Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis.
to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65.



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.



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)).



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.
Division of Primary Care, University of Nottingham, Nottingham, UK.
Arun
A
Kumar
NeuRA, University of New South Wales, New South Wales, Australia.
Kim
K
Delbaere
Department of Health Services Research, Maastricht University and CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
G A R
GA
Zijlstra
Division of Primary Care, University of Nottingham, Nottingham, UK.
Hannah
H
Carpenter
Research Department of Primary Care and Population Health, University College London, London, UK.
Steve
S
Iliffe
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Tahir
T
Masud
Institute of Allied Health Research, Glasgow Caledonian University, Glasgow, UK.
Dawn
D
Skelton
Research Department of Primary Care and Population Health, University College London, London, UK.
Richard
R
Morris
Division of Primary Care, University of Nottingham, Nottingham, UK.
Denise
D
Kendrick
D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology*; D005239:Fear / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living / Q000293:injuries / Q000523:psychology*; D008297:Male; D004856:Postural Balance / Q000502:physiology; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
exercise; falls; fear; older people; systematic review