RESEARCH TO PRACTICE
Group Exercise to Prevent Falls
Lord, S. R.; Castell, S.; Corcoran, J.; Dayhew, J.; Matters, B.; Shan, A.; & Williams, P. (2003). The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: A randomized controlled trial. Journal of the American Geriatrics Society 51 (12) 1685-1692.
It has become clear that exercise can modify key falls risk factors such as decreased muscle strength, reduced speed, and poor balance in older people as well as evidence that exercise can reduce the incidence of falls. This study builds on previous studies that have found that resistance, endurance and flexibility training generally don’t reduce fall rates. However programs targeted to individuals with mild strength and balance deficits, women over 80 years, and those with one or more falls who undertake 12-months of exercises designed to improve activities for daily living can reduce fall risk.
This study of 551 individuals aged 62 to 95 living in self and intermediate-care retirement villages in Australia were divided into group exercise (GE) and combined control (CC) groups. The CC groups either took part in a minimal-intensity exercise program or did not take part in any group activity. Where as, the GE groups undertook 1-hour group classes twice weekly for the 12-month period.
Instructors who led the classes were trained to provide the same 1-hour program consisting of “a 5- to 10-minute warm-up period, a 35- to 40-minute conditioning period, and a 10-minute cool-down period. Most exercises were weight bearing and undertaken as group activities, with a major emphasis on social interaction and enjoyment. Although following a core theme, the exercise classes were individualized to the functional capabilities of the subjects. For example, to enable subjects with moderate balance impairments to take part in the program, these subjects undertook certain weight-bearing balance exercises holding on to or in reach of a support. All participants were encouraged to go at their own pace.”
“For the first 5 weeks of the program, the warm-up period consisted of chair activities and stretching of large muscle groups. For the remainder of the program, the warm-up included slow- to moderate-paced walking. The pace and duration of the walking increased from 5 to 15 minutes in the first 10 weeks of the program and was maintained at 15 minutes for the remainder of the program.”
“The conditioning period consisted of aerobic exercises, specific strengthening exercises, and activities for balance, hand-eye and foot-eye coordination, and flexibility. The aerobic exercises involved movement of the legs, trunk, and arms to involve all joints and major muscle groups. The leg movements were designed to use the full range of movement of the hip, knee, and ankle joints and to condition and strengthen all major muscle groups. The trunk movements were designed to maintain flexibility of the spine and to condition and strengthen the back, chest, and abdominal muscle groups. The arm movements were designed to use the full range of movement of the shoulder, elbow, and wrist joints and to strengthen all major muscle groups. Whole-body exercises included pacing, dance patterns, directional changes and speeds, and complicated routines of whole-body movement. Walking pattern exercises consisted of large strides, heel-toe walking, narrow- and wide-based walking, and sidestepping.”
“Specific graded muscle group strengthening exercises were undertaken with an increased number of repetitions per session. Muscle groups targeted included ankle dorsiflexors, knee extensors, hip abductors, and hip side-flexors. Repetitions were increased from four at Week 2 to 30 at Week 10. Thirty repetitions were then maintained for the remainder of the program.”
“The activities for balance included tandem foot standing, heel-toe walking, line walking, standing on one leg, altering the base of support, weight transfers (from one leg to the other), rocking back and forth onto toes and heels, rotating on the spot, lateral movement challenges, and reaching and stretching movements away from the center of gravity (forward, laterally, and upward). The flexibility exercises were undertaken in the seated and standing positions. They included toe pointing forward and laterally and heel strike exercises moving the heel forward and to the sides.” “The cool-down period consisted of muscle relaxation, controlled breathing, and guided imagery.”
The GE groups had 22% fewer falls during the 12-month trial period than the CC groups. This program was most effective for previous fallers, who had 31% fewer falls. “This study provides complementary finding to the growing literature on the effectiveness of exercise as a falls-prevention strategy by showing that group-based exercise can produce benefits with regard to maintaining physical functioning and reducing falls frequency in frail older persons.”
Implications: Enjoyable group weight bearing exercise programs that improve activities of daily living and social interaction not only reduce fall rates but enhance life for residents.