The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

OBJECTIVE: To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies. METHODS: Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures. RESULTS: Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I(2) = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I(2) = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I(2) = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I(2) = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I(2) = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I(2) = 0%, p = 0.15). CONCLUSION: Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men. TRANSLATIONAL POTENTIAL: The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.