Why is Falling a Problem?

Falls are a significant health risk for older adults, with approximately one in three community-dwelling people aged 65 years or older falling every year, and the risk of falling increasing with age.

In addition, falls are the leading cause of injury-related hospitalisation, accounting for some 40% of injury-related hospitalisations. That is compared to 12% for transport crashes.

Through associated injuries, falls increase the risk of ending up in residential care is approximately tenfold and, even if someone is not injured when they fall, they can suffer a loss of confidence afterwards and start to limit their activities, which can contribute to a downwards spiral.

Falling is only a Problem for Older Adults!

The issue of falls does not just apply to older adults. Approximately one in five women aged between 40 and 50 will fall each year, and while most research has looked at falls in people aged over 65, there is a new body of research looking at falls prevalence in people over 40.

How Can Exercise Professionals Help?

Preventing falls takes on an all-new level of importance in light of the fact that one of the main risk factors to falling is having had a previous fall – and it is an area where exercise professionals can make a difference.

For example, the exercise professional might be the first person to notice that a client’s balance is changing and, because you are working in that space with them already, they may be more amenable to accepting balance exercises from you.

What Causes Falls?

We fall even before we start learning to walk, mastering better balance as we start to walk and grow. However, falls become prevalent later on in life due to changes that happen with the ageing process. Ageing affects different systems in our body, including motor systems, sensory and neurological systems and our cognitive abilities, so all of those things progressively deteriorating with age contribute to an increased risk of falling.

Decreases in muscle strength, balance and reaction time can make it harder for people to keep themselves upright if they trip. However, individual differences mean that a ‘fit’ 65 year old may be resistant to falls as a middle-aged adult.

Falls may be more to do with physical inactivity than age-related deterioration.

What is the Effect of Exercise on Falls?

Over the past decade, the amount of research into exercise for falls prevention has grown significantly, providing strong evidence that appropriate exercise programs (not just physical activity in general) can help prevent falls in older people.

To cite a few leading papers, a 2012 Cochrane systematic review concluded that exercise interventions reduce the rate of falls and the risk of falling in older, community-dwelling people. Interestingly, the review found that exercise, by itself, had a fall prevention effect similar to multifaceted interventions. This suggests that if the general population were to zone in on one key strategy to protect against falls, exercise would be a front-runner.

Another paper published in 2017 in the British Journal of Sports Medicine (BJSM) established that overall, exercise reduced the rate of falls in community-dwelling older people by a substantial 21%. The researchers found even greater reductions in falls from particular exercise programmes, about a 40% reduction with exercises that challenge balance and involve more than three hours a week of exercise.

What about Movement Prescription?

What the BJSM review clarified is that the most important element of a fitness programme aimed at preventing falls is exercises that provide a high challenge to balance. For example, seated exercises are not challenging enough to balance in order to prevent falls.

 Instead, exercises need to involve movement of the centre of mass, so not just standing still but moving; minimising the base of support by bringing the feet together or standing on one leg, and minimising the use of upper limb support during exercises. For example, exercises that challenge balance include:

• Standing lateral side leg raises;
• Single leg squats;
• Rocking up onto the toes;
• Adding head turns; and/or
• Moving the arms while standing on one leg,

For younger clients, exercise professionals might want to add in some fast movements as well, because it is all about activating the muscles quickly, which can help prevent falls in the future. Further, group classes like aerobics or anything that challenges balance control can be beneficial. Research also suggests that Tai Chi, yoga and Pilates can all be useful for reducing the risk of falls.

What about Functional Strength?

Increasing functional strength is another aspect of preventing falls. Exercise professionals will want to make sure they are training the postural and proximal muscles, which helps to maintain upright posture and balance. If we are at risk of tripping up, we might use our hip and core muscles to keep our balance, so it is important to target those muscles.

Who Can Benefit?

As for the age group that can benefit from fall-prevention exercises, it is advisable to incorporate them with clients aged 40 or older, although balance is important for people of all ages.

Safety

Any exercises prescribed should be tailored to the capabilities of the client and progressed gradually, based on initial screening. If an exercise professional finds a client who is at an increased risk of falling, they should make sure the client is set up in a safe environment. For example, with a chair they can hold onto and/or with an instructor always close by.

Screening for Falls Risk

• Ask about Slips, Trips and Falls:
  • One of the main ways to assess if a client is at risk of falls is to ask them if they have had a fall in the past 12 months – a previous fall is the single strongest indicator of a future fall.
  • However, remember to ask about slips and trips, not just falls. A percentage of clients will not talk about falling because they do not view a slip or trip as a fall.
• Observe clients closely:
  • When making observations, you are looking for any limitations in the client’s gait or transfer ability, as well as any difficulties in their activities of daily living, which can be risk factors for falls.
  • A current client may become less confident and/or start holding on to stationary objects.
• Refer Onwards:
  • If you have a concern about a client it is important to refer them to a medical professional (e.g. doctor or physiotherapist).
  • This way a tailored healthcare and exercise programme can be developed for the client.
• Understand & Consider other Risk Factors:
  • It is important to note that balance and muscle strength are not the only factors that determine the risk of falls.
  • Examples of other factors include:
    • Poor eyesight (e.g. cataracts);
    • Psychoactive medications;
    • Medical conditions (e.g. stroke);
    • Parkinson’s disease; and
    • Carotid sinus hypersensitivity (CSH): This is an exaggerated response to carotid sinus baroreceptor stimulation. It results in dizziness or syncope from transient diminished cerebral perfusion. Although baroreceptor function usually diminishes with age, some people experience hypersensitive carotid baroreflexes.
  • If a client reports dizziness or falls that cannot be explained by balance and strength factors, it is important to refer them to their medical professional.