Skelton D A, Beyer N
University College London Institute of Human Performance, Royal National Orthopaedic Hospital, Stanmore, UK.
Scand J Med Sci Sports. 2003 Feb;13(1):77-85. doi: 10.1034/j.1600-0838.2003.00300.x.
This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries. Falls and injury may lead to a spiral of inactivity and decline that take older people close to or below the critical "thresholds" of performance necessary for everyday activities. Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk factors for falls modifiable with tailored exercise. Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention. It is clear that the target population must be at risk or already fallers, they must be "not too fit" and "not too frail". Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly. In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective. There are, however, research questions that still need answering - whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries. This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.
本综述旨在为读者提供有关运动在降低风险因素以及预防跌倒和受伤方面作用的最新证据。跌倒和受伤可能会导致身体活动减少和机能衰退的恶性循环，使老年人接近或低于日常活动所需的关键“表现阈值”。然而，力量和功率低、平衡能力差、步态和功能能力不佳以及害怕跌倒都是可通过量身定制的运动加以改善的跌倒风险因素。尽管关于预防跌倒的运动类型、运动量和针对性的证据尚不完整，但已发布的建议无论是作为单独的运动干预措施，还是作为多因素干预措施的一部分，都已证明是有效的。显然，目标人群必须是有跌倒风险或已经跌倒的人，他们必须“不太健康”且“不太虚弱”。有监督的居家运动计划可能对80岁以上的老年人有效，因为他们跌倒频率更高、更容易受伤且恢复更慢。对于居住在社区的较年轻跌倒者，包括针对平衡、力量、功率、步态、耐力、灵活性、协调性和反应能力的多因素群体干预措施可能更有效。然而，仍有一些研究问题有待解答——某些类型的运动是否对特定老年亚组有害，不同老年亚组（一级和二级预防）运动的理想强度、频率和持续时间是多少，以及不同身体素质成分对预防跌倒和受伤的相对价值。本综述强调了在多学科预防跌倒和受伤中进行量身定制的特定平衡和力量训练的必要性。
