Falls are one of the main concerns for the elderly and their caregivers. In fact, it is estimated that at least 30% of adults over 65 falls at least once a year, and this figure increases up to 50% for those over 80 years (1). These encrypts are especially relevant taking into account that one third of the falls causes moderate or severe serious injuries that require hospitalization, with the consequent impact for both health and social systems (2). In addition, falls suppose the main cause of physical activity restriction in the elderly (3), which contributes even more to their functional decline. Therefore, the prevention of the risk of falls in the elderly should be a priority to ensure healthy aging.
We have more and more evidence that exercise should play a key role in fall prevention programs. For example, a systematic review published in Cochrane analyzed the effectiveness of the main strategies aimed at reducing falls in people over 65. After including more than 150 studies with almost 80,000 participants, the authors concluded that multicomponent exercise interventions (for example, including strength, aerobic and/or balance exercises) were effective in reducing the risk of falls around 29% ( 4). These results go in line with others of a meta-analysis recently published in the prestigious British Journal of Sports Medicine magazine, where after analyzing 108 studies the authors concluded that exercise interventions reduce the risk of falls by 23% (5). In addition, the results showed that while the inclusion of 'functional' and equilibrium exercises reduced the risk of falls by 24%, if strength exercises were added this decrease reached 34% (5).
Exercise interventions are therefore fundamental for the prevention of falls, especially if they include force exercises. And it is that the latter has been one of the greatest predictors of the risk of falls in older people. For example, in a recent study in which we follow up on the elderly (average age of 88 years) we observe that the measurement of the isometric force of knee and even manual grip were better predictors of the risk of falls of falls that other classic tests such as getting up from the chair and walking ('Timed Up and Go Test') (6). Similarly, another study observed that the level of knee extension force predicted the risk of falls in the elderly (as well as a worse performance in equilibrium tests, gear speed and reaction tests) that other factors such as muscle mass or obesity (7).
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Therefore, existing evidence leaves no doubt: if you want to reduce the risk of falls, exercise and improve your strength. We must not forget, however, that there are multiple factors that affect the risk of falls, including both extrinsic factors to the person (household conditions and the surface and the amount of light) and intrinsic. Therefore, interventions aimed at decreasing falls must be multifactorial. In this sense, the aforementioned review that was published in Cochrane concluded that other interventions such as adjusting drugs (for example, reducing the dose of psychotropic drugs), improving the view (for example, operating cataracts) or modifying home safety (especially in people with visual deficits or with a great risk of falls) are also effective in reducing falls, and their implementation must be due to Therefore, as a whole to ensure the greatest effectiveness (4).
References
1. World Health Organization. WHHO GLOBAL REPORT ON FALLS PREVENTION IN OLDER AGE [INTERNET]. Community Health. 2007. Available from: http://www.who.int/ageing/publications/falls_prevention7March.pdf
2. Florence Cs, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriat soc. 2018; 66 (4): 693–8.
3. Rubenstein LZ. Falls in Older People: Epidemiology, Risk Factors and Strategies for Prevention. Ageing Ageing. 2006; 35 (Suppl.2): 37–41.
4. Gillespie L, Robertson M, Gillespie W, Sherrington C, Gates S, Clemson L, et al. Interventions for Preventing Falls in Older People Living in the Community. Cochrane Database Syst Rev. 2012; 9: CD007146.
5. Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff Za, Howard K, et al. Exercise for Preventing Falls in Older People Living in the Community: ABRIDGED Cochrane Systematic Review. Br J Sports Med. 2019; 1–8.
6. Valenzuela P, Maffiuletti N, Saner H, Schütz N, Rudin B, Nerf T, et al. Isometric strength measures are upper to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from A Prospective Cohort Study. Clin Interv Aging. 2020; in press.
7. MENANT JC, WEBER F, LO J, STURNIEKS DL, CLOSE JC, SACHDEV PS, et al. Strength Measures Are Better Than Muscle Mass Mesures in Predicting Health-Related Outcomes in Older People: Time to Abandon The Tercopenia? Osteoporos Int. 2017; 28 (1): 59–70.