KMCRIC

Exercise for reducing fear of falling in older people living in the community.

Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014 Nov 28;11:CD009848.

Cochrane Systematic review.

To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community.

fear of falling in older people living in the community.

Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.

Many older people are afraid of falling, more so after experiencing a fall. Fear of falling can have a serious impact on an older person's health and life as it often reduces their physical and social activities.
We wanted to find out whether exercise, in the form of a planned, structured, repetitive physical activity aimed at improving physical fitness, helps to reduce fear of falling. Types of exercise interventions include balance training, strength and resistance training and three-dimensional (3D) exercises, such as dance or Tai Chi. Exercise can be provided in various ways. It can involve group sessions where participants are taught in a class by an instructor or individuals may be provided with exercise instruction booklets, DVDs or tapes to enable them to exercise on their own without supervision.
We searched the medical literature up to July 2013 for studies that tested the effects of exercise and reported fear of falling in community-dwelling people (i.e. who live either at home or in places of residence that do not provide nursing care or rehabilitation) aged 65 years and older. The studies compared exercise with no treatment or an alternative intervention, such as education.

Summary of the evidence
We included 30 studies in the review, with a total of 2878 participants whose average age ranged from 68 to 85 years. Most studies recruited mainly women. Twelve studies recruited participants at increased risk of falls and three of these recruited people who also had fear of falling. All of the studies were at some risk of bias mainly because the participants were aware what group they were in. This lack of blinding may have influenced the study results.
We found low quality evidence from 24 studies that exercise interventions result in a small to moderate reduction in fear of falling immediately after the intervention. Some exploratory analyses did not enable us to determine whether this effect differed in different groups of people, such as those at high risk of falling, or with different exercise interventions, such as group or individual exercise. We are very unsure that the effect of exercise on fear of falling is maintained in the next few months after the end of the intervention.
We only included studies that reported fear of falling, therefore the evidence on our other outcomes (occurrence of falls, depression, anxiety and physical activity) is only a small part of the total evidence of the effects of exercise on these outcomes. However, the evidence from nine studies included in our review showing that exercise reduced the risk and number of falls is consistent with the results of another Cochrane review testing the effects of exercise on preventing falls. The evidence on the other outcomes was far less and none of the included studies reported the effects of exercise interventions on activity avoidance or costs.

Conclusion
We concluded that exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. We also concluded that there is not enough evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. We encourage further research on this topic.