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Elderly exercisers have fewer broken bones after falls

By Andrew M. Seaman

NEW YORK (Reuters Health) - Older adults who exercise are less likely to fall, but if they do, they're also less likely to get hurt, a new analysis suggests.

Researchers found that older adults taking part in fall prevention exercise programs were about 37 percent less likely to be injured during a tumble, compared to non-exercising participants.

"Falls are recognized as a serious and common medical problem experienced by older adults, but it's also widely known that falls are preventable, and that exercise is an efficient way to prevent them," Fabienne El-Khoury, the study's lead author, told Reuters Health in an email.

"However there was no clear evidence that exercise (programs) can also reduce severe or more moderate injuries caused by falls, even though injuries due to falls have serious medical, psychological and economic consequences," El-Khoury added.

She is a doctoral candidate at the University of Paris-Sud and at INSERM, the French National Institute of Health and Medical Research.

Between 30 to 40 percent of people age 65 or older fall at least once each year, according to the government-backed U.S. Preventive Services Task Force (USPSTF). About five to 10 percent of those people will have a serious injury such as a hip fracture.

For older adults who live independently and are at a high risk for falls, the USPSTF recommends exercise or physical therapy and/or vitamin D supplements (see Reuters Health story of May 30, 2012 here: http://reut.rs/V1ARom.)

Older people who are at a high risk for falls include those with a history of falls, mobility problems and those who have trouble getting up from a chair and walking.

While several studies have found that exercise programs reduce tumbles, the researchers wondered whether those programs also prevented injuries if older adults did fall.

For the analysis, published in BMJ, El-Khoury and her colleagues used data from 17 previous studies comparing 2,195 people assigned to take part in exercise programs and 2,110 people who were not.

The average age of the people included in the analysis was about 77 years old and more than three quarters of the participants were women.

Overall, the researchers found that people in the exercise group were about 37 percent less likely to be injured during a fall, compared to the non-exercisers. Those injuries could be anything from bruises to broken bones.

The exercisers were 61 percent less likely to have broken bones after falls, and 43 percent less likely to experience a fall leading to any injury serious enough to warrant admission to a hospital.

El-Khoury said it's hard to know how many injuries those reduced risks represent, because all of the studies reported injuries differently. Also, results varied between studies.

For example, there were 81 injuries per 100 people over a year in the exercise group of one study included in the analysis. There were 134 injuries per 100 people over a year for the non-exercise group.

In other studies, researchers have found no such difference between groups based on exercise.

When there is a difference, Yvonne Michael, who has studied falls among older people but wasn't involved in the new analysis, said the reason could be that the bodies of people who exercise are better at absorbing a fall.

The authors suggest the minds of people who exercise may also be sharper than those of non-exercisers and they can respond better to falling, for instance by grabbing onto something.

Michael said the findings are consistent with previous studies, but there is still uncertainty about which exercise programs work best.

In the new analysis the programs emphasized exercises to improve balance, but most had several components. Three of the included studies used Tai Chi.

It's also uncertain whether routine activities, such as gardening, walking and mowing the lawn, are just as good as more structured exercise programs.

"It's harder to test the routine activity because it doesn't fit well into a randomized controlled trial setting," said Michael, an associate professor at the Drexel University School of Public Health in Philadelphia.

She added, however, that people living in urban or suburban areas should be able to find structured exercise programs through their local senior center. Also, some medical plans include exercise programs for older adults.

Those are typically low cost and may even be included in some insurance plans, she said.

"I think the evidence continues to grow in terms of the benefit of physical activity," Michael said. "It seems like there's really no downside to staying active."

SOURCE: http://bit.ly/1dqbUJF BMJ, online October 29, 2013.

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