Table 2 Summary of exercise programs for included studies
From: Implementing exercise programs to prevent falls: systematic descriptive review
Authors (year) Successful/Unsuccessfula Quality Score (of 10)b | Exercise setting; Standardized (S), Individualized (I), Semi- individualized (SI) | Population and recruitment | Above-average risk or Average/below-average riskc | Exercise description and Instructor | Supervised/Unsupervised: Exercise componentsd Time, Frequency and Program Duration | Adherence | Attrition rate | Exercise instruction cost per participante |
|---|---|---|---|---|---|---|---|---|
Ashburn et al. (2007a) Successful | Home; I | Patients with idiopathic Parkinson’s disease with more than 1 fall in past year identified through clinical registers of specialists; letter sent | Above-average Risk | Treatment goals established and exercises from exercise menu were taught in home. Menu designed with 6 levels of progression and comprised muscle strengthening, range of movement, balance training and walking. Exercises chosen at appropriate level and progressed at each visit. Patients encouraged to continue exercise after 6 weeks. Instructor: physiotherapist | Supervised: Balance, Strength, Flexibility, General physical activity • 1 hr, 1 time per week, 6 weeks Unsupervised: Balance, Strength, Flexibility, General physical activity • Daily | 69 of 70 had at least 6 sessions | 2 % per month | $41per week |
Barnett et al. (2003) Successful 8 | Class and Home; S | Women and men aged 65 years and older recruited from general practice clinics or acute hospital physiotherapy departments | Above-average Risk | Group exercise class to improve balance, coordination, aerobic capacity and muscle strength. Participants also received a home exercise program based on class content. Also received information on practical strategies for avoiding falls. Instructor: accredited exercise instructor | Supervised: Strength, Balance, Endurance, Flexibility, 3D • 1 hr, 1 time per week, 1 year Unsupervised: based on class content but not specified | Participants attended median of 23 classes; 91 % of those who attended classes performed home exercises 1+ times per week | 2 % per month | $2 per week |
Buchner et al. (1997) Successful | Class; S | Women and men aged 68 to 85 years old with mild deficits in strength and balance enrolled in HMO; PCP approved participation and sent letter | Average/below-average Risk | Exercise consisted of endurance training and/or strength training in supervised classes. Exercise sessions began with a 10- to 15-min warm-up and ended with a 5- to 10-min cool-down. Endurance training used stationary cycles. Strength training groups did resistance exercise of the upper and lower body using weight machines. Subjects received a discharge planning intervention to promote continued exercise. Instructor: NR | Supervised: Strength, Endurance • 1 hr, 3 times per week, 24-26 weeks | Participants attended 95 % of scheduled exercise sessions | 3 % per month | $8 per week |
Bunout et al. (2005) Unsuccessful 5 | Class; SI | Elderly women and men; recruitment not reported | Average/below-average Risk | Moderate-intensity resistance exercise training program included functional weight bearing exercises, squats, step-ups in stair, and arm pull-ups. Participants also engaged in walking before and after resistance training. Instructor: specialized coach | Supervised: Strength, General physical activity • 1 hr, 2 times per week, 1 year | Participants attended 52 % of sessions | NR | $3 per week |
Successful (Campbell and Robertson 2010; Campbell and Robertson 2007; Gardner et al. 2001; Robertson and Campbell 2008; Robertson et al. 2002) 8 | Home; I | Women aged 80 and older identified from registers of general practices; invited by PCP to participate | Above-average Risk | Otago: Physiotherapist prescribed exercises individually during 4 visits over first 2 months. Program consisted of muscle strength, balance retraining, and walking program. Level of difficulty increased by increasing number of repetitions and weights. Instructor: physiotherapist | Supervised: Balance, Strength • 1 hr, 4 times over 1st 2 months Unsupervised: Balance, Strength • 30 min, 3 times per week, 1 year Unsupervised: General physical activity • 2 times per week, 1 year | At end, 44 % of total were still exercising 3+ times per week | 4 % per month during second year | $20 per week |
Campbell et al. (1999b) Successful (Campbell and Robertson 2010;Campbell and Robertson 2007; Gardner et al. 2001; Robertson and Campbell 2008; Robertson et al. 2002) 6 | Home; I | Women and men aged 65 and older taking antidepressant or tranquilizer identified from register of general practice groups; invited by PCP | Above-average Risk | Otago: Physiotherapist prescribed exercises individually during 4 visits over first 2 months. Program consisted of muscle strength, balance retraining, and walking program. Level of difficulty increased by increasing number of repetitions and weights. Also included Medication withdrawal component. Instructor: physiotherapist | Supervised: Balance, Strength • 1 hr, 4 times over 1st 2 months Unsupervised: Balance, Strength • 30 min, 3 times per week, 44 weeks Unsupervised: General physical activity • 2 times per week, 44 weeks | After 44 weeks, 63 % of those remaining completed their exercise 3+ times per week, 72 % walked 2+ times per week | 5 % per month | $20 per week |
Campbell (2005) Unsuccessful (Campbell and Robertson 2010; Campbell and Robertson 2007; Gardner et al. 2001; Robertson and Campbell 2008) 8 | Home; I | Women and men aged 75 years and older with poor vision from register, optometry clinic, and low vision outpatient clinics | Above-average Risk | Otago: Physiotherapist prescribed exercises individually during 5 visits over 6 months. Program consisted of muscle strength, balance retraining, and walking program. Level of difficulty increased by increasing number of repetitions and weights. Program was modified for those with severe visual acuity loss. Instructor: physiotherapist | Supervised: Balance, Strength • 1 hr, 5 times over 6 months Unsupervised: Balance, Strength • 30 min, 3 times per week, 1 year Unsupervised: General physical activity • 2 times per week, 1 year | 18 % completed exercises 3+ times per week, 36 % completed exercises 2 times per week. 44 % walked 2+ times per week | 1 % per month | $8 per week |
Carter (2002) Successful | Class; S | Women with osteoporosis recruited from those diagnosed at health center | Above-average Risk | Osteofit targets posture, balance, gait, coordination, and hip and trunk stabilization with 8 to 16 strengthening and stretching exercises and strength training. Instructor: certified by hospital osteoporosis program | Supervised: Balance, Strength, Flexibility • 40 min, 2 times per week, 20 weeks | NR | 4 % per month | $5 per week |
Clemson et al. (2012) Successful (Clemson et al. 2010) 7 | Home; I | Women and men aged 70 years or older with two or more falls or one injurious fall in past 12 months; recruited from Veteran’s Affairs and general practice databases | Above-average Risk | Lifestyle integrated Functional Exercise (LiFE) program included movements prescribed to improve balance or increase strength that are embedded within everyday activities so that movements can be done multiple times per day. Instructor: physiotherapist | Supervised: Balance, Strength • 7 times over 6 months Unsupervised: Balance, Strength • Multiple times per day, 7 days per week, 1 year | 64 % completed exercises at 12 months; 3.89 mean days per week exercised in final month | 2 % per month | $6 per week |
Dangour et al. (2011) Unsuccessful | Class; SI | Women and men aged 65 to 67.9 recruited from health center catchment areas | Average/below-average Risk | Physical activity group training sessions focused on resistance exercises. Participants were encouraged to walk to sessions. Instructor: physical activity instructor | Supervised: Strength, General physical activity • 1 hr, 2 times per week, 2 years | 38 % attended at least 24 classes over 12 months | 1 % per month | $3 per week |
Ebrahim et al. (1997) Unsuccessful 6 | Home; SI | Women who had sustained an upper arm fracture in past 2 years from registers of Emergency Department and orthopedic clinics of hospitals; recruited through letters explaining study | Above-average Risk | Participants encouraged to gradually work up to walking for 40 min, 3 times a week. Instructed to progressively increase the amount and speed of walking. Seen every 3 months to discuss problems, reinforce intervention and allow physiological measurements to be taken. Instructor: nurse | Unsupervised: Endurance • 40 min, 3 times per week, 2 years | All who remained in trial reported regular walking | 3 % per month during year 1 | $3 per week |
Freiberger et al. (2012) Successful (Fitness group) (Freiberger et al. 2007) 8 | Class and Home; SI | Women and men aged 70+ who had fallen in past 6 months or fear of falling from health insurance company membership database; recruited through questionnaires | Above-average Risk | All 3 interventions included strength and balance exercises but differed regarding their second feature (Additional strength and balance; endurance; fall risk education). Interventions were progressive over time and included intro discussion, warm-up exercise, main program, cool-down, and discussion. For home, participants received brochure describing how to perform the strength, balance, and gait exercises. Instructor: Fall prevention instructors | Strength and balance group: Supervised: Balance, Strength • 1 hr, 2 times per week, 4 months Unsupervised: Balance, Strength • Daily Fitness group: Supervised: Balance, Strength, Endurance • 1 hr, 2 times per week, 4 months Unsupervised: Balance, Strength • Daily Multifaceted group: Supervised: Balance, Strength • 1 hr, 2 times per week, 4 months Unsupervised: Balance, Strength • Daily | 82 % of strength and balance group, 84 % of fitness group, and 84 % of multifaceted group attended at least 24 of the 32 sessions | 1 % per month | $6 per week |
Green et al. (2002) Unsuccessful (De Weerdt and Feys 2002; Dowswell et al. 2002; Green et al. 2004) 8 | Outpatient rehab center or Home; I | Women and men who had a stroke at least 1 year previously and an associated persisting mobility problem; recruited from hospital and community therapy stroke registers | Above-average Risk | Patients were assessed by a physiotherapist and then treated with a problem solving approach at home or in outpatient rehabilitation centers. The main interventions given were gait re-education, exercise therapy, functional exercises, and balance re-education Instructor: physiotherapist | Supervised: Balance • At least 3 contacts over 13 week period | Median: 3 treatments per patient | 2 % per month | $7 per week |
Haines et al. (2009) Successful 7 | Home; SI | Women and men treated on geriatric rehabilitation, medical, or surgical units of hospital with gait instability; physiotherapist identified patients and referred to research team | Above-average Risk | First home visit provided instruction for the Kitchen Table Exercise Program. Program consisted of DVD and workbook for progressive exercise program combining lower limb strength and balance exercises. Program included 6 types of exercises each with 6 different levels of difficulties. Instructor: physiotherapist. | Supervised: Balance, Strength • At least initial and follow up visit Unsupervised: Balance, Strength • 2 times per week, 8 weeks | 15 of 19 attempted the program at least once during week 1; 8 attempted 1+ times during week 8 | 0 % per month | $10 per week |
Hauer et al. (2001) Successful 6 | Class at outpatient rehab unit; SI | Women with fall as reason for admission to hospital or recent history of injurious fall; recruited at end of rehabilitation from hospital | Above-average Risk | Ambulatory training of strength, functional performance, and balance. Exercise included warm up on stationary cycles, high-intensity progressive resistance training of functionally relevant muscle groups, and training in walking, stepping, and sitting to modify unsafe or inefficient performance. Patients progressed to advanced levels of exercise. Physiotherapy included massaging, stretching, and heat/ice to orthopedic problems. Instructor: therapeutic recreation specialist. | Supervised: Balance, Strength • 2.25 hr, 3 times per week, 3 months Supervised: Flexibility, Other • 25 min sessions, 2 times per week, 3 months | 85 % adherence | 8 % per month | $50 per week |
Hornbrook et al. (1994) Successful | Class and Home; S | Members of large HMO aged 65 years and older; Letter sent with follow up phone call or home visit if no response | Average/below-average Risk | Weekly group meetings included didactic presentations, demonstrations of falls prevention exercises, and small group meetings. Exercises were chosen to provide active involvement of all body parts, maintain full range of motion of all joints, provide strengthening, improve posture by preventing forward flexion of the head and shoulders, and improve balance. Participants were given a manual describing the exercises to follow at home and encouraged to begin walking. After the first 4 sessions, quarterly maintenance sessions were held. Instructor: health behaviorist and physical therapist | Supervised: Balance, Strength • 90 min, 1 time per week, 4 weeks Unsupervised: Balance, Strength • Time not specified Unsupervised: General physical activity • 3 times per week | 78 % attended at least 1 session, 61 % attended 3+ sessions | NR | $4 per week |
Iwamoto et al. (2009) Successful 6 | Clinic or hospital; S | Women and men aged 50 or older who visited hospital Department of Orthopedic Surgery or clinic | Above-average Risk | Exercise program in clinic or hospital consisted of calisthenics, body balance training, muscle power training, and walking ability training. Instructor: NR | Supervised: Balance, Strength, Flexibility • 30 min, 3 times per week, 5 months | Compliance with exercise 100 % | 0 % | $62 per week |
Kronhed et al. (2009) Successful (Kronhed 2009) 7 | Class; I | Women with established osteoporosis and at least one fragility fracture identified from files at the Osteoporosis Unit at hospital; invitation letter sent | Average/below-average Risk | Exercise consisted of a strength training program supervised by a physiotherapist. The program consisted of a warm-up using exercise bicycles and a cross-trainer. Back strengthening exercises, abdominal muscle training, sequence training exercises, and balance exercises were performed. In the introductory instruction, participants received personal instruction and an individually designed load that was progressively increased according to the participant’s capacity. Sessions finished with 10 min of stretching. Participants were encouraged to continue the training exercise program on their own at senior gyms after the supervised group exercise training period. Instructor: physiotherapist | Supervised: Balance, Strength, Flexibility, Endurance • 1 hr, 2 times per week, 4 months | Participants completed an average of 24 of 30 sessions | 5 % per month | $3 per week |
Latham et al. (2003a) Unsuccessful | Hospital and Home; SI | Frail women and men aged 65 and older admitted to geriatric rehabilitation units | Above-average Risk | Resistance exercise consisted of a quadriceps exercise program using adjustable ankle cuff weights. The aim was for patients to exercise at a high intensity by midway through the program. Each session began with individualized warm-up stretches, followed knee extensions. Most of the patients performed their first two exercise sessions in the hospital and continued the rest of their sessions at home. Instructor: physical therapist | Supervised: Strength • 2 sessions, then biweekly Unsupervised: Strength • 3 times per week, 10 weeks | Patients adhered to 82 % of prescribed sessions | 3 % per month | $29 per week |
Li et al. (2005) Successful | Class; S | Women and men aged 70 years or older enrolled in non-profit hospital system; recruited through letter sent by PCP, follow-up call from research staff. | Above-average Risk | Classical Yang Style Tai Chi (24 forms) classes emphasize multidirectional weight shifting, awareness of body alignment, and movement coordination. Instructor: experienced Tai Chi instructor | Supervised: 3D • 1 hr, 3 times per week, 26 weeks | Median compliance was 61 of 78 sessions | 5 % per month | $4 per week |
Lin et al. (2007) Successful 5 | Home; I | Women and men aged 65 and older who had medical attention due to a fall; recruited from clinics and hospitals | Average/below-average Risk | Exercise consisted of stretching, muscle strengthening, and balance training at increasing levels of difficulty. The training was individualized for each participant and consisted of 10 min of warm-up, 30 min of exercise, and 10 min of cool-down. Participants were instructed to practice these exercises at least three times a week. Instructor: physical therapist | Supervised: Balance, Strength, Flexibility • Every 2 weeks, 4 months Unsupervised: Balance, Strength, Flexibility • 40-60 min, 3 times per week, 4 months | NR | 6 % per month | $17 per week |
Logghe et al. (2009) Unsuccessful | Class and Home; S | Women and men aged 70 years and older; recruited from patient registration files of PCPs; letters sent by PCP | Above-average Risk | Tai Chi Chuan training with ten positions. Participants asked to practice the Tai Chi Chuan positions at home. Instructor: Tai Chi Chuan instructor | Supervised: 3D • 1 hr, 2 times per week, 13 weeks Unsupervised: 3D • 15 min, 2 times per week, 13 weeks | 47 % attended at least 80 % of lessons, 85 % completed home exercise | 9 % per month | $4 per week |
Luukinen et a. (2007) Unsuccessful | Class and/or home; I | Women and men aged 85 years or older; Recruitment not reported | Above-average Risk | Individual intervention plans were made during home visits by physiotherapist and occupational therapist based on risk factors. Home and group exercise, and walking exercises were recommended. Instructor: physiotherapist and occupational therapist | Supervised: General physical activity • Time not reported Unsupervised: not reported • 3 times per day, 1.5 years | NR | <1 % per month | NR |
Madureira et al. (2007) Successful 6 | Class and Home; S | Women aged 65 years and older; recruited from patients of Osteometabolic Disease Outpatient Clinic | Above-average Risk | Balance Training Program consisted of warm-up and stretching, walking, and balance training in dynamic and static positions. Patients were encouraged to continue same exercises at home. Instructor: experienced physiotherapist | Supervised: Balance, Flexibility, General physical activity • 1 hr, 1 time per week, 1 year (40 classes total) Unsupervised: Balance, Flexibility, General physical activity • 30 min, 3 times per week, 1 year | 60 % participated in all classes; 77 % completed home exercises 1+ times per week | 1 % per month | $1 per week |
Protas et al. (2005) Successful 5 | Outpatient research center; I | Men with idiopathic Parkinson’s disease diagnosed at Veterans Affairs center | Above-average Risk | Gait training consisted of walking on a treadmill at speed greater than over ground walking speed while walking in 4 directions and supported in harness for safety. Step training included suddenly turning treadmill on and off while subject stood in safety harness. Instructor: physical therapist | Supervised: Balance • 1 hr session, 3 times per week, 8 weeks | NR | NR | $124 per week |
Robertson et al. (2001) Successful (Campbell and Robertson 2010; Campbell and Robertson 2007; Gardner et al. 2001; Robertson and Campbell 2008; Robertson et al. 2002) 8 | Home; I | Women and men aged 75 and older from registers at 17 practices; letter sent from PCP | Average/below-average Risk | Otago: Set of muscle strengthening and balance retraining exercises that progressed in difficulty and a walking plan. Program individually prescribed during 5 home visits at weeks 1, 3, 4, and 8, and a booster visit after 6 months. Instructor: nurse | Supervised: Balance, Strength • 5 times Unsupervised: Balance, Strength • 30 min, 3 times per week, 1 year Unsupervised: General physical activity • 1 year | 43 % exercised 3+ times per week, 72 % exercised 2+ times per week, 71 % walked 2+ times per week | 1 % per month | $3 per week |
Rubenstein et al. (2000) Successful 7 | Class; S | Men aged 70 years or older with at least 1 key fall risk factor; recruited through Veterans Affairs Ambulatory Care Center. | Above-average Risk | Group exercise focused on increasing strength and endurance and improving mobility and balance. Strengthening exercises progressed over first 4 weeks. Endurance training included bicycle, treadmill, and indoor walking. Balance training increased in difficulty over 12 weeks. Instructor: exercise physiology graduate students. | Supervised: Balance, Strength, Endurance • 90 min, 3 times per week, 12 weeks | Participants attended 84 % of sessions | 3 % per month | $10 per week |
Steadman et al. (2003) Unsuccessful 5 | Hospital; I | Subjects aged 60 and older recruited from attendees at multidisciplinary falls clinic | Above-average Risk | Assisted walking within parallel bars, assessment for mobility aids, stair practice, general bed mobility skills, and transfers. Balance exercises consisted of repetition of a series of graded tasks specific to functional balance with targets of distance and time to provide feedback. Also discussed fall avoidance behaviors and strategies for coping with a long time on the floor. Instructor: clinical physiotherapists | Supervised: Balance • 45 min, 2 times per week, 6 weeks | Random selection of patients showed protocol being adhered to | 10 % per month | $62 per week |
Swanenburg et al. (2007) Successful 6 | Hospital physiotherapy dept.; I | Women with osteoporosis; recruitment not reported. | Above-average Risk | Program tailored to individual during initial 2 weeks. Two sessions per week focused on progressive resistance training and individual exercises to improve coordination, balance and endurance. One session per week consisted of a group exercise focused on balance exercises and games. Participants were also given daily protein supplements and encouraged to continue program after initial 3 months. Instructor: physical therapist | Supervised: Balance, Strength, Endurance • 70 min, 2 times per week, 12 weeks Supervised: Balance • 70 min, 1 time per week, 12 weeks | Compliance with exercise 93 % | 3 % per month | $144 per week |