Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and Meta-Analysis

Abstract

Objective: To determine the effect of exercise interventions on fear of falling in Community-Living people aged ≥65. Design: Systematic review and Meta-Analysis. Bibliographic databases, trial registers and other sources were searched for randomised or Quasi-Randomised trials. Data were independently extracted by pairs of reviewers using a standard form. Results: Thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n=9); balance training (n=19); strength and resistance training (n=8)). The risk of bias was low in few trials. Most studies were from High-Income countries (Australia=8, USA=7). Intervention periods (<12 weeks=22; 13-26 weeks=7; >26 weeks=7) and exercise frequency (1-3 times/week=32; =4 times/week=4) varied between studies. Fear of falling was measured by Single-Item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-Analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately Post-Intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; Low-Quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months Post-Intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)). Conclusions: Exercise interventions probably reduce fear of falling to a small to moderate degree immediately Post-Intervention in Community-Living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-Quality trials are needed to strengthen the evidence base in this area.