The reason for the apparent lesser effect of exercise on
fall rates when walking programs are included may be due
to: (a) increased exposure to risk with walking, (b) walking
taking time away from high level balance training or (c) confounding
of the results as walking programs were more likely
to be prescribed in high risk populations (e.g. in residential
care) and the beneficial effects of exercise in this population
are less marked. Although walking appears not to be the
best fall prevention strategy there are other benefits of walking
programs for older people.26,29 We therefore suggest that
walking training be included in a program as long as it is
not at the expense of balance training. However, high risk individuals should not be prescribed brisk walking programs
due to the increased risk of falls with this activity.30 The Otago
Exercise Programme31 is a home based strength and balance
training program involving intensity progression with the use
of ankle cuff weights. It is effective in preventing falls and
includes the prescription of a walking program if the exercise
provider considers the individual participant to be safely able
to undertake such a program. We suggest that this approach
be used for participants in fall prevention exercise programs.