A large randomized control trial led by a team from Neuroscience Research Australia (NeuRA) and UNSW researchers found that gamified step exercises at home were effective in preventing falls in elderly people over 65, reducing the number of falls by 26% when compared with a control group.
The results of researchconducted by NeuRA, were published in Nature Medicine.
Elderly people over 65: preventing falls is possible
With an ever-aging population, researchers say we need effective, older adult fall prevention strategies to address the growing impact of falls in the community.
“Regular exercise that challenges balance is effective in preventing falls, so we tried to make exercise fun and easy to do,” says Dr. Daina Sturnieks, lead author of the study and senior researcher at NeuRA and UNSW Sydney.
“It was really encouraging to see that smart±step, an exercise game console that anyone can enjoy at home without the assistance of a therapist, benefited seniors by preventing falls.”
A total of 769 seniors over the age of 65, all living in the community, participated in Dr. Sturnieks' study. They were asked to play smart step exercise games for 120 minutes a week over the course of 12 months. They reported their falls during this period and this data was compared with a control group, who only received a public health leaflet on falls prevention.
During the 12-month study period, older adults who received the exercise intervention showed significantly fewer falls than the control group: 36% of the exercise group had a fall over the study period, while 48.2% of the group with the brochure had a fall.
While these findings are encouraging, the researchers said a limitation of the research was that the sample consisted primarily of well-educated, high-achieving older adults.
“The findings cannot be generalized to more frail older adults,” the researchers said.
“Furthermore, older adults were not blinded to their intervention, so the level of fall prevention expectation may be different between groups, which could contribute to a placebo effect that could influence the results.”
Every year one in three people over the age of 65 who live independently suffer a fall. Falls represent a significant public health problem, contributing to mobility-related disability and loss of independence, and are the second leading cause of death from unintentional injuries worldwide.
The best evidence for fall prevention in the community is exercise that tests balance, says Dr. Sturnieks.
“We've known for a long time that, when done correctly and consistently, exercises that impair balance can prevent falls. But the problem is that older people often don't keep up with the exercises because they can get boring very quickly,” she explained. she says.
This led Dr. Sturnieks and the team at NeuRA's Falls, Balance and Injury Research Center to explore the idea of gamifying balance exercises.
“Older adults become addicted to games because they are fun and they are motivated to beat their high score and lose themselves in the game,” says Dr. Sturnieks.
smart±step is connected to a television screen and, once the game of choice is selected, requires the person to step on target panels on a pad, just as one would with a game controller.
The benefits of smart±step exercise games – or exergames – go beyond the benefits of physical exercise: people also undertake cognitive training, which can easily be incorporated into these games.
“These exergames require people to think quickly, unlike traditional exercise programs where you often simply go through the motions,” says Dr. Sturnieks. The smart±step exercises involve stepping on a mat, which acts as a controller.
The exergames vary in content and range from collecting treasure to stepping on moving cockroaches or avoiding obstacles. Overall, games require timely movements and quick thinking to keep up.
“Exergames are like two in one: you get physical benefits but also maintain yourself cognitively, which is good for the brain and for healthy aging in older adults. Plus, it's fun.”
Providing better opportunities for exercise and group training has reduced recurrent falls and fall-related injuries among older adults, a further study from the University of Eastern Finland shows. The results were published in Age and Aging.
Previous studies have shown that exercise can promote the health and functional capacity of older adults. Although the health benefits of exercise are widely documented, pragmatic studies demonstrating the effectiveness of social strategies to increase physical exercise for the prevention of falls, for example, are scarce.
In collaboration with the city of Kuopio, Finland, the Kuopio Musculoskeletal Researc
h Unit at the University of Eastern Finland conducted a large, population-based, randomized controlled trial of older adults involving a total of 914 women. Researchers have examined whether providing better opportunities for exercise and group training can prevent falls and related injuries.
The average age of the women participating in the study was 76.5 years at baseline, and participants were randomized into two groups: the exercise intervention group and the control group. The exercise intervention group received free entry for 12 months to the city's recreational sports facilities, including weekly supervised gym and Thai Chi sessions during the first six months of the intervention.
The elderly were followed for approximately two years. Information on recent falls was collected every two weeks via SMS queries and fall diaries. During the follow-up, a total of 1,380 falls were recorded and in 93% of cases the details of the accidents were verified by telephone.
As expected, almost half of the recorded falls of older adults occurred on flat surfaces, in most cases caused by trips or slips. One in four falls occurred indoors.
In both groups, approximately 60% of older adults fell at least once during follow-up. However, the effects of the exercise intervention were particularly visible when it came to recurrent falls and injuries and fractures caused by falls.
In the exercise intervention group, there were 14.3% fewer falls overall and 25.6% fewer indoor falls compared to the control group. Furthermore, fewer fall-related injuries occurred overall in the intervention exercise. Fewer fall-related injuries occurred overall.
The number of seniors' falls that caused significant pain was a whopping 41 percent lower, and the number of falls that led to a fracture diagnosis was 38 percent lower than in the control group.
The number of falls that caused significant pain was a whopping 41 percent lower, and the number of falls among older adults that led to a fracture diagnosis was 38 percent lower than in the control group.
The study demonstrated that light-to-moderate intensity group exercise with free admission to sports facilities can prevent falls and reduce fall-related injuries among older women in an urban environment.
“Wider implementation of such strategies by municipal services and communities should be promoted in order to achieve these objectives. Overall, an approach where local communities work alongside healthcare workers to prevent falls seems to work better,” says first author, senior researcher Toni. Rikkonen of the University of Eastern Finland.
Tai Chi is more effective than conventional exercise in preventing falls among high-risk older adults.
Fuzhong Li, Ph.D., of the Oregon Research Institute in Eugene, and colleagues randomized 670 older community-dwelling adults aged ≥70 years who had fallen in the previous year or had limited mobility to one of three exercise interventions.
Participants were randomized to two weekly 60-minute Tai Ji Quan: Moving for Better Balance (TJQMBB) classes for 24 weeks; multimodal exercise (MME) that integrates balance, aerobic, strength and flexibility activities; or stretching exercises.
The researchers found that during the study period, 152 falls (85 individuals) occurred in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. In the TJQMBB group and the MME group, the incidence rate ratios (IRR) were significantly lower at six months (IRR, 0.42 [P < 0,001] and 0.60 [P = 0,001], respectively) compared to the stretching group. For the TJQMBB group, falls were reduced by 31% compared to the MME group (IRR, 0.69; P = 0.01).
“Among older adults living in communities at high risk for falls, a therapeutically tailored Tai Ji Quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls,” the authors write. .
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