A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults
Fear of Falling , Older adults , Exercise
Fear of falling (FOF) contributes to activity restriction and increases fall risks and institutionalization among older adults. Exercise interventions are associated with a reduction in FOF. Adhering to exercise principles and adopting proper exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The objectives of this thesis were to describe FOF exercise interventions in community-dwelling older adults to inform future programs, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and finally quantify the effect of these interventions on reducing FOF. Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from MEDLINE, Embase, PsycINFO, and CINAHL databases from inception to 2020. Two reviewers independently screened and assessed the relevant literature, and a third reviewer was engaged to resolve any conflicts. The methodological quality of RCTs was assessed using the PEDro scale. The qualitative data were narratively synthesized, and a random-effect model was used in the meta-analysis. Sensitivity analyses were carried out to examine the impact of trials with small sample sizes and a high risk of bias on the findings. Seventy-five RCTs were included in this review. Most trials with a significant effect on FOF used multicomponent exercises and group-based interventions, moderate intensity, three-times-per-week frequency for 12 to 16 weeks, and 30 to 60 minutes for each exercise session. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminishing return in 21%, and initial value in only 8% of trials. For exercise parameters, 97% of RCTs reported exercise type, 89% reported frequency, and 85% reported time. Only 25% of trials reported the intensity of exercises. The pooled effect of exercise interventions on FOF reduction among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). The sensitivity analysis showed that the pooled effect size decreased after removing trials with small sample sizes (-0.25; 95% CI = 0.37 to 0.13) and with fair methodological quality (-0.22; 95% CI = -0.36 to -0.8), but the results were still significant. This study showed a significant small-to-moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and the intensity of exercises were not adequately reported in included trials. These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. Researchers must give more attention to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.