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Wuber J.S. Soares, Alexandre D. Lopes, Eduardo Nogueira, Victor Candido, Suzana A. de Moraes and Monica R. Perracini

: (“aged” OR “older adult” OR “elderly”) AND (“accidental falls” OR “falling” OR “faller”) AND (“physical activity” OR “energy expenditure” OR “exercise” OR “physical fitness”) AND (“risk factor” OR “exposure” OR “relative risk”). The Appendix presents the search strategies in detail. Selection of

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Susan A. Carlson, Judy Kruger, Harold W. Kohl III and David M. Buchner

Background:

Falls are a major health problem for older adults. The purpose of this study is to examine the cross-sectional association between non-occupational physical activity and falls and fall-related injuries in US adults age 65 y or older.

Methods:

Respondents age 65 y or older were selected from the 2003 Behavioral Risk Factor Surveillance System (n = 47,619).

Results:

The age-adjusted incidence of falls was significantly higher among inactive respondents (16.3%, 95% CI: 15.2–17.6) than insufficiently active (12.3%, 95% CI: 11.4–13.2) or active (12.6%, 95% CI: 11.6–13.7) respondents. After controlling for sex, age, education, and body-mass index, active and insufficiently active respondents were significantly less likely to have fallen and were significantly less likely to have had a fall-related injury than their inactive peers.

Conclusion:

These results show that active and insufficiently active older adults experience a lower incidence of falls than their inactive peers.

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Marie-Louise Bird and James Fell

This study investigated the effect of Pilates exercise on physical fall risk factors 12 months after an initial 5-week Pilates intervention. The authors hypothesized that ongoing Pilates participation would have a positive effect on physical fall risk factors in those who continued with Pilates exercise compared with those who ceased. Thirty older ambulatory adults (M = 69 years, SD = 7) participated in Pilates classes for 5 weeks with testing preintevention (Time 1 [T1]) and postintervention (Time 2 [T2]) and 12 months later (Time 3 [T3]). Balance and leg strength were compared using a 2-way analysis of variance with repeated measures. Postural sway, dynamic balance, and function improvements evident after the initial Pilates training (T1–T2) were maintained at T3 (p < .01). Significant differences existed at T3 for dynamic balance and strength between participants who continued performing Pilates (n = 14) and those who had ceased. Balance improvements after a short Pilates intervention were maintained 1 year later in all participants, with increased benefits from ongoing participation.

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Lucy McPhate, Emily M. Simek, Terry P. Haines, Keith D. Hill, Caroline F. Finch and Lesley Day

Background:

Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults’ preferences for how these programs can be delivered are unknown.

Objective:

To identify older people’s preferences for how group exercise programs for falls prevention can be delivered.

Design:

A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia.

Methods:

Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach.

Results:

Ninetyseven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently.

Conclusions:

This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program.

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Michael L. Madigan

The purpose of this study was to investigate agerelated differences in muscle power during a surrogate task of trip recovery. Participants included 10 healthy young men (19–23 years old) and 10 healthy older men (65–83). The task involved releasing participants from a forward-leaning posture. After release, participants attempted to recover their balance using a single step of the right foot. Muscle power at the hip, knee, and ankle of the stepping limb were determined from the product of joint angular velocity and joint torque. Muscle powers during balance recovery followed a relatively consistent pattern in both young and older men, and showed effects of both lean and age. Interestingly, the effects of age did not always involve smaller peak power values in the older men as expected from the well-documented loss of muscle power with aging. Older men exhibited smaller peak muscle power at the knee and larger peak muscle power at the ankle and hip compared to young men. The increases in muscle power at the ankle and hip may result from a neuromuscular adaptation aimed at improving balance recovery ability by compensating for the age-related loss of muscle function.

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Ellen C. Jørstad-Stein, Klaus Hauer, Clemens Becker, Marc Bonnefoy, Rachel A. Nakash, Dawn A. Skelton and Sarah E. Lamb

The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures’ properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.

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Ellen F. Binder

This pilot study evaluated (a) the feasibility of a group exercise program in an institutionalized population with dementia; (b) the effects of such a program on physical performance measures; and (c) the potential additional effects of vitamin D supplementation on gait and muscle strength. Nursing home residents (N = 25) with chronic dementia and mobility impairments attended a thrice weekly exercise class for 8 weeks. They were randomly assigned to receive either a vitamin D supplement or no supplement throughout the program. Between-group differences in the effectiveness of the exercise intervention were analyzed. Pre-to-post changes were also assessed for both groups combined. In postexercise comparisons of both groups, knee extensor torque at 0°/sec declined by 18.6% while performance of 1-RM for hip extension increased by 16.1%. Balance also improved. Although vitamin D levels increased significantly in the supplement group, the two groups did not differ in their response to the exercise intervention.

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Stephen Harvey, Chris Rissel and Mirjam Pijnappels

Falls among older adults remain a significant public health issue. Bicycling positively influences falls risk factors including reduced balance, muscle weakness, and low self-perceived confidence in maintaining balance. However, this association has not been systematically examined. We recruited 107 community-dwelling participants aged 65 years and older in the Netherlands to determine the relationship between bicycling and falls risk factors. Participants completed three questionnaires on cycling behavior and balance confidence, and also undertook five falls-related physical performance tasks encompassing tests of balance, strength, gait, and endurance. On average, current bicyclists showed significantly better scores in all physical tasks and confidence compared with nonriders ranging from a 10% difference in 6-m walk time to a 141% difference in single-leg balance time (all ps = .01). Type of bike used and duration of bicycling displayed varied associations (.01 < ps < .79). Our findings suggest that bicycle riding warrants further prospective investigation for fall prevention and active aging.

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Telassin Silva Homem, Fernando Silva Guimarães, Maurício Santos Soares, Leandro Kasuki, Mônica Roberto Gadelha and Agnaldo José Lopes

Advances in the knowledge of acromegaly are leading to an increase in the survival rate of acromegalic subjects. This study was conducted to evaluate balance control, risk of falls, and peripheral muscle function in acromegalic older adults. Seventeen older subjects with acromegaly (67 [63–73] years) and 20 paired control subjects were evaluated with balance scales, force platform, and knee isokinetic dynamometry tests. There were significant differences between the groups on several balance and gait scales, with a worse performance and greater risk of falls in the acromegalic older adults. Acromegalic older adults had lower values for peak torque, maximum repetition of the total work, and total work during extension at 240°/s. The acromegalic older adults had higher values in the medial-lateral range. Acromegaly subjects had lateral instability that compromises their body balance and increases the risk of falls. Moreover, there was a propensity for muscle fatigue in these individuals.

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Ulrika Olsson Möller, Jimmie Kristensson, Patrik Midlöv, Charlotte Ekdahl and Ulf Jakobsson

Objectives:

To investigate the effects of a home-based one-year case management intervention in older people with functional dependency and repeated contact with the health care services on self-reported falls and self-reported injurious falls.

Methods:

The study was a randomized controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to the intervention group (n = 80, mean age = 81.4 [SD 5.9]) or control group (n = 73, mean age = 81.6 [SD 6.8]). The intervention group received a case management intervention which comprised monthly home visits during 12 months by nurses and physiotherapists employing a multifactorial preventive approach.

Results:

In the intervention group, 96 falls occurred during the intervention period compared with 85 falls in the control group (p = .900). There were 40 and 38 injurious falls (p = .669) in the intervention and control groups, respectively.

Conclusions:

This home-based case management intervention was not able to prevent falls or injurious falls.