Discussion
This systematic review provides evidence that fall prevention
exercise programmes for older people not only reduce the rates
of falls but also prevent injuries resulting from falls in older
community dwelling people. The protective effect seems most
pronounced for the most severe fall related injuries: the
estimated reduction is 37% for all injurious falls, 43% for severe
injurious falls, and 61% for falls resulting in fractures.
Many of the risk factors for falls and fall induced injuries are
similar.35 These factors are correctable by well designed exercise
programmes, even in the very old and frail.26 36 37 All exercise
programmes that have proved to be effective for fall prevention
(and all trials included in this review) emphasise balance
training, and there is now ample evidence that this type of
programme improves balance ability.13 38 However, most
programmes are multicomponent—that is, also include other
types of exercise such as gait and functional training,
strengthening exercises, flexibility, and endurance. There is
evidence that these types of interventions can improve reaction
time, gait, muscle strength, coordination, and overall physical
functioning as well as cognitive functions, especially executive
function.19 28 39 It is therefore thought that exercise prevents
injurious falls not only by improving balance and decreasing
the risk of falling, but also by improving cognitive functioning,41
and the speed and effectiveness of protective reflexes (such as
quickly extending an arm or grabbing nearby objects) or the
energy absorbing capacity of soft tissues (such as muscles),
thereby diminishing the force of impact on the body.40 41 Hence,
for any given initial energy of a fall, improved protective
responses should decrease the severity of the resulting trauma,
which may explain why the estimated protective effect of
exercise is stronger for severe injurious falls than for all injurious
falls, the latter including severe but also minor and moderate
injuries.