Falls, Exercise and Evidence in Physical Therapy
Does exercise really help reduce falls? As physical therapists, we educate our clients in the importance of exercise daily. Of course, we know that exercise truly does reduce fall risk. Some clients are eager to exercise, experiencing an increase in energy and improved confidence with their mobility and walking. However, others need some convincing to jump on the exercise bandwagon. As a physical therapist, I love to educate my clients in strategies to keep them as independent and active as possible. Utilizing medical research studies provides great evidence to support exercise for independence. Here we will review the correlation between older adults, falls, healthcare and exercise.
According to the Centers for Disease Control and Prevention (CDC), 1 in 3 adults over age 65 years falls each year, in the United States. Almost half of individuals over age 80 fall each year. Falls are the leading cause of injury-related death in this age group. Falls not only impact the independence and quality of life of individuals as they age, but they also are very costly to the healthcare system. According to the CDC, the direct medical costs of falls among older adults in 2013, was $34 billion. Because of an aging population, this figure is likely to continue increasing. The direct costs are calculated by insurance reimbursements for treating fall-related injuries. This does not include the long term costs for future disability, dependence on others, lost work time and lower quality of life. It is estimated that the average hospitalization cost for a fall injury is over $35,000. As therapists, we know that conservative treatment through physical therapy can reduce healthcare costs drastically. It is much less expensive for insurance companies to pay for 12 visits of physical therapy, than to pay for a hip replacement and all the aftercare necessary.
Those staggering statistics can be a bit discouraging for older adults. By educating clients in the modifiable risk factors, they can take an active role in reducing their own fall risk. Research shows that risk factors highly associated with fall risk include: history of falls, balance problems, leg muscle weakness, vision problems, taking more than 4 medications, and difficulty walking. Many of these factors can be significantly reduced through exercise. Exercises should focus on leg strengthening, balance training and flexibility. There are many published medical research studies to support this claim.
In a study systematic review of literature performed by Gillespie et al.(1), 111 clinical trials were reviewed to analyze the efficacy of exercise in reducing fall risk. The authors concluded that exercise interventions reduce both the risk and rate of falling in older adults. In another review of literature, Powers et al.(2) examined what type of exercise has the greatest impact on reducing falls. They found that a program of muscle strengthening and balance training that was individualized to a person’s need (one prescribed by a trained health professional, such as a physical therapist) was highly beneficial. In addition, they found that Tai Chi group exercise was shown to reduce risk of falls, as was participation in a home hazard assessment and modification session. Group exercise classes were beneficial, but not as beneficial as individualized exercise programs. As therapists, we should consider incorporating Tai Chi as part of home exercise programs. Also, we should educate our patients in home safety strategies to reduce environmental hazards.
In another systematic review of the published literature, 54 trials were analyzed by Sherrington et al.(3), and found that exercise was the single best intervention to prevent falls. This study noted that the exercise program must challenge the balance and improve muscle strength through resistance training. The exercise program should be progressive and individualized to the client’s needs and limitations.
The main learning points of these research reviews are that the exercise programs must be tailored to individual limitations. If the client has limited strength in their hip flexors and trunk, then they will not be able to properly elicit a hip strategy to maintain balance. Therefore, the exercise program should focus on strengthening those areas of weakness. In addition, the client’s balance improves, you will need to progress the difficulty of the exercise for continued improvement. These strategies all seem like common sense to an experienced clinician. However, sometimes patient’s need to see the proof that therapy can improve their safety and independence as they age.
As therapists, we must be our own advocates. The physical therapist is a vital component of the healthcare team. We are the most capable healthcare experts to reduce the risk of falls in aging adults, through a thorough evaluation and treatment plan. We should empower our clients with a comprehensive and easy to follow home exercise program, in order to further improve their confidence and independence after completion of physical therapy. So, next time you have a client that is not a believer, show him the evidence that exercise truly does reduce fall risk.
Utilization of outcome measurement tools, functional mobility tasks and simple examination components such as single leg balance, and tandem stance are excellent means of demonstrating improvement in physical performance and reduced fall risk. Through utilization of bestPT software, we can easily document objective measures and compare pre and post intervention outcomes. These improvements can be easily faxed, printed and shared with our clients and their other healthcare providers. You will be able to turn skeptics into therapy believers.
Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
- Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;(2): CD007146.
- Powers C, Farrokhi S, Moreno J. Can exercise reduce the incidence of falls in the elderly, and, if so, what form of exercise is most effective? Physical Therapy. 2002 Nov vol 82; no 11; 1124-1130.
- Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011 Jun;22(3-4): 78-83.
