June 2017

Forward progress on falls: Studies explore risk factors, intervention

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By Jordana Bieze Foster

The multiple factors that contribute to the risk of falls in older adults present a complicated clinical puzzle, but researchers are making progress on putting some of those pieces together, as evidenced by several studies presented in late May and early June at the American College of Sports Medicine (ACSM) annual meeting in Denver.

Presented findings suggest walking aids and arthritis can affect risk of falling in some older adults, and that strength and balance as risk factors may be age-dependent. And though researchers don’t yet fully understand every aspect of the various risk factors that can contribute to falling, evidence also suggests that a multimodal, high-intensity exercise program addresses enough of those factors to significantly improve the risk of falling in sedentary older adults after just four weeks.

Researchers from New Mexico State University in Las Cruces analyzed the percentage of the gait cycle spent on propulsion—which tends to be higher in individuals with a history of falls—in 254 adults older than 60 years, 90 of whom reported having fallen in the previous year.

In the group of nonfallers, individuals who used a walking aid (such as a cane or walker) or self-reported a diagnosis of arthritis spent significantly longer in propulsion than other nonfallers. However, these variables did not affect time in propulsion for those with a history of falls.

“Interventions to improve percentage of time in active propulsion may include balance training, strength training, and mobility training,” said Eryn Murphy, MS, CSCS, an instructor in the Department of Kinesiology and Dance, who presented her group’s findings at the ACSM meeting.

Interventions to improve balance and reduce the risk of falls in older adults often involve strengthening exercises, but research from the Shanghai University of Sport in China suggests that strength and balance decline at different ages.

Investigators analyzed performance on clinical tests of strength and balance in 48 women aged between 60 and 89, who were subdivided into three age groups: younger than 65 years, 65 to 74 years, and 75 years and older.

Although only the oldest group demonstrated declines in hand strength, mediolateral sway with eyes closed declined in both of the two oldest groups; most of the other variables assessed, including lower extremity strength, decreased linearly with increasing age. Upper and lower extremity strength were significantly correlated with dynamic balance (assessed using the Timed Up and Go test) but not with static postural sway measures.

“Different exercises may be needed at different ages,” said Yuanyuan Tian, a researcher in the university’s department of physiotherapy, who presented her group’s findings at the ACSM meeting.

In developing an intervention to reduce the risk of falls in older adults, Italian researchers reported at the ACSM meeting that they have been successful using a multimodal approach rather than trying to address individual risk factors.

Investigators from Catholic University Sacred Heart in Rome randomized 30 sedentary adults aged 70 years and older, defined as being at high risk for falls according to the Berg Balance Scale (BBS), to four weeks of an exercise intervention or to a control group.

Those in the intervention group exercised three times a week for 75 minutes per session. The program emphasized dual-task performance, balancing on foam mats under different conditions, and strength training using free weights and elastic bands.

After the training, the intervention group had improved from 10.9% to 23.8% compared with baseline on all six components of the Balance Evaluation Systems Test, and all were considered no longer at risk for falling based on BBS score. The control group demonstrated no changes.

Sources:

Murphy E, Keeley DW, Wood R. Walking aid use and arthritis: Impact on time spent in active propulsion in older adults. Med Sci Sports Exerc 2017;49(5 Suppl 1):S131.

Tian Y, Han J, Zhu J, et al. Limb strength and balance in community-dwelling older women. Med Sci Sports Exerc 2017;49(5 Suppl 1):S512-S513.

Sgadari A, Martina A, Battaglioli A, Burnabei R. Effects of a short, intensive, multi-component physical exercise program in the elderly at risk of falls. Med Sci Sports Exerc 2017;49(5 Suppl 1):S513.

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