Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis

Background: The overall effect of exercise on falls and fracture prevention in long term care facilities remains controversial. In this study, we aimed to analyze the impact and the characteristics of the most effective physical exercise regime to prevent falls and fractures in this particular setting.

Methods: Our search looked for randomized controlled trials published in English language between January 1974 and June 2012 in electronic databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Occupational Therapy Seeker that specifically tested the effect of exercise on falls and/or fractures in long term care residents. Two investigators independently extracted data and assessed study quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied throughout the systematic review and meta-analysis.

Results: Twelve studies were selected that included 1292 participants. Most of the participants were women (68%) with a mean age of 83.9 ± 9 years. The intervention period was between 3 and 24 months, and the most commonly performed intervention were balance and resistance training exercises. Meta-analysis showed that exercise has a preventive effect on falls (risk ratio [RR] = 0.77, 95% confidence interval [CI], 0.64-0.92; I(2) = 72.18, P < .001). This effect was stronger when mixing several types of exercises (RR = 0.71, 95% CI, 0.55-0.90; I(2) = 72.07, P < .001), for at least 1-3 months (RR = 0.65, 95% CI, 0.43-0.98; I(2) = 61.821; P < .001) or for more than 6 months (RR = 0.70, 95% CI, 0.56-0.87; I(2) = 68.407; P < .001), with a frequency of at least 2-3 times per week (RR = 0.74, 95% CI, 0.60-0.91; I(2) = 68.092; P < .001). Physical exercise did not show any effect on fracture prevention (RR = 0.57, 95% CI, 0.21-1.57; I(2) = 48.805).

Conclusions: Combined, frequent and long-term exercise programs are effective to prevent falls in long term care facilities. No effect of exercise on fracture prevention was observed in this population.