Strength training in older adults has been shown to be effective in reducing falls in many individual studies, but what does a systematic review tell us?
Falls are the second most common cause of accidental death worldwide, with a large proportion of them occurring among the elderly. Therefore, understanding how the risk of falls can be reduced is critical to protect our vulnerable older adults.
Learn to prevent falls with Chris Tuckett
Various forms of exercise are used to reduce the risk of falls, and although there are hundreds of high quality studies investigating this, no consensus has yet been reached on the benefits of strength training for the risk of falls.
A new systematic review published in the Journal of Medicine aims to assess the effects of strength training (ST) compared to alternative multimodal or
unimodal training programs on the number of falls in older adults (≥60 years .) and help us to reach a consensus.
Methods
This systematic review was pre-registered on PROSPERO and followed the PRISMA guidelines, both of which indicate good methodological rigor. The PICOS used for the search strategy is also completely available, which increases the quality of the overview.
Studies published in peer-reviewed journals were eligible without language or date restrictions. Inclusion criteria were based on PICOS and are as follows:
P : 60+ years old, shared apartment, residential or nursing home or hospital as well as people who live and do not live with frailty
I : Strength training without combination with other exercises
C : Non-exercise controls or multimodal or unimodal exercise interventions
O : Fall risk measured as number of falls or fall rate
S : Supervised RCTs
A total of ten databases were searched, including CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, Pubmed, Scielo, Scopus, SPORTDiscus and WoS. The search strategy is complete and appears logical and robust.
A manual literature search was also carried out, along with the search criteria and the list of studies, were sent to seven experts to suggest further relevant studies.
Three authors carried out the research, and disagreements were resolved through re-analysis until a consensus was reached. The risk of bias was assessed with the Cochranes RoB 2.0 tool. The certainty of evidence was rated GRADE.
Results and clinical implications
A total of five RCTs were suitable for a review, which included 543 participants . All studies were included as a strength training group with different protocols, but all followed the recommendations for training in older adults.
The sessions varied between 1-3x / week with an exercise specification between 1-3 sets of 6-30 repetitions with a duration of 50-60 minutes. The interventions lasted between 84-365 days, with one study having a follow-up period of 3 years.
Brief summary of strength training for fall prevention
Supervised strength training is more likely to reduce falls than unimodal or multimodal training that is not focused on strength
There is too much variability in the training protocols to be able to draw reliable conclusions about the level of benefit
Exercise selection and intensity dosage are critical to the success of strength training programs in older people. Many protocols are sub-therapeutic
The risk of bias was mixed in all of the included studies. One was low risk, two medium risk, and one high risk, with randomization (difficult in these types of studies) and selective reporting the main concerns in all studies. This is because many of the studies did not pre-register a protocol or statistical analysis plan. After a sensitivity analysis it was found that the poor randomization had no influence on the result of the analysis.
The results of the meta-analysis showed that supervised strength training reduced the risk of falling compared to unimodal training units (balance, agility, stretching, tai chi or self-administered), but the results were not statistically significant.
No significant difference was found for the secondary endpoints, which included Barthel, BMD, balance, walking speed and SPPB. Interestingly, one study examined the cost-effectiveness and once a week strength training is -25% cheaper than twice a week less effective training.
There is a wealth of evidence to suggest that strength training is the best strategy to avoid falls in the form of systematic reviews.
