Stephen R. Lord

Effective Exercise for the Prevention of Falls: A Systematic Review and Meta‐Analysis

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls.

Physiological factors associated with falls in older community-dwelling women

OBJECTIVE: To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community‐dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls.

Reliability of the GAITRite® walkway system for the quantification of temporo-spatial parameters of gait in young and older people

The purpose of this study was to evaluate the test-retest reliability of an instrumented walkway system (the GAITRite mat) for the measurement of temporal and spatial parameters of gait in young and older people. Thirty young subjects (12 males, 18 females) aged between 22 and 40 years (mean 28.5, S.D. 4.8) and 31 older subjects (13 males, 18 females) aged between 76 and 87 years (mean 80.8, S.D. 3.1) walked at a self-selected comfortable walking speed across the pressure-sensor mat three times and repeated the process approximately 2 weeks later. Intra-class correlation coefficients (ICC), coefficients of variation (CV) and 95% limits of agreement were then determined. For both groups of subjects, the reliability of walking speed, cadence and step length was excellent (ICCs between 0.82 and 0.92 and CVs between 1.4 and 3.5%). Base of support and toe in/out angles, although exhibiting high ICCs, were associated with higher CVs (8.3-17.7% in young subjects and 14.3-33.0% in older subjects). It is concluded that the GAITRite mat exhibits excellent reliability for most temporo-spatial gait parameters in both young and older subjects, however, base of support and toe in/out angles need to viewed with some caution, particularly in older people.

Visual risk factors for Falls in older people

OBJECTIVES: To determine the tests most predictive of falls in community‐dwelling older people from a range of visual screening tests (high and low contrast visual acuity, edge contrast sensitivity, depth perception, and visual field size). To determine whether one or more of these visual measures, in association with measures of sensation, strength, reaction time, and balance, can accurately predict falls in this group.

Physiological factors associated with falls in an elderly population

Objective: To determine whether a battery of 13 sensorimotor, vestibular, and visual tests discriminates between elderly fallers and elderly non‐fallers.

Randomised factorial trial of falls prevention among older people living in their own homes

Abstract Objective: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. Design: A randomised controlled trial with a full factorial design. Setting: Urban community in Melbourne, Australia. Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. Results: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. Conclusions: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70–84 years living at home who rate their health as good.

The Effect of a 12‐Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial

OBJECTIVE: To determine whether a 12‐month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women.

Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations

This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95% CI 0.77-0.91). Meta-regression revealed programs that included balance training, contained a higher dose of exercise and did not include walking training to have the greatest effect on reducing falls. We therefore recommend that exercise for falls prevention should provide a moderate or high challenge to balance and be undertaken for at least 2 hours per week on an ongoing basis. Additionally, we recommend that: falls prevention exercise should target both the general community and those at high risk for falls; exercise may be undertaken in a group or home-based setting; strength and walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs; and other health-related risk factors should also be addressed.

Preseason Hamstring Muscle Weakness Associated with Hamstring Muscle Injury in Australian Footballers

Hamstring muscle strain is the most prevalent injury in Australian Rules Football, accounting for 16% of play ing time missed as a result of injury. Thirty-seven pro fessional footballers from an Australian Football League team had preseason measurements of ham string and quadriceps muscle concentric peak torque at 60, 180, and 300 deg/sec measured on a Cybex 340 dynamometer. Players were studied prospectively throughout the 1995 season. During that time, six play ers sustained clinically diagnosed hamstring muscle injuries that caused them to miss match-playing time. The injured hamstring muscles were all weaker than in the opposite leg in absolute values and hamstring-to- quadriceps muscle ratios. According to our t-test re sults, hamstring muscle injury was significantly asso ciated with a low hamstring-to-quadriceps muscle peak torque ratio at 60 deg/sec on the injured side and a low hamstring muscle side-to-side peak torque ratio at 60 deg/sec. Flexibility (as measured by the sit-and-reach test) did not correlate with injury. Discriminant-function analysis using the two significant ratio variables re sulted in a canonical correlation with injury of 0.4594 and correctly classified legs into injury groups with 77.4% success. These results indicate that preseason isokinetic testing of professional Australian Rules foot ballers can identify players at risk of developing ham string muscle strains.

Acceleration patterns of the head and pelvis when walking on level and irregular surfaces.

The aim of this study was to evaluate acceleration patterns at the head and pelvis while subjects walked on a level and an irregular walking surface, to develop an understanding of how the postural control system responds to challenging walking conditions. Thirty young, healthy subjects walked on a level corridor and on artificial grass underlain with foam and wooden blocks placed in an arbitrary manner. Temporo-spatial gait parameters and acceleration patterns at the head and pelvis were measured. The results revealed that when walking on the irregular surface, subjects were able to maintain their velocity, but adopted a slower and more variable cadence and a significantly longer stride length. The magnitude of pelvis accelerations increased, however head accelerations were not affected by the walking surface. When considered as an overall pattern of movement, these findings suggest that one of the primary objectives of the postural control system when walking on irregular surfaces is head control, and that subjects adapt their stepping pattern on irregular surfaces to ensure that the head remains stable.