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Ejercicio para la reducción del temor a las caídas en pacientes mayores que residen en la comunidad

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References

Barnett 2003 {published data only}

Barnett A, Smith B, Lord SR. Community‐based group exercise improves balance and reduces falls in at‐risk older people. Age and Ageing 2003;32(4):407‐14.

Campbell 1997 {published data only}

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Ageing 1999;28:513‐8.
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997;315:1065‐9.
Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise‐based falls prevention programme. Age and Ageing 2001;30(1):77‐83.
Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta‐analysis of individual‐level data. Journal of the American Geriatrics Society 2002;50:905‐11.
Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ. Economic evaluation of a community based exercise programme to prevent falls. Journal of Epidemiology and Community Health 2001;55(8):600‐6.

Clemson 2010 {published and unpublished data}

Clemson L. MFES and ABC data [personal communication]. Email to: A Kumar 21 March 2013.
Clemson L, Singh MF, Bundy A, Cumming RG, Weissel E, Munro J, et al. LiFE Pilot Study: a randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Australian Occupational Therapy Journal 2010;57(1):42‐50.

Freiberger 2012 {published data only}

Freiberger E, Haberle L, Spirduso WW, Rixt Zijlstra GA. Long‐term effects of three multicomponent exercise interventions on physical performance and fall‐related psychological outcomes in community‐dwelling older adults: a randomized controlled trial. Journal of the American Geriatrics Society 2012;60(3):437‐46.
Freiberger E, Menz HB, Abu‐Omar K, Rutten A. Preventing falls in physically active community‐dwelling older people: a comparison of two intervention techniques. Gerontology 2007;53(5):298‐305.

Haines 2009 {published data only}

ACTRN12607000180415. Assessment and prevention of falls, functional decline and hospital re‐admission in older adults post‐hospitalisation. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81910 (accessed 30 September 2014).
Haines TP, Russell T, Brauer SG, Erwin S, Lane P, Urry S, et al. Effectiveness of a video‐based exercise programme to reduce falls and improve health‐related quality of life among older adults discharged from hospital: a pilot randomized controlled trial. Clinical Rehabilitation 2009;23(11):973‐85.

Halvarsson 2011 {published and unpublished data}

Halvarsson A. FES‐I and GDS‐20 data [Personal communication]. Email to: A Kumar 31 March 2013.
Halvarsson A,  Oddsson L,  Olsson E,  Farén E,  Pettersson A,  Ståhle A. Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial. Clinical Rehabilitation 2011;25(11):1021‐31.

Hinman 2002 {published data only}

Hinman MR. Comparison of two short‐term balance training programs for community‐dwelling older adults. Journal of Geriatric Physical Therapy 2002;25(3):10‐5.

Karinkanta 2012 {published data only}

Karinkanta S, Nupponen R, Heinonen A, Pasanen M, Sievänen H, Uusi‐Rasi K, et al. Effects of exercise on health‐related quality of life and fear of falling in home‐dwelling older women. Journal of Aging & Physical Activity 2012;20(2):198‐214.

Lai 2013 {published data only}

Lai C, Peng C, Chen Y, Huang CP, Hsiao YL, Chen SC. Effects of interactive video‐game based system exercise on the balance of the elderly. Gait and Posture 2013;37(4):511‐5.

Lajoie 2004 {published and unpublished data}

Lajoie 2004. ABC data [personal communication]. Email to: A Kumar 08 March 2013.
Lajoie Y. Effect of computerized feedback postural training on posture and attentional demands in older adults. Aging Clinical and Experimental Research 2004;16(5):363‐8.

Lin 2007 {published data only}

Lin M, Wolf SL, Hwang H, Gong S, Chen C. A randomized, controlled trial of fall prevention programs and quality of life in older fallers. Journal of the American Geriatrics Society 2007;55(4):499‐506.
Lin MR, Hwang H, Wang Y, Chang S, Wolf SL. Community‐based tai chi and its effect on injurious falls, balance, gait, and fear of falling in older people. Physical Therapy 2006;86(9):1189‐201.

Logghe 2009 {published data only}

ISRCTN98840266. Fall prevention in the elderly ‐ a randomized clinical trial on the effectiveness of Tai Chi Chuan. http://www.controlled‐trials.com/ISRCTN98840266 (accessed 1 August 2013).
Logghe IH, Verhagen AP, Rademaker AC, Bierma‐Zeinstra SM, van Rossum E, Faber MJ, et al. The effects of Tai Chi on fall prevention, fear of falling and balance in older people: a meta‐analysis. Preventive Medicine: An International Journal Devoted to Practice and Theory 2010;51:222‐7.
Logghe IH, Verhagen AP, Rademaker AC, Zeeuwe PE, Bierma‐Zeinstra SM, van Rossum E, et al. Explaining the ineffectiveness of a Tai Chi fall prevention training for community‐living older people: a process evaluation alongside a randomized clinical trial (RCT). Archives of Gerontology & Geriatrics 2011;52(3):357‐62.
Logghe IHJ, Zeeuwe PEM, Verhagen AP, Wijnen‐Sponselee RMT, Willemsen SP, Bierma‐Zeinstra SMA, et al. Lack of effect of Tai Chi Chuan in preventing falls in elderly people living at home: a randomized clinical trial. Journal of the American Geriatrics Society 2009;57(1):70‐5.
Zeeuwe PEM, Verhagen AP, Bierma‐Zeinstra SMA, van Rossum E, Faber MJ, Koes BW. The effect of Tai Chi Chuan in reducing falls among elderly people: design of a randomized clinical trial in the Netherlands [ISRCTN98840266]. BMC Geriatrics 2006;6:6.

McCormack 2004 {published and unpublished data}

McCormack G. Data on the number of female participants [personal communication]. Email to: A Kumar 12 February 2013.
McCormack G, Lewin G, McCormack B, Helmes E, Rose E, Naumann F. Pilot study comparing the influence of different types of exercise intervention on the fear of falling in older adults. Australasian Journal of Ageing 2004;23(3):131‐5.

Nguyen 2012 {published data only}

Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese. Clinical Interventions in Aging 2012;7:185‐90.

Reinsch 1992 {published data only}

MacRae PG, Feltner ME, Reinsch S. A 1‐year exercise program for older women: effects on falls, injuries, and physical performance. Journal of Aging and Physical Activity 1994;2:127‐42.
Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992;32:450‐6.

Rendon 2012 {published data only}

Rendon A, Lohman E, Thorpe D, Johnson EG, Medina E, Bradley B. The effect of virtual reality gaming on dynamic balance in older adults. Age and Ageing 2012;41(4):549‐52.

Resnick 2008 {published data only}

Resnick B, Luisi D, Vogel A. Testing the Senior Exercise Self‐efficacy Project (SESEP) for use with urban dwelling minority older adults. Public Health Nursing 2008;25(3):221‐34.

Sihvonen 2004 {published data only}

Sihvonen S, Sipilä S, Taskinen S, Era P. Fall incidence in frail older women after individualized visual feedback‐based balance training. Gerontology 2004;50(6):411‐6.
Sihvonen SE, Sipilä S, Era PA. Changes in postural balance in frail elderly women during a 4‐week visual feedback training: a randomized controlled trial. Gerontology 2004;50(2):87‐95.

Tiedemann 2012 {published data only}

Tiedemann A, O'Rourke S, Sesto R, Sherrington C. A 12‐week Iyengar yoga program improved balance and mobility in older community‐dwelling people: a pilot randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2013;68(9):1068‐75.
Tiedemann A, Sherrington C, O'Rourke S. Can yoga improve balance in older people?: A randomised controlled trial. Journal of Science and Medicine in Sport 2012;15(Suppl 1):S292.

Ullmann 2010 {published and unpublished data}

Ullman G. FES and ABC data [personal communication]. Email to: A Kumar 20 February 2013.
Ullmann G. The Efficacy of Feldenkrais in Improving Balance, Mobility and Health Related Factors in an Older Adult Population [Thesis]. South Carolina: University of South Carolina, 2008.
Ullmann G, Williams HG, Hussey J, Durstine JL, McClenaghan BA. Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community‐dwelling adults age 65 and older. Journal of Alternative & Complementary Medicine 2010;16(1):97‐105.

Vogler 2009 {published and unpublished data}

ACTRN12605000335695. Reducing falls risk in older people discharged from hospital: a randomised controlled trial comparing (i) seated lower limb resistance training, (ii) functional weight‐bearing training and (iii) social visits (control activity). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12605000335695 (accessed 12 October 2014).
Vogler C, Sherrington C, Ogle S, Lord S. Reducing risk of falling in older people discharged from hospital: a randomised controlled trial comparing seated lower limb strength training, weight‐bearing exercises and social visits [abstract]. Internal Medicine Journal 2008;38(Suppl 5):A127.
Vogler CM. MFES and GDS data [personal communication]. Email to: A Kumar 25 February 2013.
Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight‐bearing exercises, and social visits. Archives of Physical Medicine & Rehabilitation 2009;90(8):1317‐24.

Vrantsidis 2009 {published and unpublished data}

Vrantsidis F. Information about care provided at low‐care facility [personal communication]. Email to: A Kumar 10 February 2013.
Vrantsidis F, Hill KD, Moore K, Webb R, Hunt S, Dowson L. Getting Grounded Gracefully: effectiveness and acceptability of Feldenkrais in improving balance. Journal of Aging and Physical Activity 2009;17(1):57‐76.

Wallsten 2006 {published and unpublished data}

Wallsten SM. ABC data [personal communication]. Email to: A Kumar 22 March 2013.
Wallsten SM, Bintrim K, Denman DW, Parrish JM, Hughes G. The effect of Tai Chi Chuan on confidence and lower extremity strength and balance in residents living independently at a continuing care retirement community. Journal of Applied Gerontology 2006;25(1):82‐95.

Weerdesteyn 2006 {published and unpublished data}

Weerdesteyn V. ABC data [personal communication]. Email to: A Kumar 15 March 2013.
Weerdesteyn V, Rijken H, Geurts AC, Smits‐Engelsman BC, Mulder T, Duysens J. A five‐week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology 2006;52(3):131‐41.

Westlake 2007 {published and unpublished data}

Westlake K. Information about control group treatment [personal communication]. Email to: A Kumar 1 February 2013.
Westlake KP, Culham EG. Sensory‐specific balance training in older adults: effect on proprioceptive reintegration and cognitive demands. Physical Therapy 2007;87(10):1274‐83.

Wolf 1996 {published data only}

Kutner NG, Barnhart H, Wolf SL, McNeely E, Xu T. Self‐report benefits of Tai Chi practice by older adults. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 1997;52(5):242‐6.
McNeely E, Clements SD, Wolf SL. A program to reduce frailty in the elderly. In: Funk SG, Tornquist EM, Champagne MT, Weise RA editor(s). Key Aspects of Eldercare: Managing Falls, Incontinence, and Cognitive Impairment. New York: Springer, 1992:89‐96.
O'Grady M, Wolf SL, Barnhart HX, Kutner N, McNeely E. Tai Chi effect on falls in frail older adults [abstract]. Archives of Physical Medicine and Rehabilitation 1997;78:1028.
Wolf SL, Barnhart HX, Ellison GL, Coogler CE. The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Physical Therapy 1997;77(4):371‐81.
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Journal of the American Geriatrics Society 1996;44(5):489‐97.
Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Selected as the best paper in the 1990s: reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training (commentary by Lavery LL and Studenski SA. Reprinted from JAGS 1996 page 1794). Journal of the American Geriatrics Society 2003;51:1794‐805.
Wolf SL, Kutner NG, Green RC, McNeely E. The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. Journal of the American Geriatrics Society 1993;41(3):329‐32.

Wolf 2001 {published data only}

Wolf B,  Feys H,  De Weerdt,  van der Meer J,  Noom M,  Aufdemkampe G,  et al. Effect of a physical therapeutic intervention for balance problems in the elderly: a single‐blind, randomized, controlled multicentre trial. Clinical Rehabilitation 2001;15(6):624‐36.

Yang 2012 {published data only}

Yang XJ,  Hill K,  Moore K,  Williams S,  Dowson L,  Borschmann K,  et al. Effectiveness of a targeted exercise intervention in reversing older people's mild balance dysfunction: a randomized controlled trial. Physical Therapy 2012;92(1):24‐37.

Yoo 2010 {published data only}

Yoo EJ, Jun TW, Hawkins SA. The effects of a walking exercise program on fall‐related fitness, bone metabolism, and fall‐related psychological factors in elderly women. Research in Sports Medicine 2010;18(4):236‐50.

Zhang 2006 {published data only}

Zhang JG, Ishikawa‐Takata K, Yamazaki H, Morita T, Ohta T. The effects of Tai Chi Chuan on physiological function and fear of falling in the less robust elderly: an intervention study for preventing falls. Archives of Gerontology & Geriatrics 2006;42(2):107‐16.

Bainbridge 2011 {published data only}

Bainbridge E, Bevans S, Keeley B, Oriel K. The effects of the Nintendo Wii fit on community‐dwelling older adults with perceived balance deficits: a pilot study. Physical & Occupational Therapy in Geriatrics 2011;29(2):126‐35.

Ballard 2004 {published data only}

Ballard JE, McFarland C, Wallace LS, Holiday DB, Roberson G. The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years. Journal of the American Medical Women's Association 2004;59(4):255‐61.

Banez 2008 {published data only}

Banez C, Tully S, Amaral L, Kwan D, Kung A, Mak K, et al. Development, implementation, and evaluation of an interprofessional falls prevention program for older adults. Journal of the American Geriatrics Society 2002;56(8):1549‐55.

Batson 2006 {published data only}

Batson G, Feltman R, McBride C, Waring J. Effect of mental practice combined with physical practice on balance in the community‐dwelling elderly. Activities, Adaptation & Aging 2006;31(2):1‐18.

Bean 2002 {published data only}

Bean J, Herman S, Kiely DK, Callahan D, Mizer K, Frontera WR, et al. Weighted stair climbing in mobility‐limited older people: a pilot study. Journal of the American Geriatrics Society 2002;50(4):663‐70.

Beyer 2007 {published data only}

Beyer N, Simonsen L, Bulow J, Lorenzen T, Jensen DV, Larsen L, et al. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training. Aging Clinical and Experimental Research 2007;19:300‐9.

Bishop 2007 {published data only}

Bishop MD, Meuleman J, Robinson M, Light KE. Influence of pain and depression on fear of falling, mobility, and balance in older male veterans. Journal of Rehabilitation Research & Development 2007;44(5):675‐84.

Bishop 2010 {published data only}

Bishop MD, Patterson TS, Romero S, Light KE. Improved fall‐related efficacy in older adults related to changes in dynamic gait ability. Physical Therapy 2010;90(11):1598‐606.

Bula 2011a {published data only}

Bula C, Monod S, Hoskovec C, Rochat S. Interventions aiming at balance confidence improvement in older adults: an updated review. Gerontology 2011;57(3):276‐86.

Bunout 2005 {published data only}

Bunout D, Barrera G, Avendano M, De la Maza P, Gattas V, Leiva L, et al. Results of a community‐based weight‐bearing resistance training programme for healthy Chilean elderly subjects. Age and Ageing 2005;34(1):80‐3.

Chang 2007 {published data only}

Chang Shuo‐Hsiu J. Improving Lateral Stability in Older Adults at Risk of Falls. North Carolina, USA: University of North Carolina, 2007.

Conroy 2010 {published data only}

Conroy S, Kendrick D, Harwood R, Gladman J, Coupland C, Sach T, et al. A multicentre randomised controlled trial of day hospital‐based falls prevention programme for a screened population of community‐dwelling older people at high risk of falls. Age and Ageing 2010;39(6):704‐10.

Davis 2011 {published data only}

Davis J, Marra C, Liu‐Ambrose T. Falls‐related self‐efficacy is independently associated with quality‐adjusted life years in older women. Age and Ageing 2011;40(3):340‐6.

Davison 2005 {published data only}

Davison J, Bond J, Dawson P, Steen IN, Kenny RA. Patients with recurrent falls attending accident & emergency benefit from multifactorial intervention ‐‐ a randomised controlled trial. Age and Ageing 2005;34(2):162‐8.

Delbaere 2006 {published data only}

Delbaere K, Bourgois J, Van Den Noortgate N, Vanderstraeten G, Willems T, Cambier D. A home‐based multidimensional exercise program reduced physical impairment and fear of falling. Acta Clinica Belgica 2006;61(6):340‐50.

Devereux 2005 {published data only}

Devereux K, Robertson D, Briffa NK. Effects of a water‐based program on women 65 years and over: a randomised controlled trial. Australian Journal of Physiotherapy 2005;51(2):102‐8.

Duque 2013 {published data only}

Duque G, Boersma D, Loza‐Diaz G, Hassan S, Suarez H, Geisinger D, et al. Effects of balance training using a virtual‐reality system in older fallers. Clinical Interventions in Aging 2013;8:257‐63.

Elley 2003 {published data only}

Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ 2003;326(7393):793‐6.

Elley 2008 {published data only}

Elley C, Robertson M, Garrett S, Kerse NM, McKinlay E, Lawton B, et al. Effectiveness of a falls‐and‐fracture nurse coordinator to reduce falls: a randomized, controlled trial of at‐risk older adults. Journal of the American Geriatrics Society 56;8:1383‐9.

Faber 2006 {published data only}

Faber MJ, Bosscher RJ, Chin A Paw MJ, Van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre‐frail older adults: a multicenter randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2006;87(7):885‐96.

Faes 2011 {published data only}

Faes M, Reelick M, Melis R, Borm G, Esselink RG. Multifactorial fall prevention for pairs of frail community‐dwelling older fallers and their informal caregivers: a dead end for complex interventions in the frailest fallers. Journal of the American Medical Directors Association 2011;12(6):451‐8.
NCT00512655. Trial to reduce falls incidence rate in frail elderly. http://clinicaltrials.gov/show/NCT00512655 (accessed 1 August 2013).

Foley 2009 {published data only}

Foley A, Hillier S, Barnard R. Evaluation of a geriatric day rehabilitation centre: subjective and objective outcomes in community‐dwelling older adults. Australian Journal of Primary Health 2009;15(2):117‐22.

Gillespie 2012 {published data only}

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD007146.pub3]

Gitlin 2006 {published data only}

Gitlin LN, Winter L, Dennis MP, Corcoran M, Schinfeld S, Hauck WW. A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society 2006;54(5):809‐16.
NCT00249925. Project ABLE: Advancing Better Living for Elders. http://clinicaltrials.gov/show/NCT00249925 (accessed 1 August 2013).

Greendale 2009 {published data only}

Greendale GA, Huang M, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult‐onset hyperkyphosis: results of a randomized controlled trial. Journal of the American Geriatrics Society 2009;57(9):1569‐79.

Hagedorn 2010 {published data only}

Hagedorn DK, Holm E. Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. European Journal of Physical and Rehabilitation Medicine 2010;46(2):159‐68.

Hakim 2003 {published data only}

Hakim RM, Newton RA, Segal J, DuCette JP. A group intervention to reduce fall risk factors in community‐dwelling older adults. Physical & Occupational Therapy in Geriatrics 2010;22(1):1‐20.

Hakim 2004 {published data only}

Balzano JM, Burke JL, Hoy TW, Roberts EM, Hakim R. A comparative study of balance measures among elderly persons participating in Tai Chi or structured exercise programs. Journal of Geriatric Physical Therapy 2002;25(3):44‐5.
Hakim RM, DiCicco J, Burke J, Hoy T, Roberts E. Differences in balance related measures among older adults participating in Tai Chi, structured exercise, or no exercise. Journal of Geriatric Physical Therapy 2004;27(1):11‐5.

Hakim 2010 {published data only}

Cissel E, Cours J, Teel S, Hakim R. A cross‐sectional study of balance‐related measures with older adults who participate in Tai Chi, Yoga, or no exercise. Journal of Geriatric Physical Therapy 2005;28(3):119‐20.
Hakim RM, Kotroba E, Cours J, Teel S, Leininger PM. A cross‐sectional study of balance‐related measures with older adults who participated in Tai Chi, yoga, or no exercise. Physical & Occupational Therapy in Geriatrics 2010;28(1):63‐74.

Harling 2008 {published data only}

Harling A, Simpson JP. A systematic review to determine the effectiveness of Tai Chi in reducing falls and fear of falling in older adults. Physical Therapy Reviews 2008;13(4):237‐48.

Harmer 2008 {published data only}

Harmer P, Li F. Tai Chi and falls prevention in older people. Medicine and Sports Science 2008;52:124‐34.

Hartmann 2009 {published data only}

Hartmann A, Murer K, De Bie RA, De Bruin ED. The effect of a foot gymnastic exercise programme on gait performance in older adults: a randomised controlled trial. Disability & Rehabilitation 2009;31(25):2101‐10.

Hess 2005 {published data only}

Hess JA. High Intensity Strength Training to Enhance Balance Control in Frail Older Adults [Thesis]. Oregon, USA: University of Oregon, 2004.
Hess JA, Woollacott M. Effect of high‐intensity strength‐training on functional measures of balance ability in balance‐impaired older adults. Journal of Manipulative & Physiological Therapeutics 2005;28(8):582‐90.

Hinrichs 2009 {published data only}

Hinrichs T, Bucchi C, Brach M, Wilm S, Endres HG, Burghaus I, et al. Feasibility of a multidimensional home‐based exercise programme for the elderly with structured support given by the general practitioner's surgery: study protocol of a single arm trial preparing an RCT. BMC Geriatrics 2009;9:37.

Huang 2011 {published data only}

Huang TT, Yang LH, Liu CY. Reducing the fear of falling among community‐dwelling elderly adults through cognitive‐behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. Journal of Advanced Nursing 2011;67(5):961‐71.

Hugel 2000 {published data only}

Hugel K, Sciandra T. The effects of a 12‐week Tai Chi program on thoracolumbar, hip, and knee flexion in adults 50 years and older. Issues on Aging 2000;23(3):15‐8.

Inokuchi 2007 {published data only}

Inokuchi S, Matsusaka N, Hayashi T, Shindo H. Feasibility and effectiveness of a nurse‐led community exercise programme for prevention of falls among frail elderly people: a multi‐centre controlled trial. Journal of Rehabilitation Medicine 2007;39(6):479‐85.

ISRCTN05350123 {published data only}

ISRCTN05350123. The effects of computer game dancing on foot placement accuracy and gaze behavior in older adults: a randomized control trial. http://www.controlled‐trials.com/ISRCTN05350123 (accessed 1 August 2013).

ISRCTN05545178 {published data only}

ISRCTN05545178. The use of a virtual reality video dance game for the training of motor control in elderly: a two‐groups pre‐test post‐test controlled experimental design. http://www.controlled‐trials.com/ISRCTN05545178 (accessed 1 August 2013).

ISRCTN21695765 {published data only}

ISRCTN21695765. Cost‐effectiveness of a proprioceptive exercise program in institutionalised elderly with fear of falling: randomised controlled trial. http://www.controlled‐trials.com/ISRCTN21695765 (accessed 1 August 2013).

ISRCTN48015966 {published data only}

ISRCTN48015966. The Chaos Clinic for prevention of falls and related injuries: a randomised, controlled trial. http://www.controlled‐trials.com/ISRCTN48015966 (accessed 1 August 2013).

ISRCTN67535605 {published data only}

ISRCTN67535605. A randomised controlled trial to compare falls prevention rehabilitation for people who fall and call an emergency ambulance but who are not transported to hospital. http://www.controlled‐trials.com/ISRCTN67535605. UK, (accessed 1 August 2013).

ISRCTN75134517 {published data only}

ISRCTN75134517. The effects of physical exercise training in combination with cognitive training on dual task costs of walking in elderly: a two‐groups pre‐test post‐test randomized controlled trial. http://www.controlled‐trials.com/ISRCTN75134517 (accessed 1 August 2013).

ISRCTN89512790 {published data only}

ISRCTN89512790. Randomised controlled trial to test the effects of, respectively, health coaching and an integrative district nurse approach for preventing falls in elderly people living in the community. ISRCTN89512790 (accessed 1 August 2013).

Iwamoto 2009 {published data only}

Iwamoto J, Suzuki H, Tanaka K, Kumakubo T, Hirabayashi H, Miyazaki Y, et al. Preventative effect of exercise against falls in the elderly: A randomized controlled trial. Osteoporosis International 2009;20(7):1233‐40.

Jansson 2004 {published data only}

Jansson S, Sunderlund A. A new treatment programme to improve balance in elderly people ‐‐ an evaluation of an individually tailored home‐based exercise programme in five elderly women with a feeling of unsteadiness. Disability & Rehabilitation 2004;26(24):1431‐43.

Juarbe 2009 {published data only}

Juarbe A, Bondoc S. Reducing fear of falling through guided imagery. Gerontology Special Interest Section Quarterly 2009;32(4):1‐4.

Jury 2009 {published data only}

Jung D, Juhee L, Lee S. A meta‐analysis of fear of falling treatment programs for the elderly. Western Journal of Nursing Research 2009;31(1):6‐16.

Kelsey 2010 {published data only}

Kelsey JL, Berry SD, Procter‐Gray E, Quach L, Nguyen UDT, Li W, et al. Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Journal of the American Geriatrics Society 2010;58(11):2135‐41.

Kemmler 2010 {published data only}

Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA. Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Archives of Internal Medicine 2010;170(2):179‐85.

Kerse 2010 {published data only}

Kerse N, Hayman KJ, Moyes SA, Peri K, Robinson E, Dowell A, et al. Home‐based activity program for older people with depressive symptoms: DeLLITE‐‐A randomized controlled trial. Annals of Family Medicine 2010;8(3):214‐23.

Kim 2009a {published data only}

Kim BH. The effects of guided relaxation and exercise imagery on older adults with a fear of falling. Dissertation Abstracts International: Section B: The Sciences and Engineering 2009;70(6‐B):3771.

Kim 2011 {published data only}

Kim H, Yoshida H, Suzuki T. The effects of multidimensional exercise on functional decline, urinary incontinence, and fear of falling in community‐dwelling elderly women with multiple symptoms of geriatric syndrome: a randomized controlled and 6‐month follow‐up trial. Archives of Gerontology & Geriatrics 2011;52(1):99‐105.

Kuo 2011 {published data only}

Kuo SL, Nitz NL. Effect of exercise intervention on balance and fear of falling in elderly subjects. Hong Kong Physiotherapy Journal 2011;29(2):96‐7.

Kuptniratsaikul 2011 {published data only}

Kuptniratsaikul V, Praditsuwan R, Assantachai P, Ploypetch T, Udompunturak S, Pooliam J. Effectiveness of simple balancing training program in elderly patients with history of frequent falls. Clinical Interventions in Aging 2011;6:111‐7.

Kuramoto 2006 {published data only}

Kuramoto M. Therapeutic benefits of Tai Chi exercise: research review. Wisconsin Medical Journal 2006;105(7):42‐6.

Kwok 2011 {published data only}

Kwok BC, Mamun K, Chandran M, Wong CH. Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial. Trials 2011;12:155.

Kwon 2011 {published data only}

Kwon MS. Effects of a fall prevention program on physical fitness and psychological functions in community dwelling elders. Journal of Korean Academic Nursing 2011;41:165‐74.

Lee 2010 {published data only}

Lee Y, Tabourne CES, Harris JE. Effects of Dancing Heart Program (DHP) as therapeutic recreation intervention on risk of falling among community dwelling elders. Annual in Therapeutic Recreation 2010;18:157‐63.

Leininger 2006 {published data only}

Leininger P. Physical and Psychological Effects of Yoga Exercise on Healthy Community‐dwelling Older Adult Women. Philadelphia: Temple University, 2006.

Li 2005 {published data only}

Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. Journals of Gerontology Series A: Biological Sciences & Medical Sciences 2005;60(2):187‐94.

Li 2010 {published data only}

Li KZH, Roudaia E, Lussier M, Bherer L, Leroux A, McKinley PA. Benefits of cognitive dual‐task training on balance performance in healthy older adults. Journals of Gerontology Series A: Biological Sciences & Medical Sciences 2010;65A(12):1344‐52.

Lin 2008 {published data only}

Lin LJ, McClear E, Tabourne CES. The outcomes of therapeutic dance movement on physical and emotional functioning for elderly people. American Journal of Recreation Therapy 2008;Winter:25‐34.

Liu 2007 {published data only}

Liu H, Rainey J, Zabel R, Quiben MU, Kehayov A, Boswell J. Comparison of two exercise programs using the Falls Efficacy Scale, Berg Balance Scale and ankle dorsiflexor strength in older adults. Physical & Occupational Therapy in Geriatrics 2007;26(2):23‐42.

Liu 2008 {published data only}

Liu M, So H. Effects of Tai Chi exercise program on physical fitness, fall related perception and health status in institutionalized elders. Taehan Kanho Hakhoe Chi 2008;38(4):620‐8.

Liu 2009a {published data only}

Liu H, Grando V, Zabel R, Nolen J. Pilot study evaluating fear of falling and falls among older rolling walker users... including commentary by Hakim RM, Huang M, and Pearson B. International Journal of Therapy & Rehabilitation 2009;16:670‐7.

Liu 2010 {published data only}

Liu H, Frank A. Tai chi as a balance improvement exercise for older adults: a systematic review. Journal of Geriatric Physical Therapy 2010;33:103‐9.

Lord 1995 {published data only}

Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12‐month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. Journal of the American Geriatrics Society 1995;43:1198‐206.

Lord 2005 {published data only}

Lord SR, Tiedemann A, Chapman K, Munro B, Murray SM, Sherrington C. The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. Journal of the American Geriatrics Society 2005;53:1296‐304.

Luukinen 2007 {published data only}

Luukinen H, Lehtola S, Jokelainen J, Vaananen‐Sainio R, Lotvonen S, Koistinen P. Pragmatic exercise‐oriented prevention of falls among the elderly: a population‐based, randomized, controlled trial. Preventive Medicine 2007;44(3):265‐71.

Maginnis 1999 {published data only}

Maginnis ME, Privett JL, Raskas WA, Newton RA. Balance abilities of community dwelling older adults engaged in a water exercise program. Journal of Aquatic Physical Therapy 1999;7:6‐12.

Mahoney 2007 {published data only}

Mahoney JE, Shea TA, Przybelski R, Jaros L, Gangnon R, Cech S, et al. Kenosha County Falls Prevention Study: a randomized, controlled trial of an intermediate‐intensity, community‐based multifactorial falls intervention. Journal of the American Geriatrics Society 2007;55:489‐98.

Marchetti 2005 {published data only}

Marchetti G, Hodges M, Brown R, Krohn K. Test‐retest reliability, external structure validity and responsiveness of gait parameters for older adult females walking at preferred and maximum velocity. Journal of Geriatric Physical Therapy 2005;28:114.

McCulloch 2002 {published data only}

McCulloch KL, Guerra LD, Lee C, Taylor KM. Dual‐task performance on the standardized walking obstacle course: measurement of balance changes in older adults following a pilot intervention. Journal of Geriatric Physical Therapy 2002;25:37.

McKinley 2008 {published data only}

McKinley P, Jacobson A, Leroux A, Bednarczyk V, Rossignol M, Fung J. Effect of a community‐based Argentine tango dance program on functional balance and confidence in older adults. Journal of Aging & Physical Activity 2008;16:435‐53.

McMurdo 1997 {published data only}

McMurdo ME, Mole PA, Paterson CR. Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997;314:569.

Mihay 2006 {published data only}

Mihay LM, Boggs KM, Breck AJ, Dokken EL, NaThalang GC. The effect of Tai Chi inspired exercise compared to strength training: a pilot study. Physical & Occupational Therapy in Geriatrics 2006;24:13‐26.

Miller 2010 {published data only}

Miller KL, Magel JR, Hayes JG. The effects of a home‐based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community‐dwelling older adults: a pilot study. Journal of Geriatric Physical Therapy 2010;33:85‐91.

Morgan 2004 {published data only}

Morgan RO, Virnig BA, Duque M, Abdel‐Moty E, Devito CA. Low‐intensity exercise and reduction of the risk for falls among at‐risk elders. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2004;59:1062‐7.

Nagai 2011 {published data only}

Nagai K,  Inoue T,  Yamada Y,  Tateuchi H,  Ikezoe T,  Ichihashi N,  et al. Effects of toe and ankle training in older people: a cross‐over study. Geriatrics & Gerontology International 2011;11(3):246‐55.

NCT00037167 {published data only}

NCT00037167. Effects of exercise poles on older adults during exercise walking. http://clinicaltrials.gov/show/NCT00037167 (accessed 1 August 2013).

NCT00140322 {published data only}

NCT00140322. Dane County Safety Assessment (SAFE) research study. http://clinicaltrials.gov/show/NCT00140322 (accessed 1 August 2013).

NCT00217360 {published data only}

NCT00217360. RCT to reduce further falls and injuries for older fallers presenting to an emergency department. http://clinicaltrials.gov/show/NCT00217360 (accessed 1 August 2013).

NCT00323596 {published data only}

NCT00323596. Trial of a home based strength and balance retraining program in reducing falls risk factors. http://clinicaltrials.gov/show/NCT00323596 (accessed 1 August 2013).

NCT00483275 {published data only}

NCT00483275. Fall Prevention by Alfacalcidol and Training (SPALT). http://clinicaltrials.gov/show/NCT00483275 (accessed 1 August 2013).

NCT00805220 {published data only}

NCT00805220. Nordic walking as gait training for frail elderly. http://clinicaltrials.gov/show/NCT00805220 (accessed 1 August 2013).

NCT00986466 {published data only}

NCT00986466. Vitamin D and exercise in falls prevention (DEX). http://clinicaltrials.gov/show/NCT00986466 (accessed 1 August 2013).

NCT01006967 {published data only}

NCT01006967. ActiveStep Comparative Effectiveness Trial (RACE). http://clinicaltrials.gov/show/NCT01006967 (accessed 1 August 2013).

NCT01313481 {published data only}

NCT01313481. Effect of the Otago programme delivered as home exercise or group exercise (FALLFOR). http://clinicaltrials.gov/show/NCT01313481 (accessed 1 August 2013).

NCT01523600 {published data only}

NCT01523600. Whole body vibration training among older people using sheltered housing. http://clinicaltrials.gov/ct2/show/NCT01523600 (accessed 1 August 2013).

Nitz 2004 {published data only}

Nitz JC, Choy NL. The efficacy of a specific balance‐strategy training programme for preventing falls among older people: a pilot randomised controlled trial. Age and Ageing 2004;33:52‐8.

Obuchi 2004 {published data only}

Obuchi S, Kojima M, Shiba Y, Shimada H, Suzuki T. A randomized controlled trial of a treadmill training with the perturbation to improve the balance performance in the community dwelling elderly subjects [Japanese]. Nippon Ronen Igakkai Zasshi ‐ Japanese Journal of Geriatrics 2004;41:321‐7.

Oh 2012 {published data only}

Oh DH, Park JE, Lee ES, Oh SW, Cho SI, Jang SN, et al. Intensive exercise reduces the fear of additional falls in elderly people: findings from the Korea falls prevention study. Korean Journal of Internal Medicine 2012;27:417‐25.

Robertson 2001a {published data only}

Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001;322(7288):697‐701.

Robertson 2001b {published data only}

Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres. BMJ 2001;322(7288):701‐4.

Romero 2010 {published data only}

Romero ZA. Effects of tai chi on health‐related quality of life in the elderly [Efectos del Tai Chi sobre la calidad de vida relacionada con la salud en los mayores]. Revista Española de Geriatría y Gerontología 2010;45(2):97‐102.

Rosendahl 2006 {published data only}

Rosendahl E. Fall Prediction and a High‐intensity Functional Exercise Programme to Improve Physical Functions and to Prevent Falls Among Older People Living in Residential Care Facilities [Thesis]. Sweden: Umeå University, 2006.

Rosie 2007 {published data only}

Rosie J, Taylor D. Sit‐to‐stand as home exercise for mobility‐limited adults over 80 years of age ‐ GrandStand SystemTM may keep you standing?. Age and Ageing 2007;36:555‐62.

Rubenstein 2000 {published data only}

Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, et al. Effects of a group exercise program on strength, mobility, and falls among fall‐prone elderly men. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000;55(6):M317‐21.

Schwarting 2002 {published data only}

Schwarting AE, Listerman LR, Harrison AL. The effectiveness of an intervention plan in decreasing fear of falling. Journal of Geriatric Physical Therapy 2002;25:39.

Sherrington 2008a {published data only}

Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta‐analysis. Journal of the American Geriatrics Society 2008;56(12):2234‐43.

Sherrington 2014 {published data only}

Sherrington C, Lord SR, Vogler CM, Close JC, Howard K, Dean CM, et al. Minimising disability and falls in older people through a post‐hospital exercise program: a protocol for a randomised controlled trial and economic evaluation. BMC Geriatrics 2009;9:8.
Sherrington C, Lord SR, Vogler CM, Close JCT, Howard K, Dean CM, et al. A post‐hospital home exercise program improved mobility but increased falls in older people: a randomised controlled trial. PloS One 2014;9(9):e104412.

Shigematsu 2008 {published data only}

Shigematsu R, Okura T, Sakai T, Rantanen T. Square‐stepping exercise versus strength and balance training for fall risk factors. Aging Clinical & Experimental Research 2008;20:19‐24.

Shumway‐Cook 1997 {published data only}

Shumway Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community‐dwelling older adults. Physical Therapy 1997;77(1):46‐57.

Silsupadol 2009 {published data only}

Silsupadol P, Shumway‐Cook A, Lugade V, van Donkelaar P, Chou L S, Mayr U, et al. Effects of single‐task versus dual‐task training on balance performance in older adults: a double‐blind, randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2009;90:381‐7.

Simmons 1996 {published data only}

Simmons V, Hansen PD. Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. Journals of Gerontology Series A: Biological Sciences & Medical Sciences 1996;51:M233‐8.

Singh 2012 {published data only}

Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS. Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas 2012;73(3):239‐43.

Sipe 2009 {published data only}

Sipe CL. The effects of strength and power training on functional abilities in older adults. Dissertation Abstracts International: Section B: The Sciences and Engineering 2009;69:6052.

Snow 1999 {published data only}

Snow CM. Exercise effects on falls in frail elderly: focus on strength. Journal of Applied Biomechanics 1999;15(1):84‐91.

Southard 2004 {published data only}

Southard V, Hill J, McKenna RF. A pilot study to assess an intervention to improve falls efficacy. Journal of Geriatric Physical Therapy 2004;27:108.

Southard 2006 {published data only}

Southard V. A randomized control trial of the application of efficacy training to balance assessment. Physical & Occupational Therapy in Geriatrics 2006;25:51‐66.

Spink 2011 {published data only}

Spink MJ, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, Lord SR, et al. Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. BMC Geriatrics 2011;11:51.
Spink MJ, Menz HB, Lord SR. Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial. BMC Geriatrics 2008;8:30.

Suzuki 2004 {published data only}

Suzuki T, Kim H, Yoshida H, Ishizaki T. Randomized controlled trial of exercise intervention for the prevention of falls in community‐dwelling elderly Japanese women. Journal of Bone and Mineral Metabolism 2004;22(6):602‐11.

Sze 2008 {published data only}

Sze P, Cheung W, Lam P, Lo HD, Leung K, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step‐down community program. Archives of Physical Medicine & Rehabilitation 2008;89:1329‐34.

Szturm 2011 {published data only}

Szturm T, Betker A, Moussavi Z, Desai A, Goodman V. Effects of an interactive computer game exercise regimen on balance impairment in frail community‐dwelling older adults: a randomized controlled trial. Physical Therapy 2011;91:1449‐62.

Taggart 2002 {published data only}

Taggart HM. Effects of Tai Chi exercise on balance, functional mobility, and fear of falling among older women. Applied Nursing Research 2002;15:235‐42.

Takai 2010 {published data only}

Takai I. Influence of balance exercises during an attention task on fear of falling among frail elderly fallen. Nihon Ronen Igakkai Zasshi 2010;47:220‐5.

Talley 2008 {published data only}

Talley KMC. Fear of Falling and Disability Trajectories in Community‐dwelling Older Women [Thesis]. Minnesota: University of Minnesota, 2008.

Tennstedt 1998 {published data only}

Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences 1998;53B:P384‐92.

Tousignant 2012 {published data only}

Tousignant M, Corriveau H, Roy PM, Desrosiers J, Dubuc N, Hebert R. The effect of supervised Tai Chi intervention compared to a physiotherapy program on fall‐related clinical outcomes: a randomized clinical trial. Disability & Rehabilitation 2012;34:196‐201.

Underwood 2011 {published data only}

Underwood M, Eldridge S, Lamb S, Potter R, Sheehan B, Slowther AM, et al. The OPERA trial: protocol for a randomised trial of an exercise intervention for older people in residential and nursing accommodation. Trials 2011;12:27.

Van Haastregt 2007 {published data only}

ISRCTN43792817. Reduction of fear of falling and associated increase in functional ability, activity level and quality of life in community‐living older adults who are at risk for falling: a randomised controlled trial. http://controlled‐trials.com/ISRCTN43792817 (accessed 1 August 2013).
Van Haastregt JC, Zijlstra GA, Van Rossum E, Van Eijk JT, De Witte LP, Kempen GI. Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community‐living older people: a process evaluation. BMC Health Services Research 2007;7:156.
Zijlstra G, Van Haastregt JC, Van Eijk JT, Kempen GI. Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]. BMC Public Health 2005;5:26.

Vind 2010 {published data only}

NCT00226486. Examination and treatment of elderly after a fall. http://clinicaltrials.gov/show/NCT00226486 (accessed 1 August 2013).
Vind AB, Andersen HE, Pedersen KD, Joergensen T, Schwarz P. Effect of a program of multifactorial fall prevention on health‐related quality of life, functional ability, fear of falling and psychological well‐being. A randomized controlled trial. Aging Clinical and Experimental Research 2010;22:249‐54.

Voukelatos 2007 {published data only}

Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. Journal of the American Geriatrics Society 2007;55:1185‐91.

Williams 2002 {published data only}

Williams K, Mustian K, Kovacs C. A home‐based intervention to improve balance, gait and self‐confidence in older adults. Activities, Adaptation & Aging 2002;27:1‐16.

Williams 2010 {published data only}

Williams MA, Soiza RL, Jenkinson AM, Stewart A. EXercising with Computers in Later Life (EXCELL) ‐ pilot and feasibility study of the acceptability of the Nintendo WiiFit in community‐dwelling fallers. BMC Research Notes2010; Vol. 3:238.

Williams 2010a {published data only}

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home‐based exercise program on improving balance and gait stability in women with lower‐limb osteoarthritis or rheumatoid arthritis: a pilot study. Archives of Physical Medicine & Rehabilitation 2010;91:106‐14.

Woo 2007 {published data only}

Woo J, Hong A, Lau E, Lynn H. A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community‐living elderly people. Age and Ageing 2007;36(3):262‐8.

Wrisley 2006 {published data only}

Wrisley DM, Nunn D, Stephens MJ. The effects of a novel training paradigm on balance ‐‐ preliminary results... Platforms, thematic posters, and posters for CSM 2007. Journal of Neurologic Physical Therapy 2006;30:218.

Wu 2010 {published data only}

Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and home‐based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls. Archives of Physical Medicine & Rehabilitation 2010;91:849‐56.

Yamada 2011 {published data only}

Yamada M, Arai H, Uemura K, Mori S, Nagai K, Tanaka B, et al. Effect of resistance training on physical performance and fear of falling in elderly with different levels of physical well‐being. Age and Ageing 2011;40:637‐41.

Yamada 2011a {published data only}

Yamada M, Tanaka B, Nagai K, Aoyama T, Ichihashi N. Rhythmic stepping exercise under cognitive conditions improves fall risk factors in community‐dwelling older adults: Preliminary results of a cluster‐randomized controlled trial. Aging & Mental Health 2011;15:647‐53.

Yan 2009 {published data only}

Yan T, Wilber KH, Wieckowski J, Simmons WJ. Results from the Healthy Moves for Aging Well program: changes of the health outcomes. Home Health Care Services Quarterly 2009;28:100‐11.

Zilstra 2007 {published data only}

Zijlstra GAR, van Haastregt JCM, van Rossum E, van Eijk JTM, Yardley L, Kempen GIJM. Interventions to reduce fear of falling in community‐living older people: a systematic review. Journal of the American Geriatrics Society 2007;55(4):603‐15.

Arai 2007 {published data only}

Arai T, Obuchi S, Inaba Y, Nagasawa H, Shiba Y, Watanabe S, et al. The effects of short‐term exercise intervention on falls self‐efficacy and the relationship between changes in physical function and falls self‐efficacy in Japanese older people: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation 2007;86(2):133‐41.

Brouwer 2003 {published data only}

Brouwer BJ, Walker C, Rydahl SJ, Culham EG. Reducing fear of falling in seniors through education and activity programs: a randomized trial. Journal of the American Geriatrics Society 2003;51(6):829‐34.

Henwood 2008 {published data only}

Henwood TR, Riek S, Taaffe DR. Strength versus muscle power‐specific resistance training in community‐dwelling older adults. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:83‐91.

Jorgensen 2013 {published data only}

Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OB, Aagaard P. Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community‐dwelling older adults: a randomized controlled trial. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2013;68(7):845‐52.
NCT01371253. 10 weeks of Nintendo Wii Fit balance training improved postural balance and muscle strength in elderly individuals. http://clinicaltrials.gov/show/NCT01371253. UK, (accessed 1 August 2013).

Kim 2009b {published data only}

Kim S, Lockhart T, Roberto K. The effects of eight‐week balance training or weight training: for the elderly on fear of falling measures and social activity levels. Quality in Ageing 2009;10(4):37‐48.

Morris 2008 {published data only}

Morris DM. An Evaluation of Yoga for the Reduction of Fall Risk Factors in Older Adults [Thesis]. Florida: Florida State University, 2008.

Wolf 2003 {published data only}

Sattin R, Easley K, Wolf S, Chen Y, Kutner M. Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. Journal of American Geriatrics Society 2005;53:1168‐78.
Wolf SL, Sattin RW, Kutner M, O'Grady M, Greenspan AI, Gregor RJ. Intense Tai Chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial (commentary by Lavery L and Studenski S). Journal of the American Geriatrics Society 2003;51:1693.

Iliffe 2010b {published data only}

Iliffe S, Kendrick D, Morris M, Skelton D, Gage H, Dinan S, et al. Multi‐centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial. Trials 2010;11:6.
NCT00726531. Multi‐centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for over 65s in primary care. http://www.clinicaltrials.gov/show/NCT00726531 (accessed 25 January 2013).

NCT01032252 {published data only}

NCT01032252. Prevention of falls in community‐dwelling older adults by a standardized assessment of fall risks in the general practitioner setting and through implementation of a network for effective individual reduction on fall risks. http://clinicaltrials.gov/show/NCT01032252 (accessed 25 January 2013).

Andresen 2006

Andresen EM, Wolinsky FD, Miller JP, Wilson M‐MG, Malmstrom TK, Miller DK. Cross‐sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle‐aged African Americans. Gerontologist 2006;46(2):249‐57.

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Bridle C, Spanjers K, Patel S, Atherton NM, Lamb SE. Effect of exercise on depression severity in older people: systematic review and meta‐analysis of randomised controlled trials. British Journal of Psychiatry 2012;201:180‐5.

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Bula C, Monod S, Hoskovec C, Rochat S. Interventions aiming at balance confidence improvement in older adults: an updated review. Gerontology 2011;57(3):276‐86.

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Centers for Disease Control and Prevention. Physical activity for everyone: Glossary of terms. Available at http://www.cdc.gov/physicalactivity/everyone/glossary (accessed 3 August11).

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Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. [DOI: 10.1002/14651858.CD004366.pub6]

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Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF‐36 scores, and nursing home admission. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000;55:M299–305.

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Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 2010;341:c4165.

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Fletcher PC, Hirdes JP. Restriction in activity associated with fear of falling among community‐based seniors using home care services. Age and Ageing 2004;33(3):273‐9.

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Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD007146.pub3]

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Gottfries C‐G, Noltorp S, Nörgaard N, Holmén A, Högstedt B. Recognition and management of depression in the elderly. International Clinical Psychopharmacology 1997;94(12):1099‐102.

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Hadjistavropoulos T, Martin RR, Sharpe D, Lints AC, McCreary DR, Asmundson GJG. A longitudinal investigation of fear of falling, fear of pain, and activity avoidance in community‐dwelling older adults. Journal of Aging & Health 2007;19(6):965‐84.

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Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

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Higgins JPT, Deeks JJ (editors). Chapter 7: Selecting studies and collecting data. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

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Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Archives of Physical Medicine & Rehabilitation 1996;77(10):1025‐9.

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Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD004963.pub3]

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Howland J, Peterson EW, Levin WC. Fear of falling among the community‐dwelling elderly. Journal of Aging and Health 1993;5:229–43.

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Hoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five‐item version of the Geriatric Depression Scale. Journal of American Geriatric Society 1999;47(7):873‐8.

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Iliffe S, Kendrick D, Morris M, Skelton D, Gage H, Dinan S, et al. Multi‐centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial. Trials 2010;11:6.

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Jorstad EC, Hauer K, Becker C, Lamb SE. Measuring the psychological outcomes of falling: a systematic review. Journal of American Geriatric Society 2005;53:505‐10.

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Jung D. Fear of falling in older adults: comprehensive review. Asian Nursing Research 2008;2(4):214‐22.

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Kempen GIJM, Yardley L, van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K, et al. The Short FES‐I: a shortened version of the falls efficacy scale‐international to assess fear of falling. Age and Ageing 2008;37(1):45‐50.

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Kempen GI, Van Haastregt JC, McKee KJ, Delbaere K, Zijlstra GR. Socio‐demographic, health‐related and psychosocial correlates of fear of falling and avoidance of activity in community‐living older persons who avoid activity due to fear of falling. BMC Public Health 2009;9:170.

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Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1998;53(1):43‐50.

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Legters K. Fear of falling. Physical Therapy 2002;82:264‐72.

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Lusardi MM,  Smith EV. Development of a scale to assess concern about falling and applications to treatment programs. Journal of Outcome Measurement 1997;1:34‐55.

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McClure R, Turner C, Peel N, Spinks A, Eakin E, Highes K. Population‐based interventions for the prevention of fall‐related injuries in older people. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD004441.pub2]

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Parry SW,  Steen N,  Galloway SR . Falls and confidence related quality of life outcome measures in an older British cohort. Postgraduate Medicine 2001;77:103‐8.

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Scheffer 2008

Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing 2008;37(1):19‐24.

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Tinetti ME,  Mendes de Leon CF,  Doucette JT . Fear of falling and fall‐related efficacy in relationship to functioning among community‐living elders. Journal of Gerontology 1994;49:M140–7.

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References to other published versions of this review

Kendrick 2012

Kendrick D, Carpenter H, Morris RW, Skelton DA, Gage H, Bowling A. Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 5. [DOI: 10.1002/14651858.CD009848]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Barnett 2003

Methods

RCT

Participants

Country: Australia

n = 163

67% female

Mean age in years (SD) = 75 (5.5)

Study population: recruited from general practice clinics or 2 acute physiotherapy departments

Inclusion criteria: participants were aged 65 years and older recruited from general practice clinics with 1 or more physical performance impairments known to be important risk factors for falls (i.e. lower limb weakness, poor balance and slow reaction time)

Exclusion criteria: cognitive impairments, degenerative conditions or medical condition involving neuromuscular, skeletal or cardiovascular system which could prevent them from taking part in an exercise programme

Interventions

1. Exercise group (n = 83). Weekly structured exercise group in a community setting, combined with a home exercise programme and written information on practical strategies for avoiding falls. Classes ran for 1 hour, over 4 terms for 1 year (37 classes) and steadily increased in speed and complexity. Class content was designed by a physiotherapist to specifically address physical falls risk factors and was delivered in groups of 6 to 18. Content included stretching, balance, co‐ordination, aerobic capacity and muscle strengthening exercises. The home exercise programme was based on the class content with diaries to record participation. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 80). Provided with the same information about falls prevention, but no alternative 'non‐exercise' activity

Outcomes

Number of falls (recorded by retrospective monthly fall calendars); fear of falling (single‐item measure ‐ recorded as % of participants who are afraid of falling); physical activity (Physical Activity Scale for the Elderly (PASE)). Outcomes were measured at baseline and 6 months post baseline. Falls were measured over the 12‐month intervention period

Notes

The outcomes for the study were measured at 6 months into the 12‐month trial as this was deemed a sufficient period to achieve the beneficial results of the exercise programme. Adherence: 91% were still attending exercise classes at the end of the trial and performing home exercises at least once a week

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No further information provided on sequence generation

Allocation concealment (selection bias)

Unclear risk

"Subjects were randomised in matched blocks (n = 6) after the baseline assessment using consecutively numbered opaque envelopes". Paper does not say if envelopes were sealed

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Fear of falling, number of falls and PASE were self reported by unblinded participants

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Falls data collected retrospectively by postal survey at the end of each month

Campbell 1997

Methods

RCT

Participants

Country: New Zealand

n = 233

100% female

Mean age in years (SD) = 84 (3.3)

Study population: recruited from general practice registers

Inclusion criteria: women aged 80 and over who lived in the community recruited from general practice, able to move around within their own home and not receiving physiotherapy

Exclusion criteria: score < 7 from 10 on the Mental Status Questionnaire (MSQ)

Interventions

1. Exercise group (n = 116). 1‐year home‐based exercise programme prescribed by a physiotherapist. Exercises took approximately 30 minutes to complete and participants were to complete them at least 3 times a week, and walk outside the home at least 3 times per week. The programme included moderate intensity strengthening exercises with ankle cuff weights (0.5 kg and 1 kg), strength, balance and "active range of movement" exercises. The physiotherapist visited participants 4 times over 2 months prescribing a selection of exercise at appropriate and increasing levels of difficulty, and a walking plan. Participants were telephoned regularly to maintain motivation. ProFaNE taxonomy classification: strength/resistance

2. Control group (n = 117). Participants received a social visit from the research nurse 4 times during the first 2 months and telephoned them regularly during the year of follow‐up

Outcomes

Number of falls (recorded by monthly fall calendars); falls efficacy (Falls Efficacy Scale (FES)); physical activity (PASE). Outcomes were measured at baseline and post intervention. FES and PASE only presented as % change from baseline

Notes

Adherence: after 1 year 42% were still completing the exercise programme 3 or more times a week

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

The group allocation schedule was developed by a statistician using computer‐generated random numbers

Allocation concealment (selection bias)

Low risk

Central allocation (telephone) after all baseline questionnaires and assessments were completed. List held off site by an independent person

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls, FES and PASE were self reported by unblinded participants

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Low risk

Appears to be free of other sources of bias

Clemson 2010

Methods

RCT

Participants

Country: Australia

n = 34

47% female

Mean age in years (SD) = 82 (6.0)

Study population: recruited from the Department of Veterans Affairs Home Front Database and a list from a general medical practice

Inclusion criteria: community‐dwelling older adults aged 70 years and above who had 2 or more falls or an injurious fall in the past year

Exclusion criteria: moderate to severe cognitive problems (> 2 errors on the Short Portable Mental Status Questionnaire); non‐conversational English; unable to walk around independently; resident in nursing home or hostel; unstable or terminal medical illness that would preclude planned exercises; neurological conditions that would result in motor performance difficulties (e.g. Parkinson's disease)

Interventions

1. Lifestyle approach to reducing Falls through Exercise (LiFE) (n = 18). Home‐based lifestyle‐integrated balance and strengthening exercise programme specifically developed for fall prevention. LiFE was taught in 5 home visits with 2 booster visits over a 3‐month period and 2 follow‐up phone calls. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control (n = 16). No intervention

Outcomes

Number of falls (recorded by monthly fall calendars); falls efficacy (Modified Falls‐Efficacy Scale (MFES)); balance confidence (Activities Specific Balance Confidence Scale (ABC)). Measured at baseline, post intervention and 3 months follow‐up

Notes

Adherence rates not reported

MFES and ABC means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation using a random numbers table and stratifying by age and fall history (1 to 2 falls; ≥ 3 falls), but no further information provided

Allocation concealment (selection bias)

High risk

Open random allocation schedule. Participants were allocated in order of completion from random number list by an investigator not involved in assessment or intervention

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls, MFES and ABC were self reported by unblinded participants

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on > 80% of participants in intervention group, but < 80% for the control group

Selective reporting (reporting bias)

High risk

Stated that adherence was monitored for the exercise group but data are not presented. Protocol not available

Other bias

Unclear risk

The intervention group were able to stand for longer on the tandem stand eyes open test (median 15 seconds) than the control group (median 1.65 seconds) at baseline. This baseline difference was adjusted for in the falls analysis and the results remained significant. The LiFE intervention was developed collaboratively by 4 of the authors

Freiberger 2012

Methods

RCT

Participants

Country: Germany

n = 144 (groups 2 and 4 below)

47% female

Mean age in years (SD) = 76 (4.1)

Study population: recruited from a health insurance database

Inclusion criteria: community‐dwelling older adults aged 70 to 90 who had fallen in the past 6 months or reported a fear of falling

Exclusion criteria: those who were unable to walk around independently or had cognitive impairment (as noted by a score < 25 on the Digit Symbol Substitution Test (DSST))

Interventions

1. Strength and Balance Group (SBG) (n = 63). Weight‐bearing exercises with dumbbells and balance challenging exercises, stretching, plus sensory training including standing and walking with eyes closed or on unstable surfaces and training in the perception of centre of gravity in relation to the base of support

2. Fitness Group (FG) (n = 64). Strength and balance exercise with endurance training (walking with change of pace and direction and Nordic walking). ProFaNE taxonomy classification: strength/resistance

3. Multifaceted Group (MG) (n = 73). Strength and balance training with fall risk education to address fall‐related psychological aspects and cognitive training

4. Control Group (n = 80). No intervention

All active interventions included progressive exercises for upper and lower body strength, standing weight‐bearing exercises with dumbbells and balance exercises. Interventions were provided by 2 fall prevention instructors for a period of 16 weeks with 2 1‐hour group sessions per week

The intervention group used in the meta‐analysis comprised only the FG

Outcomes

Number of falls (recorded by monthly fall calendars); balance confidence (ABC); measured at post intervention, 6 months and 18 months follow‐up. ABC score at 6 months follow‐up used in the analysis of fear of falling at 6 months or more post intervention

Notes

Adherence rates: majority of participants (> 80%) attended at least 24 of the 32 sessions

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

A third party not involved in the study applied a computerised random‐number generator

Allocation concealment (selection bias)

Unclear risk

A third party not involved in the study applied a computerised random number generator

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls and ABC were self reported by unblinded participants

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

No baseline scores for ABC presented. The control group had a greater proportion reporting fear of falling and higher education levels than the intervention group (fitness group) at baseline. Analyses were adjusted for these variables. The majority of falls occurred during sports activities (including cycling and skiing)

Haines 2009

Methods

RCT

Participants

Country: Australia

n = 53

60% female

Mean age in years (SD) = 81 (7.7)

Study population: patients of a publicly funded, metropolitan, tertiary hospital

Inclusion criteria: aged 65 years and over, treated on the geriatric rehabilitation medical or surgical units of a local hospital being planned for discharge to the community, gait instability as determined by physiotherapists or walked with a mobility aid

Exclusion criteria: severe cardiac disease, cognitive impairment (determined by Abbreviated Mental Test Score less than 6 out of 10), aggressive behaviour, restricted lower limb weight‐bearing status or had been referred for post discharge community rehabilitation services

Interventions

1. Exercise Group (n = 19). A DVD and workbook describing a progressive 2‐month home exercise programme based on the Kitchen Table exercise programme containing lower limb strength and balance exercises with 6 types of exercises each with 6 different levels of difficulty. A physiotherapist visited participants at home to help engagement with the DVD and workbook, ensure a safe environment and set appropriate starting level.The physiotherapist also made weekly phone calls for 8 weeks after the first home visit to measure participation in the exercise programme and to give advice on any problems the participants had encountered in attempting the exercise programme. Participants were encouraged to continue the exercise after the 8 weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control (n = 34). No intervention

Outcomes

Number of falls (recorded by monthly fall calendars); balance confidence (ABC). Measured at baseline and post intervention

Notes

Adherence: less than 50% were still completing the exercise programme at the end of the trial

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computerised random number generator

Allocation concealment (selection bias)

Low risk

Sequentially numbered, sealed, opaque envelopes (with participant numbers)

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls and ABC scales were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Control group had longer length of hospital stay and higher median number of falls than intervention group at baseline

Halvarsson 2011

Methods

RCT

Participants

Country: Sweden

n = 59

71% female

Mean age in years (range) = 77 (67 to 93)

Study population: recruited from advertisements in local newspapers

Inclusion criteria: community‐dwelling older people aged 65 years or older, with a fear of falling and/or an experience of a fall during the previous 12 months. An ability to walk unaided indoors and a mini mental state examination score equal or greater than 24. Recruited by advertisements in local newspapers

Exclusion criteria: severely impaired vision or hearing, severe cancer, severe pain, neurological disease or damage with symptoms, dizziness requiring medical care, or heart and respiratory symptoms that might affect participation

Interventions

1. Balance group training (n = 38). Individually adjusted progressive and specific balance training, provided by physiotherapists for 45 minutes 3 times per week for 3 months. The programme was performed at 5 levels, each reflecting different demands on the postural control system. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control (n = 21). No intervention

Outcomes

Concern about falling (FES‐International (FES‐I); depressive symptoms (Geriatric Depression Scale‐20 (GDS‐20)). Measured at baseline and post intervention

Notes

Adherence rates not reported

FES‐I and GDS‐20 means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Subjects drew an allocation slip from an envelope filled with 20 slips in a 2:1 ratio. No further information given on sequence generation

Allocation concealment (selection bias)

High risk

Participants could possibly see their allocation as they drew the allocation slip themselves from the envelope. No further information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES‐I and GDS‐20 were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

High risk

GDS scores not presented. Protocol not available

Other bias

Low risk

Appears to be free of other sources of bias

Hinman 2002

Methods

RCT

Participants

Country: USA

n = 97

63% female

Mean age in years (range) = 72 (63 to 87)

Study population: recruited from local community. No further details given

Inclusion criteria: able to walk around independently (unassisted or with a walking aid) and be able to follow a structured exercise programme

Exclusion criteria: acute neurological or orthopaedic conditions, history of dementia

Interventions

1. Home Exercise (HE) Programme (n = 32). Participants expected to perform a set of 20‐minute balance exercises and activities on an independent basis 3 times a week for 4 weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Computer Balance (CB) Training (n = 34). Biodex balance system which provides an unstable platform that moves in response to changes in the user's centre of mass and tilts up to 20 degrees in every direction. 4‐week programme with 8 stability levels, supervised by a research assistant. First 2 weeks consisted of a 10‐minute warm‐up and then 10 minutes training. Final 2 weeks consisted of a 15 minute warm‐up and then 15 minutes training. In the final week, participants were given goggles to obscure their vision during the warm‐up exercises. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

3. Control group (n = 31). No training programme for 4 weeks and advised not to engage in any new exercise or training programmes for the duration of the trial

The intervention group used in the analysis comprised the combined HE and CB groups

Outcomes

Falls efficacy (MFES). Measured at baseline and post intervention

Notes

Adherence: over 90% adhered to the exercise programme. Cash incentive offered

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no further information provided

Allocation concealment (selection bias)

Unclear risk

No information on allocation concealment provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

MFES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Participants received a monetary compensation for their participation in the study, with intervention groups compensated at a higher rate than the control group

Karinkanta 2012

Methods

RCT

Participants

Country: Finland

n = 149

100% female

Mean age in years = 73 (2.3)

Study population: random population sample invited to express interest in study by post

Inclusion criteria: 70 to 79‐year old women living in the city of Tampere, Finland; willingness to participate, full understanding of the study procedures, no history of any illness contraindicating exercise or limiting participation in the exercise programme or of illness affecting balance or bone, no uncorrected vision problems, and taking no medications known to affect balance or bone metabolism (within 12 months before the enrolment)

Exclusion criteria: participants were excluded if they did high‐intensity exercises more than twice a week or if there femoral‐neck T score was lower than –2.5 (i.e. indicating osteoporosis and requiring medical attention)

Interventions

1. A resistance‐training (RT) group (n = 37). The resistance training consisted of exercises for large muscle groups with increasing intensity from 50% to 60% of 1‐repetition maximum (1RM) to 75% to 80% of 1RM. ProFaNE taxonomy classification: strength/resistance

2. A balance‐jumping (BJ) group (n = 37). The balance‐jumping training comprised modified aerobics and step aerobics including a variety of balance, agility and impact exercises

The degree of difficulty of movements, steps, impacts, and jumps was gradually increased. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

3. A combination (CG) group doing resistance and balance‐jumping training (n = 38). The combination training programme consisted of resistance and balance‐jumping training in alternating weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

4. No intervention (n = 37). Participants in the control group were asked to maintain their pre‐study level of physical activity during the 12‐month trial

The intervention lasted for 3 weekly sessions of 45 minutes for 12 months

The intervention group used in the analysis comprised the combined RT, BJ and CG groups

Outcomes

Fear of falling (visual analogue scale ‐ no fear at all (0) to very great fear (100)). Measured at baseline, post intervention and 12 months

Notes

Adherence: 67% adhered to the exercise programmes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated randomisation list

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

VAS was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Self rated general health slightly better in the intervention group than control group at baseline

Lai 2013

Methods

RCT ‐ cross‐over design

Participants

Country: Taiwan

n = 30

57% female

Mean age in years (SD) = 72 (4.6)

Study population: recruitment not described

Inclusion criteria: community‐dwelling older adults aged 65 years and above

Exclusion criteria: participants were excluded if they had a neurological condition such as Parkinson's disease, dementia and stroke, or if they had arthritis, vision impairment and cardiovascular disease that impaired walking, or if they were unable to walk without assistance

Interventions

1. Xavix Measured Step System (XMSS) (n = 15) console with 1 step mat and connectors to TV. The XMSS exercise was conducted for 30 minutes, 3 times a week for 6 weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 15). No intervention for the first 6 weeks, then given XMSS exercises for 6 weeks. The first 6 weeks served as the control

Outcomes

Falls efficacy (MFES). Measured at baseline and post intervention, and 6 weeks post intervention (after cross‐over)

Notes

Adherence rates not reported

Data were used from the first period prior to cross‐over

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no further information provided

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

MFES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Intervention group had higher MFES and Berg Balance Scale scores and lower Timed Up and Go times at baseline than control group

Lajoie 2004

Methods

Quasi‐randomised trial

Participants

Country: Canada

n = 24

83% female

Mean age in years (SD) = 71 (not reported)

Study population: recruited from the community and from residential care facilities

Inclusion criteria: aged 65 or older, able to stand and walk without an aid

Exclusion criteria: participants with diabetes, neurological or sensory disorders, recurrent dizziness or unsteadiness, use of medications that may affect balance, joint replacement and medical conditions interfering with daily activities

Interventions

1. Computerised balance training group (n = 12). 1‐hour computerised balance training sessions completed twice per week over an 8‐week period. Participants stood on a Kistler force platform and were asked to complete 15 computerised balance tests lasting 1 minute each, with resting periods given after each trial. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 12). No intervention

Outcomes

Balance confidence (ABC). Measured at baseline and post intervention

Notes

Adherence rates not reported

ABC means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Sequence generated by alternation. The author stated in a personal communication that this was achieved by "First subject was in group 1, second in group 2, third in group 1 etc."

Allocation concealment (selection bias)

High risk

Allocation not concealed. Quasi‐randomised study

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

ABC was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Paper describes only minimal baseline characteristics, so unclear if groups well balanced at baseline

Lin 2007

Methods

RCT

Participants

Country: Taiwan

n = 100 (groups 1 and 2 only)

51% female

Mean age in years (SD) = 77 (not reported)

Study population: recruited from clinics and hospitals in rural agricultural area

Inclusion criteria: community‐dwelling older adults aged 65 and older who had required medical attention due to sustaining a fall in the previous 4 weeks

Exclusion criteria: none specified

Interventions

Intervention details:

1. Home‐based exercise group (n = 50). The intervention consisted of stretching, muscle strengthening and balance training. Participants exercised at home once every 2 weeks under supervision and were instructed to practice these exercises at least 3 times a week during the 4‐month intervention period. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Home safety assessment and modification group (n = 50). Participants were visited by a public health worker to perform a safety assessment on their home environment and given a list of specifically recommended modifications

3. Education group (n = 50). Participants received 1 social visit of 30 to 40 minutes every 2 weeks over the study period, plus pamphlets on falls prevention, including stretching and strengthening exercises to encourage initiation and persistence in activities

The intervention group used for this review comprised the home‐based exercise group and the control group comprised the home safety assessment and modification group

Outcomes

Fear of falling (visual analogue scale); 15‐item Geriatric Depression Scale (GDS); number of falls (self reported). Measured at baseline, and 2 and 4 months post intervention

Notes

Fear of falling was assessed using a 10 cm visual analogue scale, marked with the labels "No fear" and "Extremely fearful" where participants were asked to place a mark on the line at the point representing the extent of their fear

Adherence rates not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Block randomised, but no information provided about randomisation sequence generation

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

VAS and GDS‐15 self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on ≥ 80% of participants in control group, but < 80% in intervention group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all prespecified outcomes have been reported

Other bias

Unclear risk

Most baseline characteristics not presented by treatment group so unclear if groups well balanced at baseline

Logghe 2009

Methods

RCT

Participants

Country: Netherlands

n = 269

71% female

Mean age in years (SD) = 77 (4.7)

Study population: recruited from general practices

Inclusion criteria: aged 70 years and older living at home and having a high falls risk (defined as 1 or more self reported fall incidents in the year preceding the study or at least 2 self reported risk factors for falling (disturbed balance, mobility problems, dizziness, and the use of benzodiazepines or diuretics))

Exclusion criteria: none specified

Interventions

1. Tai Chi Chuan group (n = 138). Participants received 1 hour of Tai Chi Chuan training twice a week for 13 weeks. Classes were provided by 4 professional Tai Chi Chuan instructors using a predefined protocol. Participants were encouraged to practice at home at least twice a week for 15 minutes. Also received a brochure explaining how to prevent fall incidents in and around the house. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control group (n = 131). No intervention

Outcomes

Number of falls (recorded by monthly fall calendars); falls efficacy (FES); physical activity (PASE). Measured at baseline, post intervention and 9 months follow‐up

Notes

Adherence: 47% attended at least 80% of the Tai Chi lessons

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated randomisation list

Allocation concealment (selection bias)

Unclear risk

No information provided on allocation concealment. An independent research assistant performed a pre‐stratified block randomisation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls, FES and PASE were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group at all follow‐up time points

Selective reporting (reporting bias)

Low risk

Protocol available. All pre‐specified outcomes have been reported

Other bias

Unclear risk

Inconsistency between the number of participants with missing data in flow chart and the denominators reported in the text for falls outcomes

McCormack 2004

Methods

RCT

Participants

Country: Australia

n = 43

70% female

Mean age in years (SD) = 79 (5.9)

Study population: recruited from the community by postal invitation

Inclusion criteria: community‐dwelling older adults aged 65 years and over

Exclusion criteria: participants were excluded if they reported uncontrolled hypertension, heart attack in the previous year, irregular heart beat and if they already belonged to a formal exercise class

Interventions

1. Conventional Exercise (CE) group (n = 17). Low intensity stretching and conditioning exercises using body weight and light dumbbells as resistance. Performed 2 days per week for 10 weeks with each session approximately lasting 30 to 45 minutes. ProFaNE taxonomy classification: strength/resistance

2. Holistic exercise (HE) group (n = 18). Participants used a Range of Motion (RoM) dance method using the principles of Tai Chi. Performed 2 days per week for 10 weeks with each session approximately lasting 30 to 45 minutes. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

3. Control group (n = 8). No intervention

The intervention group used in the analysis comprised the combined CE and HE groups

Outcomes

Falls efficacy (MFES). Measured at baseline and post intervention

Notes

Adherence: adherence did not differ between groups. Combined adherence over 80% in each group

Data on the number of females obtained from personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information provided about sequence generation

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

MFES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in Holistic and Conventional exercise groups, and > 80% of participants in the control group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Very minimal baseline data presented so unclear if groups well balanced at baseline

Nguyen 2012

Methods

RCT

Participants

Country: Vietnam

n = 96

50% female

Mean age in years (SD) = 69 (5.1)

Study population: recruitment not described

Inclusion criteria: community‐dwelling older adults aged 60 to 79 years old. Being able to finish the Mini Mental State Examination (MMSE) with a score greater than 25 and having no experience in Tai Chi

Exclusion criteria: serious diseases, such as symptomatic coronary insufficiency, angina, arrhythmia, orthostatic hypotension, and dementia

Interventions

1. Tai Chi (n =48). Participants in the Tai Chi group attended a 60‐minute Tai Chi practice session twice a week for 6 months. The session consisted of a 15‐minute warm‐up and a 15‐minute cool‐down period. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. No intervention (n = 48)

Outcomes

Falls efficacy (FES). Measured at baseline, interim and post intervention

Notes

Adherence rates not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no further information provided

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on > 80% of participants in intervention group but < 80% of participants in the control group

Selective reporting (reporting bias)

Unclear risk

Time periods for interim data not reported. Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

FES slightly higher in control group than intervention group at baseline

Reinsch 1992

Methods

Cluster‐RCT with randomisation by senior centre

Participants

Country: USA

n = 107 (groups 1 and 4 only) and 8 senior centres

89% female

Mean age in years (SD) = 75 (7.5)

Study population: recruited from 16 senior centres located in low socioeconomic areas

Inclusion criteria: aged over 60 living in a senior centre

Exclusion criteria: none given

Interventions

Intervention details:

1. Exercise intervention (n = 57). Participants performed the low intensity "stand‐up/step‐up" exercises, designed to improve strength and balance for 1 hour 3 times per week for 1 year. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Cognitive‐behavioural intervention (n = 51). Participants received health and safety advice to prevent falls, relaxation training and video game playing to improve reaction time 1 hour per week for 1 year

3. Exercise‐cognitive intervention (n = 72). 1 meeting per week as per cognitive behavioural intervention group and 2 meetings per week focusing on exercise, relaxation training and discussion of safety topics for 1 year

4. Discussion control group (n = 50). Participants discussed health and discussion topics of interest to older people 1 hour per week for 1 year

The intervention group used for this review comprised the exercise group and the control group comprised the discussion group

Outcomes

Fear of falling (measured by 5‐point scale (1 = not at all worried to 5 = extremely worried))

Notes

Adherence: 77% of the exercise group attended at least 67% of the exercise classes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no further information provided

Allocation concealment (selection bias)

Unclear risk

Senior centres were randomised but no information given on concealment of allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Fear of falling and number of falls self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in the intervention group but > 80% of participants in the control group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Analyses do not appear to be adjusted for clustering

Rendon 2012

Methods

RCT

Participants

Country: USA

n = 40

65% female

Mean age in years (SD) = 85 (5.4)

Study population: recruited from retirement communities

Inclusion criteria: community‐dwelling adults between 60 and 95 years of age, able to participate in physical activity for 45 to 60 minutes and who verbally reported having normal vision

Exclusion criteria: participants with known orthopaedic, neurological or circulatory disorders that would prevent them from participating in the study

Interventions

1. Virtual reality group (n = 20). Participants used 3 different balance games from the Nintendo® Wii Fit Software package. Participants alternated the exercise game sequence week‐to‐week during the 18‐session intervention (3 times a week for 6 weeks). Each session lasted approximately 35 to 45 minutes. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. No intervention (n = 20)

Outcomes

Balance confidence (ABC); depressive symptoms (Geriatric Depression Scale). Measured at baseline and post intervention

Notes

Adherence: 80% met the 15 sessions minimum

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no further information provided

Allocation concealment (selection bias)

Unclear risk

No information provided on allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

ABC and GDS were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Little baseline data presented. ABC score was higher at baseline in the control group than the intervention group. GDS score was higher at baseline in the intervention group than the control group

Resnick 2008

Methods

Cluster‐RCT with randomisation by senior centre

Participants

Country: USA

n = 166 participants and 13 senior centres

81% female

Mean age in years (SD) = 73 (8.2)

Study population: recruited from senior centres

Inclusion criteria: community‐dwelling urban minority older adults aged 60 years and older, having a blood pressure recording less than 200/100, heart rate between 60 to 120, no known recent (within past 6 months) history of heart attack, stroke or new irregular heartbeat

Exclusion criteria: not obtaining consent from their primary health care provider

Interventions

1. Senior Exercise Self‐efficacy Project (SESEP) group (n = 100). 12 weeks of twice weekly exercise sessions, each lasting between 60 and 90 minutes, and including stretching, resistance and aerobic activities; plus 30 minutes per week of group efficacy‐enhancing programme. ProFaNE taxonomy classification: strength/resistance

2. Control (n = 66). Participants provided with twice weekly 60 to 90‐minute sessions of nutrition education for 12 weeks

Outcomes

Fear of falling (self rated on a scale of 0 to 4); depressive symptoms (GDS); overall activity (Yale Physical Activity Survey (YPAS)). Measured at baseline and post intervention

Notes

Adherence: mean adherence rate was 77%

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Sequence generated by coin toss

Allocation concealment (selection bias)

Unclear risk

Senior centres were randomised by geographic area using coin toss. No information given on concealment of allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Fear of falling, GDS and YPAS self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Analyses do not appear to be adjusted for clustering

Sihvonen 2004

Methods

RCT

Participants

Country: Finland

n = 28

100% female

Mean age in years (SD) = 82 (5.2)

Study population: recruited from residential care homes

Inclusion criteria: female, aged 70 years or over, living in residential care

Exclusion criteria: unable to stand without a walking aid, unable to see visual feedback from a computer screen and unable to follow instructions

Interventions

1. Exercise (n = 20) group. Participants attended 20‐ to 30‐minute long individualised specific balance exercise sessions using a computerised force platform with visual feedback 3 times a week for 4 weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control (n = 8) group. No intervention

Outcomes

Number of falls (self reported monthly fall calendar); Fear of falling (single‐item measure ("No", "Yes, some", "Yes, a lot"); physical activity (the Senior Fitness Test). Measured at baseline, post intervention and 12‐month follow‐up

Notes

Adherence: over 90% adhered to the exercise programme

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation was done in blocks by drawing lots

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls and fear of falling were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Intervention group undertook more physical activity and more reported high fear of falling at baseline than control group

Tiedemann 2012

Methods

RCT

Participants

Country: Australia

n = 54

80% female

Mean age in years (SD) = 68 (7.1)

Study population: recruited from advertisements in local newspapers, newsletters and websites

Inclusion criteria: participants were eligible if they were community‐dwelling, aged 59 years or older, were cognitively intact (defined as a score of ≥ 7 on the Short Portable Mental Status Questionnaire) and were willing and able to attend 12 weeks of group‐based yoga classes

Exclusion criteria: having a medical condition that precludes exercise (e.g. unstable cardiac disease, uncontrolled hypertension, uncontrolled metabolic diseases, and large abdominal aortic aneurysm), minimal English language skills, hostel or nursing home resident, and/or current participation in yoga or Tai Chi

Interventions

1. Yoga (n = 27). Participants attended a 1‐hour, twice‐weekly, group‐based yoga class for 12 weeks. Participants were also instructed to practise the poses at home for 10 to 20 minutes on at least 2 days per week. The balance challenge increased over time by gradually increasing the difficulty of the postures performed. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control (n = 27) group. Provided with information about falls prevention

Outcomes

Concern about falling (FES‐I). Measured at baseline and post intervention

Notes

Adherence: 70% attended at least 20 out of 24 classes, 30% attended all classes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random number schedule

Allocation concealment (selection bias)

Unclear risk

An investigator not involved in recruitment performed a pre‐stratified block randomisation using a computer‐generated random number schedule. No further information provided on allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES‐I was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Higher proportion of control group reported balance as fair or poor than the intervention group at baseline

Ullmann 2010

Methods

RCT

Participants

Country: USA

n = 47

70% female

Mean age in years (SD) = 76 (7.3)

Study population: recruited from senior centres, churches and retirement communities

Inclusion criteria: older adults aged 65 years or older

Exclusion criteria: participants were screened on the Mini‐Mental State Examination and their performance on the Timed Up and Go (TUG). No further information provided

Interventions

1. Feldenkrais intervention (FG) (n = 25). 1‐hour Feldenkrais sessions were held 3 times per week for 5 weeks. Feldenkrais is a mind‐body exercise that involves gentle movements carried out in a quiet, non‐competitive environment focused on improving balance and mobility. Classes were taught by a certified Feldenkrais teacher. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control group (n = 22). Waiting list control

Outcomes

Falls efficacy (FES); balance confidence (ABC). Measured at baseline and post intervention

Notes

Adherence: over 90% adhered to the exercise programme. 6 of the control group crossed over to the FG at the end of the intervention period. Their data are only included prior to cross‐over

FES and ABC means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The screening TUG score and age were used to complete the stratified randomisation of participants. No further information provided

Allocation concealment (selection bias)

Unclear risk

No information given on allocation concealment. Persons who expressed a desire to attend the same class (couples, friends and carpool) were allowed to do so in order to facilitate participation. Members of these units were assigned to the same treatment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES and ABC were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

The control group had a lower BMI and had experienced a higher number of falls in the 3 months prior to randomisation than the intervention group

Vogler 2009

Methods

RCT

Participants

Country: Australia

n = 180

79% female

Mean age in years (SD) = 80 (7.0)

Study population: inpatients from aged care and rehabilitation services were approached to participate after leaving hospital

Inclusion criteria: older people aged 65 years or older recently discharged from an Aged Care and Rehabilitation hospital, who were medically fit to exercise and had completed hospital‐related rehabilitation

Exclusion criteria: participants were excluded if they had medical contraindications to exercise, if they were cognitively impaired (Mini‐Mental State Examination score < 24 out of 30), or if they were discharged to a high‐care residential facility

Interventions

1. Seated exercises (SE) (n = 60). Prescribed exercises to be performed while sitting on a standard dining chair with cuff weights and exercise bands. Exercises were to be done 3 times a week for 12 weeks, with the physiotherapist visiting 8 times in the 12 weeks to ensure the exercises were being performed correctly and to progress exercise intensity. ProFaNE taxonomy classification: strength/resistance

2. Weight‐bearing exercises (WBE) (n = 60). Prescribed strengthening and resistance exercises to be performed while standing with a chair or bench for support if required. Resistance was provided with weight‐loaded waist belts. Exercises were to be done 3 times a week for 12 weeks, with the physiotherapist visiting 8 times in the 12 weeks to ensure the exercises were being performed correctly and to progress exercise intensity. ProFaNE taxonomy classification: strength/resistance

3. Control group (n = 60). Received a 1‐hour social visit by a research assistant each week for 12 weeks

The intervention group used in the analysis comprised the combined SE and WBE groups

Outcomes

Number of falls (self reported weekly fall calendar); falls efficacy (MFES); depressive symptoms (GDS). Measured at baseline, post intervention and 3 months follow‐up

Notes

Adherence: mean adherence rate was 70% in the seated exercise group, and 62% in the weight‐bearing group

MFES means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation was performed in blocks of 15 participants by computer‐generated random numbers

Allocation concealment (selection bias)

Unclear risk

Allocations for each participant were concealed in opaque envelopes. Unclear if envelopes were sealed or not

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls, MFES and GDS were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Low risk

The study appears to be free of other sources of bias

Vrantsidis 2009

Methods

RCT

Participants

Country: Australia

n = 62

76% female

Mean age in years (SD) = 75 (8.2)

Study population: recruited from advertisements in newspapers, promotion at local community groups and retirement villages and from volunteers in a research database

Inclusion criteria: adults aged 55 years or over living at home, in a retirement village or a low‐care residential aged‐care facility, and who have at least 1 functional impairment (based on the Frenchay Activity Index) or have a history of 1 or more falls in the previous 6 months

Exclusion criteria: cognitive impairment (< 7 on the Abbreviated Mental Test Score), inability to understand English, and unable to stand unsupported for at least 1 minute or walk a short distance indoors (minimum 5 metres) without a walking aid

Interventions

1. Exercise group (n = 29). Participants participated in the Getting Grounded Gracefully programme based on the Feldenkrais method to specifically target dynamic balance, postural and turning stability, and weight‐shift transfers, which involved 2 40‐ to 60‐minute sessions per week over an 8‐week period. Classes were conducted at a community‐library meeting group and provided by the programme designer, an experienced Feldenkrais practitioner. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control group (n = 33). No intervention

Outcomes

Falls efficacy (MFES). Measured at baseline and post intervention

Notes

Participants included those living in low‐care residential homes where they were provided with help with dressing, eating, bathing and other support services such as cleaning, laundry and meals. No nursing care provided

Adherence: mean adherence rate was 88%

Personal communication with author to confirm participants were not receiving nursing care at the low‐care residential facility

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly ordered opaque envelopes used, but no information provided on how random sequence generated

Allocation concealment (selection bias)

Unclear risk

Participants were randomised to the intervention group or control group by the use of randomly ordered opaque envelopes by a research officer not involved in the assessments. Unclear if envelopes were sealed

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

A conflict of interest might have been present in that the designer (and supplier) of the Getting Grounded Gracefully programme was the Feldenkrais practitioner in this study and that CDs of the programme were purchased by interested participants at the end of the study

Wallsten 2006

Methods

RCT ‐ cross‐over design

Participants

Country: USA

n = 77

74% female

Mean age in years (range) = 81 (61 to 92)

Study population: recruited from posted flyers and flyers on bulletin boards in residential facilities

Inclusion criteria: older adults (age range 61 to 92 years) living independently in a continuing care retirement community

Exclusion criteria: history of hip fracture or replacement, currently enrolled in a balance study, knee replacement, Parkinson's disease, neurological condition which interfered with balance or walking, leukaemia or cancer, using an assistive device to walk 25 feet or further, Mini‐Mental State Exam score < 24

Interventions

1. Tai Chi Chuan (TC) group (n = 41). 1‐hour twice weekly Tai Chi classes conducted for 20 weeks focusing on gait, balance and strength. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control group (n = 36). No intervention for the first 20 weeks, then given Tai Chi classes for 20 weeks. The first 20 weeks served as the control

Outcomes

Balance confidence (ABC). Measured at baseline, 10 weeks post baseline, post intervention and 5 months follow‐up

Notes

Adherence rates not reported

Data were used from the first period prior to cross‐over

ABC means and SDs obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Patients were "randomised" to a group, but no information provided on how randomisation sequence generated

Allocation concealment (selection bias)

Unclear risk

"After all eligible patients completed the baseline assessments, they were randomised to the early or late groups." No information provided on allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

ABC was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group. Only 46% of participants remained in trial at 40 weeks. Those remaining had significantly higher baseline functional assessment scores than those lost to follow‐up

Selective reporting (reporting bias)

High risk

No baseline or follow‐up data reported for ABC. Protocol not available

Other bias

Unclear risk

Most baseline data only presented for those with outcome data at specific time points. Unclear if groups well balanced at baseline

Weerdesteyn 2006

Methods

Randomised trial with additional non‐randomised group

Participants

Country: The Netherlands

n = 58 (groups 1 and 2 only)

72% female

Mean age in years (SD) = 74 (5.7)

Study population: recruited from advertisements in newspapers

Inclusion criteria: community‐dwelling older adults aged 65 and over, with at least 1 fall prior to participation and able to walk 15 minutes without the use of a walking aid

Exclusion criteria: severe cardiac, pulmonary or musculoskeletal disorders, pathologies associated with increased fall risk (i.e. stroke or Parkinson's disease), osteoporosis and the use of psychotropic drugs

Interventions

1. Exercise group (n = 30). Twice weekly 1.5‐hour exercise sessions for 5 weeks comprised of balance, gait and co‐ordination training in an obstacle course, walking exercises that stimulated walking in a crowded environment with changes in speed and direction, the practice of fall techniques derived from marital arts. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 28). No intervention

3. Non‐randomised group (n = 49). Assigned same exercise as Exercise group above. Non‐randomised group participants have been excluded from analyses in this review

Outcomes

Number of falls (recorded by monthly fall calendars) measured at baseline, 6 months and 7 months follow‐up after intervention. Balance confidence (ABC). Measured at baseline and post intervention

Notes

Adherence: mean attendance rate was 87% for the combined exercise group and non‐randomised group

ABC means and SDs (excluding non‐randomised group) obtained through personal communication with author

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The following information was obtained from Gillespie 2012. Quote: "Block randomisation (3 blocks of 20) with gender stratification with equal probability for either exercise or control group assignment."

Allocation concealment (selection bias)

Unclear risk

The following information was obtained from Gillespie 2012. Quote:"The group allocation sequence was concealed (to both researchers and participants) until assignment of interventions. We had participants draw a sealed envelope with group allocation ticket from a box containing all remaining envelopes in the block"

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Falls incidence and ABC were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

The intervention group had a significantly higher proportion of fallers at baseline than the control group

Westlake 2007

Methods

RCT

Participants

Country: Canada

n = 36

% female not reported

Mean age in years (SD) = not reported

Study population: recruited from advertisements in newspapers and flyers

Inclusion criteria: community‐dwelling older adults aged 65 years and older

Exclusion criteria: pre‐existing major lower extremity pathology neurological disorders or balance difficulties, and health conditions that would prevent participation in the exercise programme

Interventions

1. Exercise group (n = 17). 1‐hour sensory specific balance classes were held 3 times per week over an 8‐week period, following the FallProof programme which focuses on static and dynamic balance exercises with transitions between different sensory conditions. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 19). 1‐hour falls prevention education group, held once a week for 8 weeks. The education group received information about 'non‐exercise' related potential fall risk factors, such as nutrition, environmental hazards and the importance of sleep

Outcomes

Balance confidence (ABC); physical activity (PASE). Measured at baseline and post intervention. Additionally the exercise group were re‐assessed at 2 months follow‐up

Notes

Adherence: mean adherence rate was 66%

Personal communication with author confirmed no exercise information was provided to the control group

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Participants were randomised into the exercise or education group. No information given on generation of randomisation schedule

Allocation concealment (selection bias)

Unclear risk

No information provided on allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

ABC and PASE were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

44 participants randomised into the exercise or control group. The number per group at baseline is not reported. Outcomes assessed on 17 exercise group and 19 control group participants

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Limited baseline data reported so unable to assess if groups were well balanced at baseline

Wolf 1996

Methods

RCT

Participants

Country: USA

n = 200

81% female

Mean age in years (SD) = 76 (4.7)

Study population: recruited by advertisements in newspapers and from an independent living facility

Inclusion criteria: aged 70 years and older, living in unsupervised environments, ambulatory and agreeing to participate weekly for 15 weeks with 4‐month follow‐up

Exclusion criteria: the presence of debilitating conditions such as cognitive impairments, metastatic cancer, crippling arthritis, Parkinson's disease or major stroke, or profound visual defects that could compromise balance or ambulation

Interventions

1. Computerised Balance Training (BT) group (n = 64). Individual balance training on a computerised force platform. Participants had 1 hour of instruction per week (with approximately 45 minutes individual contact time with an instructor) for 15 weeks. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Tai Chi Quan (TC) group (n = 72). Classes of Tai Chi Quan focusing on all components of movement that typically becomes limited with ageing. Participants had 2 hours of instruction per week (2 separate sessions) with a total of approximately 45 minutes contact time with an instructor. Participants were encouraged to practice at least 15 minutes twice a day at home. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

3. Education group (n = 64). Weekly 1‐hour meetings for 15 weeks were held with a gerontological nurse/researcher to discuss a variety of topics such as pharmacological management, sleep disorders, cognitive deficits, coping with bereavement and other issues important to each group

The intervention group used in the analysis comprised the combined BT and TC groups

Outcomes

Number of falls (recorded by weekly fall calendars); falls efficacy (FES) and Center for Epidemiologic Studies ‐ Depression (CES‐D) scale. Falls were defined using the FICSIT definition ("unintentionally coming to rest on the ground, floor or lower level") and the Atlanta site definition ("falls resulting in fractures, dislocation, sprains, bruises, lacerations, scrapes and other medical problems"). Mean and SD for FES presented at baseline and categories of fear of falling (not at all afraid, somewhat afraid, fairly afraid, very afraid of falling) presented at follow‐up. Measured at baseline, post intervention and at 4‐month follow‐up

Notes

We used falls defined using the FICSIT definition in the meta‐analysis. A subset of participants (n = 72) who "tended to be reclusive" were reported on in Wolf 1997. Adherence: over 90% adhered to the exercise programme

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Individuals were assigned to an intervention using a computer‐generated, fixed randomisation procedure

Allocation concealment (selection bias)

Unclear risk

No information provided on allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls and fear of falling were self reported by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on ≥ 80% of participants in each group

Selective reporting (reporting bias)

High risk

Protocol not available. Data only presented for outcomes that differed significantly between groups post intervention or at follow‐up

Other bias

Unclear risk

The Tai Chi group had a higher proportion of participants in paid work than the balance training or control group, a higher proportion volunteering than the balance training group and a higher proportion with cataracts than the control group at baseline. The Tai Chi group had a lower mean BMI than the balance training or control group at baseline

Wolf 2001

Methods

RCT

Participants

Country: The Netherlands

n = 94

73% female

Mean age in years (SD) = 84 (5.6)

Study population: recruited from 3 residential care facilities and by advertisements in newspapers

Inclusion criteria: older adults aged 75 years and older, living independently or in a residential care facility

Exclusion criteria: recovering from an acute illness, received physical therapy during the previous month, a Mini‐Mental State Examination score < 17, Berg Balance Scale (BBS) score < 52 and impaired balance during functional activities (as determined by a physiotherapist)

Interventions

1. Balance training group (n = 47). Participants received 12 sessions of 30‐minute balance training provided by physical and recreational therapists 2 to 3 times per week during a 4‐ to 6‐week period at home or at a physical therapy department. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control group (n = 47). Offered individual‐orientated activities including handicraft, music, media, board games, discussion groups, memory training and car tours

Outcomes

Fear of falling (visual analogue scale (VAS)); anxiety and depression (Hospital Anxiety and Depression Scale (HADS)). Measured at baseline, post intervention and 1 month follow‐up

Notes

Adherence rates not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Subjects were randomly assigned to the 2 treatments using sealed envelopes selected by a blindfolded person. No information provided on how randomisation sequence generated

Allocation concealment (selection bias)

Unclear risk

Sealed envelopes selected by a blindfolded person. Unclear if envelopes were sequentially numbered

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

VAS and HADS were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on > 80% of participants in the control group, but < 80% in the intervention group

Selective reporting (reporting bias)

High risk

Means and SDs not presented for HADS. Protocol not available

Other bias

Unclear risk

Control group had slightly higher HADS depression scores at baseline than the intervention group

Yang 2012

Methods

RCT

Participants

Country: Australia

n = 165

44% female

Mean age in years (SD) = 81 (6.2)

Study population: recruited from advertisements in newspapers, newsletters and presentations to community groups

Inclusion criteria: community‐dwelling older adults aged 65 years and older, community ambulant, requiring no walking aid, no more than 1 fall in the previous 12 months, having concerns about balance and a mild balance dysfunction

Exclusion criteria: participants were excluded if balance performance was within normal limits

Interventions

1. Home‐based exercise programme (n = 82). Participants received a 6‐month physical therapist prescribed balance and strength home exercise programme based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. The programme consisted of a warm‐up, balance and strength exercises with a tailored walking programme. All exercises were performed without upper limb support and with ankle weights if able. Participants were instructed to perform exercises taking approximately 20 minutes 5 times per week and a graduated walking programme aiming for at least 30 minutes per day. ProFaNE taxonomy classification: gait, balance, co‐ordination, functional tasks

2. Control (n = 83). No intervention

Outcomes

Number of falls (self reported); falls efficacy (MFES); Human Activity Profile ‐ Adjusted Activity Score (HAP‐AAS). Measured at baseline and post intervention

Notes

Adherence: 44.1% reported full adherence

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Group allocation schedule was developed by computer‐generated random numbers

Allocation concealment (selection bias)

Unclear risk

Group allocation was performed by a researcher who was not involved in recruiting or assessing participants. No further information on allocation concealment provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Number of falls, MFES and HAP‐AAS were self reported by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Groups appeared well balanced at baseline. Those who withdrew from the trial had significantly worse scores on the step test and limit of stability maximum excursion test than those who completed the trial

Yoo 2010

Methods

RCT

Participants

Country: South Korea

n = 21

100% female

Mean age in years (SD) = 71 (2.7)

Study population: community volunteers. No further information provided

Inclusion criteria: community‐dwelling older women aged 65 years and older capable of participating in moderate intensity aerobic and resistance exercises, with no more than 1 risk factor for cardiovascular disease

Exclusion criteria: difficulty with activities of daily living (ADL), uncontrolled hypertension, a history of metabolic disorders, irregular menstrual cycles or amenorrhoea, hip or vertebral fracture and currently taking hormones or hormonal medication

Interventions

1. Exercise group (n = 11). Participants were involved in a 12‐week supervised walking exercise programme 3 times a week wearing ankle weights (1 kg each) in an outdoor field in a local elementary school. The programme included a 10‐minute warm‐up without ankle weights, 45 minutes of walking with ankle weights, and a 5‐minute cool down without ankle weights. Exercise intensity was maintained at 60% of heart rate reserve (HRR) determined by a heart rate monitor. ProFaNE taxonomy classification: strength/resistance

2. Control group (n = 10). No intervention

Outcomes

Falls efficacy (K‐FES), Tideiksaar (1997) Fear of Falling questionnaire Yale Physical Activity score (YPAS). Measured at baseline and post intervention

Notes

Adherence rates not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned, but no information provided about randomisation sequence generation

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Tideiksaar Fear of Falling questionnaire and K‐FES were self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

High risk

Outcome data are based on < 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Low risk

Appears to be free of other sources of bias

Zhang 2006

Methods

RCT

Participants

Country: China

n = 49

47% female

Mean age in years (SD) = 70 (4.3)

Study population: selected from a previous study investigating falls among community‐dwelling older adults

Inclusion criteria: community‐dwelling older adults aged 60 and older who had a lower ability for maintaining balance (defined as a 1‐leg stand time between 5 and 20 seconds) and able to walk around independently

Exclusion criteria: participants were excluded if they had a 1‐leg stance time of less than 5 seconds and were considered at risk to practice Tai Chi Chuan

Interventions

1. Tai Chi Chuan (TC) group (n = 25). Participants attended 1‐hour group classes 7 times a week for 8 weeks and were instructed to perform 24 simplified forms of TC. Exercises were performed in a park and taught by experienced TC instructors. If participants could not attend the class, they were asked to complete a home TC programme consisting of 11 easy forms of TC taking approximately 30 minutes to complete. ProFaNE taxonomy classification: 3D (Tai Chi, Qi Gong, dance, yoga)

2. Control group (n = 24). No intervention

Outcomes

Falls efficacy (FES ‐ translated into Chinese). Measured at baseline and post intervention

Notes

Adherence: over 90% adhered to the exercise programme

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Prior to randomisation, the 49 participants were divided into 25 pairs according to sex, experience of falling and exercise habits. Not all pairs were matched for sex or exercise habits. Pairs were then randomly assigned to either the intervention or control group by a coin toss

Allocation concealment (selection bias)

Unclear risk

No information provided about allocation concealment

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants not blinded to allocation. Note: blinding not possible due to nature of intervention

Blinding of outcome assessment (detection bias)
All outcomes

High risk

FES was self completed by participants who knew their allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Outcome data are based on > 80% of participants in each group

Selective reporting (reporting bias)

Unclear risk

Protocol not available. Unclear if all pre‐specified outcomes have been reported

Other bias

Unclear risk

Participants were selected from a previous study by the authors (Zhang et al 2003)

ABC: Activities‐specific Balance Confidence scale
BBS: Berg Balance Scale
BMI: body mass index
FES: Falls Efficacy Scale
FES‐I: FES‐International
FICSIT: 'Frailty and Injuries: Cooperative Studies of Intervention Techniques' study
GDS: Geriatric Depression Scale
GDS‐20: Geriatric Depression Scale‐20
HADS: Hospital Anxiety and Depression Scale
HAP‐AAS: Human Activity Profile ‐ Adjusted Activity Score
K‐FES: Korean version of the FES
LiFE: Lifestyle approach to reducing Falls through Exercise
MFES: Modified Falls‐Efficacy Scale
PASE: Physical Activity Scale for the Elderly
RCT: randomised controlled trial
SD: standard deviation
TUG: Timed Up and Go
VAS: visual analogue scale
XMSS: Xavix Measured Step System
YPAS: Yale Physical Activity Survey

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Bainbridge 2011

Not a RCT or quasi‐RCT

Ballard 2004

Multi‐component intervention. Participants received strength and balance exercises plus 6 home safety education sessions. Comparator group invited to attend exercise programme for 6 classes

Banez 2008

Not a RCT or quasi‐RCT

Batson 2006

Multi‐component intervention. Participants received exercise and mental practice of motor imagery. Comparator group were provided with exercise

Bean 2002

Comparator group were assigned to a walking programme

Beyer 2007

Multi‐component intervention. Participants were allocated to a multidimensional training programme and behaviour counselling

Bishop 2007

Not a RCT or quasi‐RCT

Bishop 2010

Not a RCT or quasi‐RCT

Bula 2011a

Not a RCT or quasi‐RCT

Bunout 2005

Fear of falling not measured

Chang 2007

Community‐dwelling people and nursing home residents. Data not presented separately for community participants

Conroy 2010

Multi‐component intervention. Participants invited to attend a falls prevention programme involving a medical review, physiotherapy and occupational therapy treatments

Davis 2011

Not a RCT or quasi‐RCT

Davison 2005

Multi‐component intervention. The intervention group received medical assessment, physiotherapy and occupational therapy

Delbaere 2006

Not a RCT or quasi‐RCT

Devereux 2005

Study population restricted to participants with osteopenia or osteoporosis

Duque 2013

Multi‐component intervention. Participants received training on a virtual reality system, an invitation to join an exercise programme, medication review, home visit by an occupational therapist, hearing and visual assessment, nutritional supplements and educational materials on falls prevention. Comparator group participants received the same intervention but with no training on the virtual reality system

Elley 2003

Majority of participants under 65 years old

Elley 2008

Multi‐component intervention. Exercise group referred to optometrist, podiatrist, physical therapist and occupational therapist

Faber 2006

Participants recruited from low and high‐level care nursing centres

Faes 2011

Multi‐component intervention. Physical and psychological interventions provided

Foley 2009

Not a RCT or quasi‐RCT

Gillespie 2012

Not a RCT or quasi‐RCT

Gitlin 2006

Multi‐component intervention. Participants provided with physical and occupational therapy

Greendale 2009

Study population restricted to participants with adult‐onset hyperkyphosis

Hagedorn 2010

Comparator group received resistance, balance and physical fitness training

Hakim 2003

Not a RCT or quasi‐RCT

Hakim 2004

Not a RCT or quasi‐RCT

Hakim 2010

Not a RCT or quasi‐RCT

Harling 2008

Not a RCT or quasi‐RCT

Harmer 2008

Not a RCT or quasi‐RCT

Hartmann 2009

Not a RCT or quasi‐RCT

Hess 2005

Not a RCT or quasi‐RCT

Hinrichs 2009

Not a RCT or quasi‐RCT

Huang 2011

Multi‐component intervention. Tai Chi with cognitive behavioural strategies

Hugel 2000

Not a RCT or quasi‐RCT

Inokuchi 2007

Not a RCT or quasi‐RCT

ISRCTN05350123

Comparator group received strength and balance exercises

ISRCTN05545178

Comparator group received strength and balance exercises

ISRCTN21695765

Nursing home residents

ISRCTN48015966

Multi‐component intervention. Intervention group received general guidance for physical activity, guidance for adequate nutrition, individually tailored or group training of strength and balance, treatment of illnesses increasing the risk of falling, review of medications, home hazard assessment and modification

ISRCTN67535605

Multi‐component intervention. Intervention group received strength and balance training, community falls prevention rehabilitation and medical and social care

ISRCTN75134517

Multi‐component intervention. Intervention group received exercise training in combination with cognitive training. Comparator group received exercise training

ISRCTN89512790

No exercise intervention reported. Health coaching programme using face to face and telephone coaching sessions

Iwamoto 2009

Fear of falling not measured

Jansson 2004

Not a RCT or quasi‐RCT

Juarbe 2009

Not a RCT or quasi‐RCT

Jury 2009

Not a RCT or quasi‐RCT

Kelsey 2010

Not a RCT or quasi‐RCT

Kemmler 2010

Comparator group received a wellness programme of low‐intensity walking and strength and balance exercises. Fear of falling not measured

Kerse 2010

Multi‐component intervention. Intervention group received exercises on a Green Prescription and motivational interviewing techniques from exercise specialists. Fear of falling not measured

Kim 2009a

Intervention did not include exercise

Kim 2011

Study population restricted to community‐dwelling women aged 70 or older with multiple symptoms of geriatric syndrome (MSGS) including functional decline, urinary incontinence and fear of falling

Kuo 2011

Not a RCT or quasi‐RCT

Kuptniratsaikul 2011

Not a RCT or quasi‐RCT

Kuramoto 2006

Not a RCT or quasi‐RCT

Kwok 2011

Multi‐component intervention. All participants given home safety and modification advice in addition to their exercise. Comparator group provided with a gym‐based rehabilitation programme and home exercise

Kwon 2011

Not a RCT or quasi‐RCT

Lee 2010

Not a RCT or quasi‐RCT

Leininger 2006

Comparator group were provided with 4 1‐hour presentations on osteoporosis and exercise in older adults, including discussion and handouts over a 10‐week period

Li 2005

Comparator group were provided with a stretching exercise programme for 1 hour, 3 times a week, for 26 weeks

Li 2010

Intervention did not include exercise

Lin 2008

Not a RCT or quasi‐RCT

Liu 2007

Comparator group provided with seated exercises

Liu 2008

Not a RCT or quasi‐RCT

Liu 2009a

Not a RCT or quasi‐RCT

Liu 2010

Not a RCT or quasi‐RCT

Lord 1995

Fear of falling not measured

Lord 2005

Multi‐component interventions. The extensive intervention group received group exercises and strategies for maximising vision and sensation. The minimal intervention group received home exercise sheets and written advice about how to maximise their vision and take precautions for loss of peripheral sensation

Luukinen 2007

Study population restricted to participants with ≥ 1 risk factor for falling (≥ 2 falls in previous year, loneliness, poor self rated health, poor visual acuity, poor hearing, depression, poor cognition, impaired balance, impaired chair rise and slow walking speed)

Maginnis 1999

Not a RCT or quasi‐RCT

Mahoney 2007

Multi‐component intervention. Intervention group provided with exercise, falls risk assessment and medication review

Marchetti 2005

Not a RCT or quasi‐RCT

McCulloch 2002

Fear of falling not measured

McKinley 2008

Comparator group provided with walking exercises for 2 hours, 2 times per week, for 10 weeks

McMurdo 1997

Multi‐component intervention. Intervention group exercised and took calcium supplements

Mihay 2006

Comparator group provided with strength training exercises 3 times a week for 18 months

Miller 2010

Not a RCT or quasi‐RCT

Morgan 2004

Fear of falling not measured

Nagai 2011

Not a RCT or quasi‐RCT

NCT00037167

Fear of falling not measured

NCT00140322

Multi‐component intervention. Intervention group received a comprehensive health assessment combined with tailored risk reduction strategies such as strength and balance exercises

NCT00217360

Multi‐component intervention. Intervention participants received a "customised multifactorial falls prevention program"

NCT00323596

Multi‐component intervention. Strength and balance training, plus falls risk factor assessment followed by a comprehensive geriatric assessment and treatment

NCT00483275

Multi‐component intervention. Intervention included fall prevention programme with alfacalcidol and calcium, patient education and a mobility programme

NCT00805220

Comparator group participated in a walking programme

NCT00986466

Multi‐component intervention. Participants received exercise and vitamin D supplementation

NCT01006967

Comparator group received a standard programme of physical therapy for gait and balance

NCT01313481

Comparator group performed strength and balance exercises 3 times a week for 12 weeks

NCT01523600

Comparator group received wellness education, which consisted of supervised group training done once a week with the focus on stretching and flexibility exercises

Nitz 2004

Comparator group received balance training strategies

Obuchi 2004

Comparator group provided with treadmill exercises. Fear of falling not measured

Oh 2012

Multi‐component intervention. Before randomisation, all participants attended 3 educational classes that discussed falling, osteoporosis and bone fracture. Comparator group were provided with daily stretch exercises

Robertson 2001a

Fear of falling not measured

Robertson 2001b

Not a RCT or quasi‐RCT

Romero 2010

Not a RCT or quasi‐RCT

Rosendahl 2006

Multi‐component intervention. Participants provided with exercise and protein‐enriched energy supplement

Rosie 2007

Comparator group performed low‐intensity knee extension exercises daily for 6 weeks

Rubenstein 2000

Fear of falling not measured

Schwarting 2002

Not a RCT or quasi‐RCT

Sherrington 2008a

Not a RCT or quasi‐RCT

Sherrington 2014

Multi‐component intervention. Participants provided with home exercises and a 32‐page booklet about fall prevention. The booklet contained information about risk factors for falls, environmental modification for falls risk reduction and what to do after a fall

Shigematsu 2008

Comparator group provided with strength and balance training

Shumway‐Cook 1997

Not a RCT or quasi‐RCT

Silsupadol 2009

Comparator group provided with balance training exercises

Simmons 1996

Fear of falling not measured

Singh 2012

Majority of participants under 65 years old

Sipe 2009

Comparator group provided with resistance exercises 3 days a week for 12 weeks

Snow 1999

Not a RCT or quasi‐RCT

Southard 2004

Not a RCT or quasi‐RCT

Southard 2006

Multi‐component intervention. Intervention group received balance retraining exercises and efficacy training (including discussion of group fears, introduction to home safety and an opportunity to practise any skill that is difficult or avoided secondary to fear). Comparator group provided with balance retraining exercises

Spink 2011

Not a RCT or quasi‐RCT

Suzuki 2004

Fear of falling not measured

Sze 2008

Not a RCT or quasi‐RCT

Szturm 2011

Comparator group provided with strength and balance exercises, assessment of walking aids, a gait re‐education programme and an unsupervised walking programme

Taggart 2002

Not a RCT or quasi‐RCT

Takai 2010

Nursing home residents

Talley 2008

Not a RCT or quasi‐RCT

Tennstedt 1998

Multi‐component intervention. Participants received group discussions focused on self efficacy, cognitive restructuring and exercise

Tousignant 2012

Comparator group provided with strength and walking exercises

Underwood 2011

Multi‐component intervention. Care home staff received depression awareness and physical activity training. Intervention participants received a twice weekly exercise group

Van Haastregt 2007

Not a RCT or quasi‐RCT

Vind 2010

Multi‐component intervention. Participants received personalised exercises and medical treatment

Voukelatos 2007

Fear of falling not measured

Williams 2002

Multi‐component intervention. Intervention participants received a 16‐week balance and mobility exercise group with a self efficacy intervention. Comparator group provided with balance and mobility exercises

Williams 2010

Not a RCT or quasi‐RCT

Williams 2010a

Not a RCT or quasi‐RCT

Woo 2007

Fear of falling not measured

Wrisley 2006

Majority of participants under 65 years old

Wu 2010

Comparator group provided with Tai Chi exercises

Yamada 2011

Not a RCT or quasi‐RCT

Yamada 2011a

Comparator group provided with strength and balance training exercises each week

Yan 2009

Not a RCT or quasi‐RCT

Zilstra 2007

Not a RCT or quasi‐RCT

RCT: randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Arai 2007

Methods

RCT

Participants

Country: Japan

n = 171

% female not reported

Mean age in years (SD) = 74.1 (not reported)

Study population: recruited via advertisements in publications and clubs for the elderly

Inclusion criteria: community‐dwelling, aged ≥ 65, ambulatory with or without assisting devices

Exclusion criteria: cerebrovascular or cardiovascular accidents reported within the past 6 months, acute liver problems or the active phase of chronic hepatitis, diabetes mellitus with a history of hypoglycaemic attack, or with fasting levels of plasma glucose concentrations of 200 mg/dl or higher, or with complications such as retinopathy or nephropathy, systolic blood pressure above 180 mm Hg or diastolic blood pressure above 110 mm Hg at rest, diagnosis of severe heart disease or an acute orthopaedic problem, diagnosis of dementia or depression made by a medical doctor, or an inability to understand and follow the instructions of the research staff; restriction of physical activities by a medical doctor

Interventions

1. Exercise group (n = 86). Group‐based resistance and balance training for 1.5 hours, twice weekly, for 3 months

2. Control group (n = 85). Health education group for 1.5 hours, twice a month, for 3 months. Lectures included "Knowledge of Resistance Training"

Outcomes

Falls efficacy (FES ‐ translated into Japanese, with the degree of confidence in accomplishing tasks based on a scale of 1 to 4 rather than 1 to 10). Measured at baseline and post intervention

Notes

Brouwer 2003

Methods

RCT

Participants

Country: Canada

n = 38

74% female

Mean age in years (SD) = 77.1 (5.1) for exercise group, 78.0 (5.5) for control

Study population: recruited through newspaper and radio advertisements seeking individuals fearful of falling

Inclusion criteria: seniors living independently with a lasting concern about falling causing them to avoid or curtail activities they felt they were capable of doing

Exclusion criteria: coexisting conditions affecting balance (e.g. neuropathy, vestibular deficits, mobility limiting arthritis, pre‐existing neurological conditions), not being able to commit to an 8‐week intervention

Interventions

1. Exercise group (n = 17). Group‐based low‐resistance exercises and weight shifting activities, and a 40‐minute, twice weekly home programme of exercises and stretches

2. Control group (n = 17). Group‐based education programme focused on identifying and reducing risk factors for falls. Topics included "the importance of good nutrition and activity"

Both groups were delivered by a physiotherapist for 1 hour, weekly, for 8 weeks

Outcomes

Balance confidence (ABC). Measured at baseline, post intervention and 6 weeks follow‐up. Adherence to exercise intervention measured by class attendance and participant log books

Notes

38 participants randomised but 4 withdrew during study. Number of participants randomised to each group before the withdrawals not reported

Henwood 2008

Methods

RCT

Participants

Country: Australia

n = 67

54% female

Mean age in years (SD) = 71.2 (1.3) for high‐velocity training group, 69.6 (1.1) for strength training group, 69.3 (1.0) for control

Study population: recruited by newspaper advertisement

Inclusion criteria: independently living, community‐dwelling, aged 65 to 84

Exclusion criteria: acute or terminal illness, unstable or ongoing cardiovascular and/or respiratory disorder, neurological or musculoskeletal disease or impairment, resistance training experience within the previous 12 months, the inability to commit to a period of time equivalent to the duration of the study

Interventions

1. High‐velocity training group (n = 23). High‐velocity varied resistance exercises

2. Strength training group (n = 22). Constant resistance exercises

3. Control group (n = 22). Non‐training group

Participants in the exercise interventions trained twice weekly for 24 weeks

Outcomes

Balance confidence (ABC); physical activity (PASE). Measured at baseline and post intervention

Notes

All participants were invited to attend 2 familiarisation sessions, during which exercise techniques were demonstrated and practised, before baseline assessments and randomisation

Jorgensen 2013

Methods

RCT

Participants

Country: Denmark

n = 58

69% female

Mean age in years (SD) = 75 (6)

Study population: recruited through advertisements in local newspapers, senior citizens' clubs, and senior society organisations

Inclusion criteria: ≥ 65, self reported balance poor to average (on a discrete scale: good, average, poor), capability of understanding verbal instructions

Exclusion criteria: orthopaedic surgery within the previous 6 months, acute illness within the previous 3 weeks, physiotherapy within the previous month, poor visual acuity (not capable of seeing the visual features on the TV screen)

Interventions

1. Exercise group (n = 28). Biofeedback‐based Nintendo Wii training for 35 (SD 5) minutes, twice weekly, for 10 weeks

2. Control group (n = 30). Daily use of ethylene vinyl acetate copolymer shoe insoles for 10 weeks. Participants were explicitly informed that the use of insoles was expected to increase sensory inputs from the feet to the central nervous system, resulting in an improved postural balance

Outcomes

Concern about falling (short FES‐I). Measured at baseline and post intervention

Notes

Study record reported at ‐ NCT01371253. 10 weeks of Nintendo Wii Fit balance training improved postural balance and muscle strength in elderly individuals. http://clinicaltrials.gov/show/NCT01371253 (accessed 1 August 2013)

Kim 2009b

Methods

RCT

Participants

Country: USA

n = 24

92% female

Mean age in years (SD) = 72.5 (6.8) in balance training group, 72.0 (5.5) in weight training group, 76.5 (8.3) in control

Study population: recruited from the local community via advertisements

Inclusion criteria: older adults, no history of the formal weight and balance exercises in the past 6 months, current exercises (such as walking, running, swimming, dancing, gardening, tennis and golf) do not particularly target weight lifting and balance control, current exercises that target improved muscle strength and balance do not exceed more than 30 minutes a week in total

Exclusion criteria: physical problems (i.e. hip, knee, ankle problems)

Interventions

1. Balance training group (n = 6)

2. Weight training group (n = 6)

3. Control group (n = 6). Social activities (picnics, bingo, shopping and park visits). Activities that required physical performance were not included in the control group activities, except for walking

The groups met for 50 to 60 minutes, 3 times weekly, for 8 weeks

Outcomes

Fear of falling (on a scale from 1 to 10 (10 being high)). Measured at baseline and post intervention

Notes

24 participants randomised, but 5 withdrew and 1 participant's data were eliminated because his physical abilities were exceptionally superior to the other participants' physical abilities. Number of participants randomised to each group before the withdrawals and data elimination not reported

Morris 2008

Methods

RCT

Participants

Country: USA

n = 26

100% female

Mean age in years (SD) = 76.1 (6.4)

Study population: recruited from among the current users of any of the activities sponsored by a hospital supported senior wellness programme

Inclusion criteria: willingness to participate after full understanding of the elements and risks involved, completion of a health history form and a signed informed consent form

Exclusion criteria: advanced osteoporosis, hip replacement, glaucoma, Parkinson's disease, common occurrences of dizziness, any surgery within the past year

Interventions

1. Group‐based yoga exercises (n = 10)

2. Group‐based balance training exercises (n = 10)

3. Control group (n = 6). Fall risk awareness group. Topics included "exercise" and "walking/healthy feet"

All groups met for 1 hour, twice weekly, for 8 weeks

Outcomes

Falls efficacy (FES); balance confidence (ABC). Measured at baseline, every other week, post intervention and at 1 month follow‐up. Adherence to exercise interventions measured by class attendance

Notes

Wolf 2003

Methods

RCT

Participants

Country: USA

n = 311

94% female

Mean age in years (SD) = 80.9 (6.6) for Tai Chi group, 80.8 (5.8) for wellness education group

Study population: recruited from congregate living facilities

Inclusion criteria: ≥ 70, transitioning to frailty, fallen at least once in the past year

Exclusion criteria: major unstable cardiopulmonary diseases (ischaemic chest pain, unaccustomed shortness of breath, shortness of breath with mild exertion, recurrent syncopal episodes, orthopnoea, paroxysmal nocturnal dyspnoea, palpitations, tachycardia, claudication or severe pitting ankle oedema), cognitive impairment defined as a Mini‐Mental State Examination (MMSE) score of less than 24, contraindications to physical exercise, such as major orthopaedic conditions (e.g. severe lumbar spine, hip, knee, or ankle arthritis that limits exercise capability), restricted to a wheelchair; terminal cancer; or evidence of any other progressive or unstable neurological or medical condition

Interventions

1. Exercise group (n = 158). Group‐based Tai Chi, for 60 to 90 minutes, twice weekly, for 48 weeks

2. Control group (n = 153). Wellness education programme for 1 hour, weekly, for 48 weeks. Topics included "exercise and balance"

Outcomes

Falls efficacy (FES); balance confidence (ABC); depression (CES‐D). Measured at baseline and every 4 months for 12 months during a 48‐week intervention. Number of falls (recorded by weekly forms). Adherence to exercise intervention measured by class attendance

Notes

Fear of falling sub‐study reported at ‐ Sattin R, Easley K, Wolf S, Chen Y, Kutner M. Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults. Journal of American Geriatrics Society 2005;53:1168‐78

ABC: Activities‐specific Balance Confidence scale
CES‐D: Center for Epidemiologic Studies ‐ Depression scale
FES: Falls Efficacy Scale
FES‐I: FES‐International
RCT: randomised controlled trial
SD: standard deviation

Characteristics of ongoing studies [ordered by study ID]

Iliffe 2010b

Trial name or title

Multicentre cluster‐randomised trial comparing a community group exercise programme with home based exercise with usual care for over 65s in primary care

Methods

Cluster‐RCT

Participants

N = 1200

Setting: UK

Inclusion criteria: community‐dwelling older adults aged 65 and over, able to walk around independently indoors and outdoors (with or without a walking aid) and not undergoing long term physiotherapy

Exclusion criteria: 3 or more falls in the previous year ("frequent fallers"), resting BP > 180/100 mm Hg, uncontrolled arrhythmia, critical aortic stenosis, very severe vestibular disturbances, psychiatric conditions, significant cognitive impairment (unable to follow simple instructions), acute medical problems such as pneumonia or acute rheumatoid arthritis, hip/knee replacement in past 3 months, stroke/transient ischaemic attacks in the last 6 months or not living independently (e.g. residential or nursing care)

Interventions

1. Home‐based exercise programme (n = 400). Otago Exercise Programme (OEP) consists of 30‐minute leg muscle strengthening and balance retraining exercises progressing in difficulty performed at least 3 times per week, for 24 weeks. Participants also advised to walk at least twice per week for up to 30 minutes at a moderate pace

2. Community‐based exercise programme (FaME) (n = 400). 1‐hour group exercise class in a local community centre, and 2 30‐minute home exercise sessions (based on the OEP) per week, for 24 weeks. Participants also advised to walk at least twice per week for up to 30 minutes at a moderate pace

3. Treatment as usual (TAU). No intervention

Outcomes

Number and type of falls (fall diary); fear of falling (FES‐I); balance confidence (ConfBal); quality of life (Older People's QOL Questionnaire (OPQOL); SF‐12); economic analysis

Starting date

June 2008

Contact information

Prof Steve Iliffe

Department of Primary Care & Population Health

University College London

Rowland Hill Street

London

NW3 2PF

United Kingdom

Notes

Recruitment completed. Study end date May 2013

NCT01032252

Trial name or title

Prevention of falls in community‐dwelling older adults by a standardized assessment of fall risks in the general practitioner setting and through implementation of a network for effective individual reduction on fall risks

Methods

RCT

Participants

N = 378

Setting: Germany

Inclusion criteria: community‐dwelling adults aged 65 years and older with an increased risk of falling, as seen by history of falls, fear of falling, chair rise > 10 seconds, TUG > 10 seconds and subjective and objective balance deficits

Exclusion criteria: older people not living independently, or suffering from physical or mental restrictions that do not allow the participation in an exercise programme or the assessment of risk of falling

Interventions

1. Exercise group. 16‐week exercise programme performed once a week for 60 minutes. Exercises include strength/power training, balance/gait training, behavioural aspects, perceptual and functional training

2. Control group. No intervention

Outcomes

Number of falls and falls rates (fall diary); fear of falling (FES‐I); quality of life (EuroQol)

Starting date

April 2009

Contact information

Dr Monika Siegrist

Department of Medicine

Division of Prevention and Sports Medicine

Technische Universität

Munich 80809

Germany

Notes

Study has been completed March 2012. Data expected to be published spring or summer 2013 (as per email from Chief Investigator received January 2013)

BP: blood pressure
RCT: randomised controlled trial
TUG: Timed Up and Go

Data and analyses

Open in table viewer
Comparison 1. Exercise versus control: primary outcome ‐ fear of falling, post intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention Show forest plot

24

1692

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 1.1

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention.

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention.

1.1 Fear of falling as measured by single‐item question

4

380

Std. Mean Difference (Random, 95% CI)

0.17 [‐0.06, 0.39]

1.2 Falls efficacy measured using the FES, MFES or K‐FES

12

872

Std. Mean Difference (Random, 95% CI)

0.56 [0.21, 0.90]

1.3 Balance confidence measured using ABC

6

333

Std. Mean Difference (Random, 95% CI)

0.13 [‐0.10, 0.37]

1.4 Concern about falling measured using the FES‐I and Short FES‐I

2

107

Std. Mean Difference (Random, 95% CI)

0.52 [‐0.09, 1.12]

2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months) Show forest plot

4

356

Std. Mean Difference (IV, Fixed, 95% CI)

0.17 [‐0.05, 0.38]

Analysis 1.2

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months).

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months).

3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more) Show forest plot

3

386

Std. Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.01, 0.41]

Analysis 1.3

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more).

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more).

Open in table viewer
Comparison 2. Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Type of exercise (as classified using ProFaNE taxonomy) Show forest plot

22

Std. Mean Difference (Random, 95% CI)

Subtotals only

Analysis 2.1

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 1 Type of exercise (as classified using ProFaNE taxonomy).

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 1 Type of exercise (as classified using ProFaNE taxonomy).

1.1 3D (Tai Chi)

7

483

Std. Mean Difference (Random, 95% CI)

0.60 [0.09, 1.12]

1.2 Strength/resistance

4

416

Std. Mean Difference (Random, 95% CI)

0.08 [‐0.18, 0.34]

1.3 Gait, balance, co‐ordination, functional tasks

11

619

Std. Mean Difference (Random, 95% CI)

0.27 [0.05, 0.50]

2 Type of control group Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.2

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 2 Type of control group.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 2 Type of control group.

2.1 Alternative intervention (e.g. social group, education, etc)

6

499

Std. Mean Difference (Random, 95% CI)

0.11 [‐0.08, 0.29]

2.2 No intervention

18

1199

Std. Mean Difference (Random, 95% CI)

0.48 [0.22, 0.73]

3 Recruited participants at increased risk of falls Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.3

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 3 Recruited participants at increased risk of falls.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 3 Recruited participants at increased risk of falls.

3.1 Studies not recruiting participants on the basis of increased risk of falls

14

926

Std. Mean Difference (Random, 95% CI)

0.44 [0.14, 0.74]

3.2 Studies recruiting participants at increased risk of falls

10

772

Std. Mean Difference (Random, 95% CI)

0.24 [0.04, 0.45]

4 Type of exercise (individual versus group) Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.4

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 4 Type of exercise (individual versus group).

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 4 Type of exercise (individual versus group).

4.1 Group exercises

15

1051

Std. Mean Difference (Random, 95% CI)

0.49 [0.22, 0.76]

4.2 Individual exercises

9

647

Std. Mean Difference (Random, 95% CI)

0.14 [‐0.06, 0.35]

5 Frequency of exercise Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.5

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 5 Frequency of exercise.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 5 Frequency of exercise.

5.1 1 to 3 times per week

20

1339

Std. Mean Difference (Random, 95% CI)

0.38 [0.15, 0.61]

5.2 4 or more times per week

4

359

Std. Mean Difference (Random, 95% CI)

0.30 [0.01, 0.58]

6 Duration of exercise Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.6

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 6 Duration of exercise.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 6 Duration of exercise.

6.1 Up to 12 weeks

17

968

Std. Mean Difference (Random, 95% CI)

0.32 [0.16, 0.48]

6.2 13 to 26 weeks

5

530

Std. Mean Difference (Random, 95% CI)

0.52 [‐0.13, 1.17]

6.3 More than 26 weeks

2

200

Std. Mean Difference (Random, 95% CI)

0.13 [‐0.41, 0.66]

7 Primary aim of the study Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

Analysis 2.7

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 7 Primary aim of the study.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 7 Primary aim of the study.

7.1 To reduce fear of falling

7

471

Std. Mean Difference (Random, 95% CI)

0.42 [0.13, 0.72]

7.2 Other primary aim (e.g. balance improvement, fall prevention, etc)

17

1227

Std. Mean Difference (Random, 95% CI)

0.34 [0.10, 0.59]

Open in table viewer
Comparison 3. Exercise versus control: secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Occurrence of at least one fall Show forest plot

9

1113

Risk Ratio (IV, Fixed, 95% CI)

0.85 [0.74, 0.98]

Analysis 3.1

Comparison 3 Exercise versus control: secondary outcomes, Outcome 1 Occurrence of at least one fall.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 1 Occurrence of at least one fall.

2 Falls rate Show forest plot

9

1121

Rate Ratio (Random, 95% CI)

0.68 [0.53, 0.87]

Analysis 3.2

Comparison 3 Exercise versus control: secondary outcomes, Outcome 2 Falls rate.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 2 Falls rate.

3 Depression score, post intervention Show forest plot

4

406

Std. Mean Difference (Fixed, 95% CI)

‐0.08 [‐0.28, 0.13]

Analysis 3.3

Comparison 3 Exercise versus control: secondary outcomes, Outcome 3 Depression score, post intervention.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 3 Depression score, post intervention.

4 Depression score, short‐term follow‐up (< 6 months) Show forest plot

3

327

Std. Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.02, 0.43]

Analysis 3.4

Comparison 3 Exercise versus control: secondary outcomes, Outcome 4 Depression score, short‐term follow‐up (< 6 months).

Comparison 3 Exercise versus control: secondary outcomes, Outcome 4 Depression score, short‐term follow‐up (< 6 months).

5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly) Show forest plot

4

547

Mean Difference (IV, Fixed, 95% CI)

3.44 [‐1.65, 8.54]

Analysis 3.5

Comparison 3 Exercise versus control: secondary outcomes, Outcome 5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly).

Comparison 3 Exercise versus control: secondary outcomes, Outcome 5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly).

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

'Risk of bias' summary: authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 2

'Risk of bias' summary: authors' judgements about each risk of bias item for each included study

'Risk of bias' graph: authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 3

'Risk of bias' graph: authors' judgements about each risk of bias item presented as percentages across all included studies

Forest plot: Exercise versus control: primary outcome ‐ fear of falling, post intervention
Figures and Tables -
Figure 4

Forest plot: Exercise versus control: primary outcome ‐ fear of falling, post intervention

Exercise versus control: primary outcome ‐ fear of falling, post intervention (see for forest plot)
Figures and Tables -
Figure 5

Exercise versus control: primary outcome ‐ fear of falling, post intervention (see Figure 4 for forest plot)

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention.
Figures and Tables -
Analysis 1.1

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention.

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months).
Figures and Tables -
Analysis 1.2

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months).

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more).
Figures and Tables -
Analysis 1.3

Comparison 1 Exercise versus control: primary outcome ‐ fear of falling, post intervention, Outcome 3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more).

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 1 Type of exercise (as classified using ProFaNE taxonomy).
Figures and Tables -
Analysis 2.1

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 1 Type of exercise (as classified using ProFaNE taxonomy).

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 2 Type of control group.
Figures and Tables -
Analysis 2.2

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 2 Type of control group.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 3 Recruited participants at increased risk of falls.
Figures and Tables -
Analysis 2.3

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 3 Recruited participants at increased risk of falls.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 4 Type of exercise (individual versus group).
Figures and Tables -
Analysis 2.4

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 4 Type of exercise (individual versus group).

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 5 Frequency of exercise.
Figures and Tables -
Analysis 2.5

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 5 Frequency of exercise.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 6 Duration of exercise.
Figures and Tables -
Analysis 2.6

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 6 Duration of exercise.

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 7 Primary aim of the study.
Figures and Tables -
Analysis 2.7

Comparison 2 Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention, Outcome 7 Primary aim of the study.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 1 Occurrence of at least one fall.
Figures and Tables -
Analysis 3.1

Comparison 3 Exercise versus control: secondary outcomes, Outcome 1 Occurrence of at least one fall.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 2 Falls rate.
Figures and Tables -
Analysis 3.2

Comparison 3 Exercise versus control: secondary outcomes, Outcome 2 Falls rate.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 3 Depression score, post intervention.
Figures and Tables -
Analysis 3.3

Comparison 3 Exercise versus control: secondary outcomes, Outcome 3 Depression score, post intervention.

Comparison 3 Exercise versus control: secondary outcomes, Outcome 4 Depression score, short‐term follow‐up (< 6 months).
Figures and Tables -
Analysis 3.4

Comparison 3 Exercise versus control: secondary outcomes, Outcome 4 Depression score, short‐term follow‐up (< 6 months).

Comparison 3 Exercise versus control: secondary outcomes, Outcome 5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly).
Figures and Tables -
Analysis 3.5

Comparison 3 Exercise versus control: secondary outcomes, Outcome 5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly).

Summary of findings for the main comparison. Exercise for reducing fear of falling in older people living in the community

Exercise for reducing fear of falling in older people living in the community

Population: older people living in the community
Setting: community
Intervention: exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness)1

Control: no intervention or alternative non‐exercise intervention2

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Exercise

Fear of falling3

Immediately post intervention

The mean fear of falling score4 in the intervention
groups was 0.37 standard deviations higher
(0.18 to 0.56 higher) (a higher score indicates less fear of falling)

SMD 0.37 (0.18 to 0.56)

1692 (24 studies)

⊕⊕⊝⊝
low5

0.2 SD represents a small difference, 0.5 SD a moderate difference and 0.8 SD a large difference

We are unaware of any definitions of minimal clinically important difference for any fear of falling measure1

There was significant heterogeneity of effect sizes, which was attributable mainly to 1 study, Nguyen 2012, having a much larger effect size than other studies. Upon removal of this study, the effect size reduced to SMD 0.24, 95% CI 0.12 to 0.36; 23 studies; 1619 participants

None of the subgroup analyses6 provided robust evidence of a difference in effect between different subgroups. The possible exception was evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control2

Fear of falling

< 6 months follow‐up

The mean fear of falling score in the intervention
groups was 0.17 standard deviations higher
(0.05 lower to 0.38 higher) (a higher score indicates less fear of falling)

SMD 0.17 (‐0.05 to 0.38)

356

(4 studies)

⊕⊝⊝⊝
very low7

Very low quality evidence7 was also available from 3 studies (386 participants) at long‐term follow‐up (6 or more months post end of the intervention period): SMD 0.20, 95% CI ‐0.01 to 0.41

Occurrence of at least 1 fall

Follow‐up: 2 to 12 months

500/10008

425/1000

(370 to 490)

RR 0.85
(0.74 to 0.98)

1113
(9 studies)

⊕⊝⊝⊝
very low9

Some studies measured falls using prospective falls diaries, some measured falls retrospectively and in some studies it was unclear whether falls were measured prospectively or retrospectively

Note: Studies included in the analysis represent only a subset of studies evaluating the effect of exercise interventions on falls risk

Very low quality evidence9 suggests exercise interventions were associated with a significant reduction in the rate of falls (rate ratio 0.68, 95% CI 0.53 to 0.87; 9 studies; 1121 participants)

Depressive symptoms10

The mean depression score in the intervention
groups was 0.08 standard deviations lower
(0.28 lower to 0.13 higher) where a lower score indicates fewer symptoms of depression

SMD ‐0.08

(‐0.28 to 0.13)

406
(4 studies)

⊕⊝⊝⊝
very low9

0.2 SD represents a small difference, 0.5 a moderate difference and 0.8 a large difference

Note: Studies included in the analysis represent only a very small subset of studies evaluating the effect of exercise interventions on symptoms of depression

Anxiety

Mean HADS11 anxiety score = 4.3 (SD 3.4)

Mean HADS anxiety score = 4.3 (SD 3.9)

Difference between means = 0. No 95% CI reported

77 participants (1 study)

⊕⊝⊝⊝
very low9

Anxiety was reported by the subscale of HADS, which ranged from 0 to 21 with a higher score indicating higher symptoms of anxiety

Note: This study represents only a subset of studies evaluating the effect of exercise interventions on anxiety

Physical activity

The mean physical activity score in the intervention
groups was 3.44
(1.65 lower to 8.54 higher) where a higher score indicates greater physical activity

MD 3.44
(‐1.65 to 8.54)

547
(4 studies)

⊕⊝⊝⊝
very low9

All studies used the Physical Activity Scale for the Elderly (PASE) scale, which ranged from 0 to 400, with a higher score indicating greater physical activity

Note: Studies included in the analysis represent only a subset of studies evaluating the effect of exercise interventions on physical activity

Activity avoidance or restriction

See comment

See comment

No studies reported this outcome

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; HADS: Hospital Anxiety and Depression Scale; MD: mean difference; RR: Risk ratio; SD: Standard deviation; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1The exercises interventions in the included trials fell into three categories: 3D (Tai Chi, Yoga); gait, balance, co‐ordination, functional tasks; and strength and resistance based interventions. They were either supervised or unsupervised activities, delivered in group settings or individually; and varied in duration from up to 12 weeks to over 26 weeks. The majority of exercise interventions were to be performed between one to three times per week.
2Twenty of the 30 included studies compared an exercise intervention with no intervention. Five studies used education as the control intervention; two studies used social home visits; one used individualised crafts/games; one used home safety assessment; and one used discussion groups.
3Measurement tools for fear of falling included:

FES: 10 questions rated 1 (very confident) to 10 (not confident at all). A higher score indicates a lower perceived self efficacy at avoiding falls.
FES‐I: 16 questions rated 1 (not at all concerned) to 4 (very concerned). A higher score indicates a higher concern about falling.
Short FES‐I: 7 questions rated 1 (not at all concerned) to 4 (very concerned). A higher score indicates a higher concern about falling.
K‐FES: 10 questions rated on a scale from 1 (no confidence) to 10 (extremely confident). A higher score indicates a higher perceived self efficacy at avoiding falls.
MFES: 14 questions rated 0 (not confident at all) to 10 (completely confident). A higher score indicates more confidence at avoiding falls.
ABC: 16 questions. Some studies rated from 0 (no confidence) to 100 (complete confidence), whilst others rated from 0 (no confidence) to 10 (very confident). A higher score indicates higher balance confidence.
Balance Self‐Perceptions Test: 12 questions rated 1 (no confidence) to 5 (complete confidence) in performing 12 activities of daily living without fear of loss of balance.
VAS: Participants asked to rate their fear of falling on a scale of 0 to 100 (0 = low, 100 = high fear of falling).

Single item questions:
(a) Participants asked to rate their fear of falling on a scale of 0 to 4 (0 = low, 4= high fear of falling).
(b) Participants asked to rate their worry about falling on a scale of 1 to 5 (1 = not at all worried, 5 = extremely worried).

4Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling (test for subgroup differences: Chi² = 5.21, df = 3, P value = 0.16).
5Downgraded by one level because of study limitations, primarily a likelihood of high risk of bias from lack of blinding, and one level because the funnel plot indicated possible publication bias.
6We carried out the following subgroup analyses: type of exercise intervention; frequency of exercise; duration of the exercise intervention; group exercises rather than individual exercises; studies which did and did not recruit participants on the basis of increased falls risk; studies whose primary aim was to reduce fear of falling and those with an alternative primary aim; no treatment versus an alternative intervention (e.g. education, social visits, craft activities, discussion groups) control group.
7Downgraded by one level because of study limitations, primarily a high likelihood of risk of bias from lack of blinding, one level because of possible publication bias, and one level because of the small number of studies contributing data to this outcome.
8Assumed control risk based on median control group risk across studies.
9Downgraded by one level because of study limitations, primarily likelihood of high risk of bias from lack of blinding, and two levels for indirectness of evidence. Our review includes only a subset of studies reporting the effect of exercise interventions on this outcome, as studies had to report fear of falling and this outcome to be included in our review.
10Measurement tools included for depression:

GDS Scale: 30 questions, range 0 to 30 with higher scores indicating greater symptoms of depression.
GDS 5‐item: 5 questions, range 1 to 5 with higher scores indicating greater symptoms of depression.
GDS‐20: 20 questions, range 0 to 20 with higher scores indicating greater symptoms of depression.
HADS Depression subscale, range from 0 to 21 with higher scores indicating higher symptoms of depression.

11HADS = Hospital Anxiety and Depression Scale.

Figures and Tables -
Summary of findings for the main comparison. Exercise for reducing fear of falling in older people living in the community
Table 1. Means and SDs for fear of falling scales entered as SMD and SE into the meta‐analysis

Study

Time point

Scale

Scale direction

Intervention group mean

Intervention group SD

Intervention group number of participants

Control group mean

Control group SD

Control group number of participants

Clemson 2010

Post intervention

MFES

High score = low FOF

49.4

6.1

17

42.6

9.4

12

Clemson 2010

Post intervention

ABC

High score = low FOF

995.3

377.9

17

805.0

297.1

12

Freiberger 2012

Post intervention

ABC

High score = low FOF

148.6

16.8

57

150.3

12.4

64

Haines 2009

Post intervention

ABC

High score = low FOF

5.3

2.0

19

5.6

2.0

28

Halvarsson 2011

Post intervention

FES‐I

High score = high FOF

‐22.6

6.1

34

‐28.9

9.3

21

Hinman 2002

Post intervention

MFES

High score = low FOF

134.6

10.9

58

135.4

14.1

30

Karinkanta 2012

Post intervention

100 mm VAS

High score = high FOF

‐10.7

15.7

106

‐16.9

21.2

34

Lai 2013

Post intervention

MFES

High score = low FOF

136.0

6.1

15

116.4

27.9

15

Lajoie 2004

Post intervention

ABC

High score = low FOF

92.0

8.0

12

82.5

26.0

12

Logghe 2009

Post intervention

FES

High score = high FOF

‐4.9

4.4

73

‐5.8

5.3

89

McCormack 2004

Post intervention

MFES

High score = low FOF

9.1

1.5

27

8.1

2.4

7

Nguyen 2012

Post intervention

FES

High score = high FOF

‐35.2

5.9

39

‐51.4

8.1

34

Resnick 2008

Post intervention

Participants asked to rate fear of falling on a scale of 0 to 4 (0 = low, 4 = high)

High score = high FOF

‐1.6

1.8

64

‐1.8

1.8

39

Reinsch 1992

Post intervention

Participants asked to rate worry about falling on a scale of 1 to 5 (1 = not at all worried, 5 = extremely worried)

High score = high FOF

‐1.5

0.8

44

‐1.7

1.3

42

Tiedemann 2012

Post intervention

FES‐I

High score = high FOF

‐9.8

4.5

27

‐10.6

3.2

25

Ullmann 2010

Post intervention

FES

High score = low FOF

9.3

1.4

19

9.0

1.7

22

Ullmann 2010

Post intervention

ABC

High score = low FOF

83.5

13.5

19

86.4

10.6

22

Vogler 2009

Post intervention

MFES

High score = low FOF

8.6

1.8

114

8.5

1.8

57

Vrantsidis 2009

Post intervention

MFES

High score = low FOF

8.6

1.6

26

7.7

1.9

29

Wallsten 2006

Post intervention

ABC

High score = low FOF

76.2

20.3

25

70.5

12.3

28

Weerdesteyn 2006

Post intervention

ABC

High score = low FOF

76.3

13.4

29

69.7

17.8

23

Westlake 2007

Post intervention

ABC

High score = low FOF

85.7

9.5

17

79.1

24.2

19

Wolf 2001

Post intervention

100 mm VAS

High score = high FOF

‐38.6

29.7

37

‐44.7

29.9

40

Yang 2012

Post intervention

MFES

High score = low FOF

9.2

1.2

59

9.1

1.4

62

Yoo 2010

Post intervention

K‐FES

High score = low FOF

100.0

0.0

11

95.4

6.8

10

Zhang 2006

Post intervention

FES

High score = low FOF

78.3

4.0

24

75.3

5.9

23

ABC: Activities‐specific Balance Confidence scale
FES: Falls Efficacy Scale
FES‐I: FES‐International
FOF: fear of falling
K‐FES: Korean version of the FES
MFES: Modified Falls‐Efficacy Scale
VAS: visual analogue scale

Figures and Tables -
Table 1. Means and SDs for fear of falling scales entered as SMD and SE into the meta‐analysis
Table 2. Means and SDs for depression scales entered into meta‐analyses as SMD and SE

Study

Time point

Scale

Scale direction

Intervention group mean

Intervention group SD

Intervention group number of participants

Control group mean

Control group SD

Control group number of participants

Halvarsson 2011

Post intervention

GDS‐20

Higher score = greater symptoms of depression

2.7

2.4

34

3

2

21

Resnick 2008

Post intervention

GDS 5‐item

Higher score = greater symptoms of depression

0.41

0.79

64

0.79

1.1

39

Vogler 2009

Post intervention

GDS

Higher score = greater symptoms of depression

7.2

4.49

114

6.4

4.3

57

Wolf 2001

Post intervention

HADS‐Depression

Higher score = greater symptoms of depression

4.8

3.85

37

5.6

4.01

40

GDS: Geriatric Depression Scale
HADS: Hospital Anxiety and Depression Scale

Figures and Tables -
Table 2. Means and SDs for depression scales entered into meta‐analyses as SMD and SE
Table 3. Exercise type classified using the ProFaNE taxonomy of interventions (ProFaNE 2011)

Study

Exercise type classified using the ProFaNE taxonomy of interventions (ProFaNE 2011)

Control Type

Supervised

activity?

Group setting?

Barnett 2003

Gait, balance, co‐ordination, functional tasks

Education (falls prevention)

Supervised

Group

Campbell 1997

Strength/resistance

Social visits

Unsupervised

Individual

Clemson 2010

Gait, balance, co‐ordination, functional tasks

No intervention

Unsupervised

Individual

Freiberger 2012

Strength/resistance

No intervention

Supervised

Group

Haines 2009

Gait, balance, co‐ordination, functional tasks

No intervention

Unsupervised

Individual

Halvarsson 2011

Gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Group

Hinman 2002

Home exercise programme: gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Individual

Hinman 2002

Computerised balance training: gait, balance, co‐ordination, functional tasks

No intervention

Unsupervised

Individual

Karinkanta 2012

Resistance training: strength/resistance

No intervention

Supervised

Group

Karinkanta 2012

Balance jumping: gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Group

Karinkanta 2012

Combined resistance and balance jumping: gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Group

Lai 2013

Gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Individual

Lajoie 2004

Gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Individual

Lin 2007

Gait, balance, co‐ordination, functional tasks

Home safety assessment

Supervised

Individual

Logghe 2009

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

McCormack 2004

Holistic exercise: 3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

McCormack 2004

Conventional exercise: strength/resistance

No intervention

Supervised

Group

Nguyen 2012

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

Reinsch 1992

Gait, balance, co‐ordination, functional tasks

Discussion group

Unsupervised

Individual

Rendon 2012

Gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Individual

Resnick 2008

Strength/resistance

Education (nutrition)

Supervised

Group

Sihvonen 2004

Gait, balance, co‐ordination, functional tasks

No intervention

Unsupervised

Individual

Tiedemann 2012

3D (Tai Chi, Qi Gong, dance, yoga)

Education (falls prevention)

Supervised

Group

Ullmann 2010

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

Vogler 2009

Seated exercise: strength/resistance

Social visits

Unsupervised

Individual

Vogler 2009

Weight‐bearing exercise: strength/resistance

Social visits

Unsupervised

Individual

Vrantsidis 2009

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

Wallsten 2006

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

Weerdesteyn 2006

Gait, balance, co‐ordination, functional tasks

No intervention

Supervised

Group

Westlake 2007

Gait, balance, co‐ordination, functional tasks

Education (falls prevention)

Supervised

Group

Wolf 1996

Tai chi: 3D (Tai Chi, Qi Gong, dance, yoga)

Education (gerontology)

Supervised

Group

Wolf 1996

Computerised balance training: gait, balance, co‐ordination, functional tasks

Education (gerontology)

Supervised

Individual

Wolf 2001

Gait, balance, co‐ordination, functional tasks

Crafts/games

Supervised

Individual

Yang 2012

Gait, balance, co‐ordination, functional tasks

No intervention

Unsupervised

Individual

Yoo 2010

Strength/resistance

No intervention

Supervised

Group

Zhang 2006

3D (Tai Chi, Qi Gong, dance, yoga)

No intervention

Supervised

Group

Five studies had two or more arms with exercise interventions. Each intervention arm is described separately in the table.

Figures and Tables -
Table 3. Exercise type classified using the ProFaNE taxonomy of interventions (ProFaNE 2011)
Comparison 1. Exercise versus control: primary outcome ‐ fear of falling, post intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fear of falling as measured by single‐item question, falls efficacy, balance confidence and concern about falling, post intervention Show forest plot

24

1692

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

1.1 Fear of falling as measured by single‐item question

4

380

Std. Mean Difference (Random, 95% CI)

0.17 [‐0.06, 0.39]

1.2 Falls efficacy measured using the FES, MFES or K‐FES

12

872

Std. Mean Difference (Random, 95% CI)

0.56 [0.21, 0.90]

1.3 Balance confidence measured using ABC

6

333

Std. Mean Difference (Random, 95% CI)

0.13 [‐0.10, 0.37]

1.4 Concern about falling measured using the FES‐I and Short FES‐I

2

107

Std. Mean Difference (Random, 95% CI)

0.52 [‐0.09, 1.12]

2 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, short term follow‐up (< 6 months) Show forest plot

4

356

Std. Mean Difference (IV, Fixed, 95% CI)

0.17 [‐0.05, 0.38]

3 Fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, long term follow‐up (6 months and more) Show forest plot

3

386

Std. Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.01, 0.41]

Figures and Tables -
Comparison 1. Exercise versus control: primary outcome ‐ fear of falling, post intervention
Comparison 2. Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Type of exercise (as classified using ProFaNE taxonomy) Show forest plot

22

Std. Mean Difference (Random, 95% CI)

Subtotals only

1.1 3D (Tai Chi)

7

483

Std. Mean Difference (Random, 95% CI)

0.60 [0.09, 1.12]

1.2 Strength/resistance

4

416

Std. Mean Difference (Random, 95% CI)

0.08 [‐0.18, 0.34]

1.3 Gait, balance, co‐ordination, functional tasks

11

619

Std. Mean Difference (Random, 95% CI)

0.27 [0.05, 0.50]

2 Type of control group Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

2.1 Alternative intervention (e.g. social group, education, etc)

6

499

Std. Mean Difference (Random, 95% CI)

0.11 [‐0.08, 0.29]

2.2 No intervention

18

1199

Std. Mean Difference (Random, 95% CI)

0.48 [0.22, 0.73]

3 Recruited participants at increased risk of falls Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

3.1 Studies not recruiting participants on the basis of increased risk of falls

14

926

Std. Mean Difference (Random, 95% CI)

0.44 [0.14, 0.74]

3.2 Studies recruiting participants at increased risk of falls

10

772

Std. Mean Difference (Random, 95% CI)

0.24 [0.04, 0.45]

4 Type of exercise (individual versus group) Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

4.1 Group exercises

15

1051

Std. Mean Difference (Random, 95% CI)

0.49 [0.22, 0.76]

4.2 Individual exercises

9

647

Std. Mean Difference (Random, 95% CI)

0.14 [‐0.06, 0.35]

5 Frequency of exercise Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

5.1 1 to 3 times per week

20

1339

Std. Mean Difference (Random, 95% CI)

0.38 [0.15, 0.61]

5.2 4 or more times per week

4

359

Std. Mean Difference (Random, 95% CI)

0.30 [0.01, 0.58]

6 Duration of exercise Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

6.1 Up to 12 weeks

17

968

Std. Mean Difference (Random, 95% CI)

0.32 [0.16, 0.48]

6.2 13 to 26 weeks

5

530

Std. Mean Difference (Random, 95% CI)

0.52 [‐0.13, 1.17]

6.3 More than 26 weeks

2

200

Std. Mean Difference (Random, 95% CI)

0.13 [‐0.41, 0.66]

7 Primary aim of the study Show forest plot

24

1698

Std. Mean Difference (Random, 95% CI)

0.37 [0.18, 0.56]

7.1 To reduce fear of falling

7

471

Std. Mean Difference (Random, 95% CI)

0.42 [0.13, 0.72]

7.2 Other primary aim (e.g. balance improvement, fall prevention, etc)

17

1227

Std. Mean Difference (Random, 95% CI)

0.34 [0.10, 0.59]

Figures and Tables -
Comparison 2. Exercise versus control: subgroup analysis for fear of falling as measured by single‐item questions, falls efficacy, balance confidence and concern about falling, post intervention
Comparison 3. Exercise versus control: secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Occurrence of at least one fall Show forest plot

9

1113

Risk Ratio (IV, Fixed, 95% CI)

0.85 [0.74, 0.98]

2 Falls rate Show forest plot

9

1121

Rate Ratio (Random, 95% CI)

0.68 [0.53, 0.87]

3 Depression score, post intervention Show forest plot

4

406

Std. Mean Difference (Fixed, 95% CI)

‐0.08 [‐0.28, 0.13]

4 Depression score, short‐term follow‐up (< 6 months) Show forest plot

3

327

Std. Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.02, 0.43]

5 Physical activity as measured using PASE (Physical Activity Scale for the Elderly) Show forest plot

4

547

Mean Difference (IV, Fixed, 95% CI)

3.44 [‐1.65, 8.54]

Figures and Tables -
Comparison 3. Exercise versus control: secondary outcomes