title: Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment.
  
  
  METHODS
  Two independent reviewers searched MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing & Allied Health Literature; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint, and Muscle Trauma Group Specialized Register; ClinicalTrials.gov; and the UK Clinical Research Network Study Portfolio up to July 2013 without language restriction. We included randomized controlled trials that examined the efficacy of physical exercise in older adults with cognitive impairment. The methodological qualities of the included trials were appraised according to the criteria developed for the Cochrane review of fall prevention trials. The primary outcome measure was the rate ratio of falls. A meta-analysis was performed to estimate the pooled rate ratio and summarize the results of the trials on fall prevention through physical exercise.
  
  
  RESULTS
  Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51-0.91).
  
  
  CONCLUSIONS
  The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population.
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong. Electronic address: waicchan@hku.hk.
authors.forename: Wai Chi
authors.initials: WC
authors.lastname: Chan
authors.affiliation: School of Chinese Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Jerry Wing Fai
authors.initials: JW
authors.lastname: Yeung
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Corine Sau Man
authors.initials: CS
authors.lastname: Wong
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Linda Chiu Wa
authors.initials: LC
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Ka Fai
authors.initials: KF
authors.lastname: Chung
authors.affiliation: Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong.
authors.forename: James Ka Hay
authors.initials: JK
authors.lastname: Luk
authors.affiliation: Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong.
authors.forename: Jenny Shun Wah
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Andrew Chi Kin
authors.initials: AC
authors.lastname: Law
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000534:rehabilitation; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods; D006723:Hong Kong; D006801:Humans; D008297:Male; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Cognitive disorders; accident prevention; accidental falls; dementia; exercise