with Parkinson’s etc.) or not, while a simultaneous increase in strength was observed¹.

Exercise with aerobic and anaerobic components provides positive results along with special balance exercises integrated into the training program. Programs that include and combine multiple types of exercise (balance, functional and resistance exercises) appear to be most beneficial².

In another study on fall prevention through exercise², among other results it was shown that exercise programs could be associated with an eventual reduction in fractures of 27%. Exercise may also reduce the risk of falls requiring medical attention, but not enough evidence was found to determine the effect on the risk of falls requiring hospital admission. Further studies may demonstrate in greater detail and with stronger evidence the role of exercise in preventing falls and their adverse effects at the clinical level.

In summary, it seems that regular physical activity including aerobic, anaerobic and proprioceptive features can improve the static balance in the elderly as a means of reducing future fall risk¹.

1. Thomas, Ewan PhD∗; Battaglia, Giuseppe PhD; Patti, Antonino MSc; Brusa, Jessica MSc; Leonardi, Vincenza MD; Palma, Antonio MD; Bellafiore, Marianna PhD. Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine 98(27):p e16218, July 2019. | DOI: 10.1097/MD.0000000000016218
2. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31;1(1):CD012424. doi: 10.1002/14651858.CD012424.pub2. PMID: 30703272; PMCID: PMC6360922.

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