title: Exercise to prevent falls in older adults: an updated systematic review and meta-analysis.
abstract: OBJECTIVE
  Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects.
  
  
  METHODS
  Update of a systematic review with random effects meta-analysis and meta-regression.
  
  
  METHODS
  Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016.
  
  
  METHODS
  We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group.
  
  
  RESULTS
  99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I247%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I265%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I221%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital.
  
  
  CONCLUSIONS
  Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: Zoe A
authors.initials: ZA
authors.lastname: Michaleff
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fairhall
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Serene S
authors.initials: SS
authors.lastname: Paul
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Tiedemann
authors.affiliation: Clinical Age Research Unit, King's College Hospital, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Whitney
authors.affiliation: School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Herbert
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia.|Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Jacqueline C T
authors.initials: JCT
authors.lastname: Close
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D060825:Cognitive Dysfunction / Q000628:therapy; D015444:Exercise; D005081:Exercise Therapy; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy; D004856:Postural Balance; D016032:Randomized Controlled Trials as Topic
keywords: Aging/ageing; Exercise rehabilitation; Fall