Pictured: Dr. Teresa Liu-Ambrose in her lab at the Djavad Mowafaghian Centre for Brain Health.
An in-home exercise program reduced subsequent falls in high-risk seniors by 36 per cent, according to the results of a 12-month clinical trial published today in the Journal of the American Medical Association. The study, conducted in partnership with clinical teams at the Falls Prevention Clinic at Vancouver General Hospital, found a reduction in fall rate and also a small improvement in cognitive function.
Falls increase risk of injury and loss of independence for older adults. Exercise is widely recommended as a fall prevention strategy, but whether it can reduce subsequent falls in those who have previously fallen is not well established. Risk factors for falls include reduce physical capacities, such as muscle strength, but also cognitive abilities.
“When we think about falls we often think about loss of muscle strength and poor balance,” said Dr. Teresa Liu-Ambrose, an investigator with the Vancouver Coastal Health Research Insitute and Professor in the Department of Physical Therapy at UBC. “However, the ability to remain upright and not fall is also dependent on cognitive abilities—calculating how far to lift your foot to get over a curb, making a decision as to when to cross the road, and paying attention to your physical environment while you are having a conversation.”
The study engaged adults aged 70 years and older who had been referred to the Falls Prevention Clinic following a fall that resulted in a visit to a medical facility such as an emergency room. Participants had a history of falls, with an average of three prior falls per person. Participants were living in the community and generally had symptoms of frailty and limited mobility; the study intervention was for participants to perform a set of balance and resistance training exercises in the comfort of their homes, using simple equipment such as free weights.
Participants in the 12-month study performed modified activities from the Otago Exercise Programme, a program of balance and muscle re-training exercises that can be tailored by a physical therapist to an individual’s skill level. Over the course of six months, a physical therapist would make five home visits to prescribe exercises, ensure that exercises were done properly, and progress participants through the exercises. People were encouraged to perform the prescribed exercises in their own homes a minimum of three times per week. For those who completed the program, the results were notable; people were less likely to experience repeat falls, and as a secondary benefit, they improved in some markers of cognitive function.
The benefits of fall reduction in older adults are wide-ranging. Falls in older adults are the third-leading cause of chronic disability. According to the Public Health Agency of Canada, 20 to 30 percent of Canadian seniors suffer falls each year, and falls are the leading cause of hospitalization for adults over age 65. Older adults who experience multiple falls can experience increased frailty and loss of independence and impaired quality of life. Reducing secondary falls—falls after referral to specialist care—and improving mobility for older adults is an urgent public health priority.
“It is well known that exercise benefits older people in general, but what was special about this study group was that they are at very high-risk for losing their independence—they had both mobility and cognitive impairments and another fall may leave then unable to continue to live in their own homes. Many already had difficulty navigating public spaces independently,” said Dr. Liu-Ambrose, who holds a Canada Research Chair in Aging, Physical Activity, and Cognitive Neuroscience. “Older adults who experience falls that require medical attention are medically complex and at high risk for both morbidity and mortality, and we demonstrated that exercise is a practical and cost-effective intervention that can improve older peoples’ outcomes after a significant fall.”
The next step for Dr. Liu-Ambrose and her team is to look at whether the exercise program resulted in reduced healthcare utilization and medical cost savings in this high-risk population.
“We’re grateful to the Vancouver Coastal Health clinical teams—the geriatricians and physical therapists—who assisted in this study,” said Dr. Liu-Ambrose. “This particular study depended greatly on the commitment of geriatricians; they engaged in the research and gave us their time, and as a result the study participants saw value in their experience beyond the benefits of participating in the study alone.”