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Saturday, December 19, 2015

Fall Prevention - From the Optimal Aging Portal

I volunteer with McMaster Family Medicine in the Tapestry program. We visit seniors who have volunteered to be in this research study. We bring an iPad and take a health survey. We also ask if they want to sign in to the McMaster Personal Health Record, which is integrated into the OSCAR EMR.  Many of the clients we have met have had falls.

Just saw this article on the McMaster Optimal Aging Portal about fall prevention. Because I have practiced Tai Chi for more several decades, and because I value the work of the Portal and the plain language systematic reviews and evidence based research they present to the public, I will post this here. It would be great if more people, both citizens and health professionals, could subscribe to the Portal.

Steady on your feet: New ways to improve balance and avoid falls


Dec 18, 2015
When it comes to keeping your feet safely on the ground – metaphorically and literally – it’s all about balance. But like many other things we take for granted when we’re young (strength, endurance, bone density, a full head of hair...) our sense of balance declines as we age. That’s one reason why older adults are at greater risk of falling and potentially becoming seriously hurt or even dying as a result (1).

Past research has shown that regular physical activity can help prevent falls, particularly when it includes exercises and movements designed to improve balance (2). Tai Chi for example, is recommended for its various benefits, including improving strength and balance through slow, controlled movements (3,4).

But if Tai Chi isn’t for you, there are other options you many want to consider. One recent systematic review of six studies measured the benefits of Pilates, a mind-body exercise program that has been popular since the early 20thcentury. Like Tai Chi, it involves controlled movements and concentrates on flexibility, strength, posture and breathing (5). Each study included older adult participants who took part in group Pilates sessions. The exercises varied (mat exercises as well as exercises using elastic bands, weights or other equipment), and included at least 2hrs of Pilates each week. The study participants were compared with a control group who kept up their usual daily activities but did not take Pilates.

Another emerging form of balance training that is gaining attention for its novel approach is “perturbation-based balance training” or balance recovery training. It focuses on improving people’s reaction time and helping them better recover from a loss of balance (6). Training can include equipment (such as moving platforms), or manual interference (such as nudges by a therapist) to enhance your ability to react and stop yourself from falling.

A recent systematic review of eight randomized controlled trials examined whether perturbation-based balance training lowers the risk for falls in older adults as well as people with neurological disorders such as Parkinson’s disease (6). More than 400 people between the ages of 50 and 98 took part in perturbation-based balance training and were compared with those in control group who participated in other types of balance enhancing exercises.

What the research tells us

Both Pilates and perturbation-based balance training appear to be promising strategies for helping older adults avoid falls and the resulting serious consequences.

Despite limitations in the quality of the Pilates studies the results suggest that Pilates is a promising way to help improve balance (5). So far the evidence on perturbation-based balance training is also encouraging: participants completing the training reported fewer falls and were less likely to fall, compared with those in the control groups (6). Further research is needed but there is cautious optimism that this approach may help people react and recover their balance more quickly so that a slip or trip doesn’t necessarily have to end in a fall.

Not sure which balance training exercises are best for you? Ask your doctor or physical therapist, or give these activities a try! At the same time, be aware of hazards and take the necessary precautions (e.g. good lighting, clear pathways, secure handrails etc.) so that you remain surefooted and safe as you enjoy an active lifestyle (7).


The Bottom Line

  • Older adults have a greater chance of falling and experiencing serious injury or even death.
  • Exercises aimed at improving balance have been shown to help prevent falls.
  • Initial studies of Pilates exercises (involving controlled movements to build flexibility, strength and posture) suggest it has the potential to improve balance.
  • Balance-recovery training aims to improve reaction time after a loss of balance and also appears to help lower risk of falls.
  • More high quality studies are needed to learn more about the benefits of Pilates and balance-recovery training.

References

  1. Centers for Disease Control and Prevention (CDC). Falls among older adults: an overview. [Internet] 2012. [cited Dec 2015] Available from: http://www.cdc.gov/homeandrecreationsafety/falls/adultfalls.html.
  2. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD.007146.
  3. Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015; 44:16-24.
  4. Leung DP, Chan CK, Tsang HW, et al. Tai chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review. Altern Ther Health Med. 2011; 17:40-48.
  5. Barker, AL, Bird M, Talevki J. Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96:715-723.
  6. Mansfield A, Wong JS, Bryce J et al. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. 2015; 95:700-709.
  7. Public Health Agency of Canada (PHAC). You Can Prevent Falls. Ottawa, Canada. [Internet] 2011. [cited Dec 4, 2015] Available from: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/prevent-eviter/index-eng.php 



AUTHOR DETAILS

Optimal Aging Portal Blog Team

The latest scientific evidence on this topic was reviewed by the McMaster Optimal Aging team. Blog Posts are written by a professional writer, assessed for accuracy by Dr. Maureen Dobbins, an expert in interpreting and communicating the scientific literature, and edited by a professional editor. There are no conflicts of interest.