Introduction

• Falls are the leading cause of fatal and non-fatal injuries in older adults aged 65 years and older.
• Every year, nearly 3 million fall-related injuries are treated in emergency departments across the U.S.
• Fear of falling, decreased physical activity, and limited community participation are common psychosocial implications associated with falls.

PICO Question

In community-dwelling adults aged 65 years or older is supervised group-based exercise compared to a non-exercise intervention effective in reducing number of falls and fear of falling?

Clinical Case

• Patient is a 71 year-old female living independently in the community with a history of falls.
• Chief complaint is feeling unsteady when walking and increased difficulty getting up from a chair.
• Previous medical history is consistent with hypertension, osteoporosis, and asthma.
• Goals are to improve her strength, balance, and confidence when walking outdoors.
• Patient reports having 3 falls in the past year.
• FES-I: 40/64

Search Strategy

• Databases searched: PubMed, CINAHL, PEDro
• Search Terms: “group exercise” OR “community group exercise” AND “physical therapy” OR “physiotherapy” AND “older adult” AND “falls prevention”
• Inclusion criteria: community-dwelling older adults ambulating independently, intervention consisted of a group-based activity designed/supervised by a health care provider, control group consisted of a non-exercise intervention, outcome measures included reports on number of falls and/or fear of falling, and articles were published between January 2011 through August, 2016.
• Exclusion criteria: disease specific populations (i.e. stroke, Parkinson’s disease, multiple sclerosis), older adults living in a long-term care facility or similar institution, intervention consisting of a group-based activity not designed or supervised by a health care provider, and lack of a non-exercise control group.

Flow Chart

• 469 articles identified (PubMed, CINAHL, PEDro, hand search)
  • 186 duplicates eliminated
    • 283 titles and abstracts screened
      • 262 articles not relevant
        • 21 full text evaluated
          • 16 articles excluded
            • 5 articles included

Results

Clinical Bottom Line

There is inconsistent evidence that supports supervised group-based exercise is more effective compared to a non-exercise intervention in decreasing number of falls and fear of falling in community-dwelling older adults aged 65 years or older.

Limitations

• Group exercise intervention was not standardized across studies.
• Therapists delivering interventions varied across studies.
• Supplemental home exercise programs.
• Non-exercise comparisons varied across studies.
• Majority of outcome measures were based on self-report.
• Not all studies collected data at long-term follow-up.

Application

• Community-dwelling older adults can potentially benefit from physical therapist supervised group-based exercise as a falls prevention intervention.
• Supervised group-based exercise promotes increased physical activity in structured exercise sessions.
• Individuals with multiple comorbidities may also benefit from an individualized intervention delivered in groups with similarly matched impairments to promote a safe environment in the community that allows for both exercise and social interaction.
• Supervised group-based exercise can be a more cost effective falls prevention intervention compared to a traditional individual exercise intervention.
• It is theorized that group-based exercise can promote increased patient satisfaction and exercise adherence.
• The lack of adverse events reported in the evidence suggest that supervised group exercise can be a viable intervention for an individual with a history of falls and fear of falling.

Acknowledgements

Heidi Ojha, PT, DPT, OCS, FAAOMPT

References

1. Halvarsson A, Franzen E, Faren E, Olsson E, Oddsson L, Stahle A. Long-term effects of new progressive group balance training for elderly people with increased risk of falling – a randomized controlled trial. Clin Rehabil. 2013;27(5):450-458. doi: 10.1177/0269215512462908 [doi].

2. Iliffe S, Kendrick D, Morris R, et al. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess. 2014;18(49):vii-xxvii, 1-105. doi: 10.3310/hta18490 [doi].

3. Lee HC, Chang KC, Tsauo JY, et al. Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Arch Phys Med Rehabil. 2013;94(4):606-15, 615.e1. doi: 10.1016/j.apmr.2012.11.037 [doi].

4. Martin JT, Wolf A, Moore JL, Rolenz E, DiNinno A, Reneker JC. The effectiveness of physical therapist-administered group-based exercise on fall prevention: A systematic review of randomized controlled trials. J Geriatr Phys Ther. 2013;36(4):182-193. doi: 10.1519/JPT.0b013e3182816045 [doi].

5. Perula LA, Varas-Fabra F, Rodriguez V, et al. Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: A randomized controlled trial. Arch Phys Med Rehabil. 2012;93(10):1677-1684. doi: 10.1016/j.apmr.2012.03.035 [doi].

For further questions please contact: patricia.garcia@temple.edu