Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis

Kathryn M Sibley; Sonia M Thomas; Areti Angeliki Veroniki; Myanca Rodrigues; Jemila S Hamid; Chantelle C Lachance; Elise Cogo; Paul A Khan; John J Riva; Kednapa Thavorn; Heather MacDonald; Jayna Holroyd-Leduc; Fabio Feldman; Gillian D Kerr; Susan B Jaglal; Sharon E Straus; Andrea C Tricco

doi:10.1016/j.exger.2020.111151

Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis

Exp Gerontol. 2021 Jan:143:111151. doi: 10.1016/j.exger.2020.111151. Epub 2020 Nov 10.

Authors

Kathryn M Sibley¹, Sonia M Thomas², Areti Angeliki Veroniki³, Myanca Rodrigues⁴, Jemila S Hamid⁵, Chantelle C Lachance⁶, Elise Cogo⁷, Paul A Khan⁸, John J Riva⁹, Kednapa Thavorn¹⁰, Heather MacDonald¹¹, Jayna Holroyd-Leduc¹², Fabio Feldman¹³, Gillian D Kerr⁶, Susan B Jaglal¹⁴, Sharon E Straus¹⁵, Andrea C Tricco¹⁶

Affiliations

¹ Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB R3E 0W3, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, 11th Floor, Toronto, ON M5G 2A2, Canada. Electronic address: Kathryn.Sibley@umanitoba.ca.
² Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada. Electronic address: Sonia.Thomas@unityhealth.to.
³ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada; School of Education, Department of Primary Education, University of Ioannina, Greece; Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London W12 0NN, United Kingdom. Electronic address: averoniki@uoi.gr.
⁴ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada. Electronic address: Myanca.Rodrigues@unityhealth.to.
⁵ Department of Mathematics and Statistics, University of Ottawa, 150 Louis-Pasteur Pvt, Ottawa, ON, K1N 6N5, Canada. Electronic address: jhamid@uottawa.ca.
⁶ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada.
⁷ Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, North York, ON M2K 1E2, Canada.
⁸ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada. Electronic address: Paul.Khan@unityhealth.to.
⁹ Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: rivaj@mcmaster.ca.
¹⁰ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, PO Box 201B, Ottawa, ON K1H 8L6, Canada. Electronic address: kthavorn@ohri.ca.
¹¹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada. Electronic address: heather.macdonald@carleton.ca.
¹² Departments of Medicine and Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada. Electronic address: Jayna.Holroyd-Leduc@albertahealthservices.ca.
¹³ Patient Safety & Injury Prevention, Fraser Health, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada. Electronic address: Fabio.Feldman@fraserhealth.ca.
¹⁴ Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, 11th Floor, Toronto, ON M5G 2A2, Canada; Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada. Electronic address: Susan.Jaglal@utoronto.ca.
¹⁵ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada; Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada. Electronic address: Sharon.straus@utoronto.ca.
¹⁶ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, ON M5T 3M7, Canada. Electronic address: Andrea.Tricco@unityhealth.to.

PMID: 33186739
DOI: 10.1016/j.exger.2020.111151

Abstract

Background: Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches.

Method: All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations.

Results: One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score = 0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination.

Conclusion: This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.

Keywords: Aging; Balance; Exercise; Falls; Mobility; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Exercise Therapy*
Exercise*
Humans
Network Meta-Analysis

Grants and funding

KRS 289648/CIHR/Canada