Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB R3E 0W3, Canada; Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, 11th Floor, Toronto, ON M5G 2A2, Canada.
Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON M5B 1T8, Canada.
Exp Gerontol. 2021 Jan;143:111151. doi: 10.1016/j.exger.2020.111151. Epub 2020 Nov 10.
Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches.
All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations.
One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score = 0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination.
This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.
系统评价已经证实，运动可减少老年人跌倒，然而，最有效的运动类型尚不清楚。本二次分析旨在确定预防跌倒的运动方法的相对有效性。
从现有的搜索中确定了所有针对老年人的预防跌倒运动干预措施，该搜索从一开始进行到 2017 年 4 月。干预措施使用 25 种运动类型的框架进行编码。两名审查员独立筛选研究、提取数据并评估偏倚风险。进行了两两荟萃分析和网络荟萃分析（NMA）。使用 P 分数对运动组合进行排名。
共纳入 169 项研究。对 73 项研究（30697 名参与者）的跌倒人数结果进行了 NMA。相对于不运动，最有可能最有效的运动组合是：预期控制、动态稳定性、功能稳定性极限、反应控制和灵活性（P 分数=0.95）。与其他 16 种组合相比，这种运动组合也显著减少了跌倒人数。没有一种运动组合在减少跌倒人数方面比这种组合更有效。
本分析确定了预防跌倒的有效运动的组成部分。研究结果可为循证运动建议提供信息，并可用于设计有效的方案。
