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EFFECTS OF EXERCISE AMONG THE ELDERLY

The Importance of Exercise Among the Elderly

Grace Andleman

College of Nursing, University of South Florida

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EFFECTS OF EXERCISE AMONG THE ELDERLY

Abstract

Clinical Problem: Elderly patients in the clinical and home setting have a high risk for falls,

which increases the rate of injuries, the need for physical therapy, the need for assistance, and the

length of stay in the hospital.

Objective: The objective of this synthesis paper is to discuss if having elderly patients participate

in an exercise program or physical therapy will help reduce the number of falls seen within the

elderly population. The main databases used to find randomized control trials (RCT) regarding

the effect of exercise among the elderly were PubMed and JAMDA. Keywords used in the

search were elderly falls, patient exercise, fall risk, injuries, physical therapy, hospital falls,

rehabilitation, and recovery.

Results: When it comes to elderly patients, who are at a high risk for falling due to physiological

changes, those who participate in some sort of physical exercise have proven to reduce the rate

of falls and improve overall physical performance compared to those who did not receive

physical therapy. Evidence suggests that the Otago exercise program can also help improve

balance and physical performance and reduce the number of falls. In addition, home-based

exercise programs that focus on balance and muscle strengthening have also proven to reduce the

rate of falls among the elderly.

Conclusion: Exercise programs and physical therapy have been observed to decrease the rate of

falls and improve overall functionality among elderly patients who are at a high risk for falling.

Types of exercise that would be most beneficial include balance and strength training.
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EFFECTS OF EXERCISE AMONG THE ELDERLY

The Importance of Exercise Among Elderly Patients

One of the most frequently reported safety incidents and adverse events that take place in

the hospital are falls (Hewitt et al., 2018). Often these falls are seen among the elderly and result

in some sort of physical injury such as bruising, fractures, bleeding, or lacerations (Hewitt et al.,

2018). The physiologic recovery of an elderly patient is more severe than younger adults (Hewitt

et al., 2018). There are a number of different reasons why older individuals have a challenging

time recovering from a fall which include the following: advanced age, poor motor and

coordination skills, and pre-existing medical conditions (Hewitt et al., 2018). In comparison to

other interventions, exercise has shown positive effects when it comes to reducing the rate of

falls among the elderly (Hewitt et al., 2018). Therefore, physical exercise may help prevent falls

seen among the elderly in the hospital and home setting (Hewitt et al., 2018).

Background questions on this topic include the following: What benefits do exercise and

physical activity have on the body? How does exercise reduce the number of falls seen among

the elderly? An appropriate evidence-based practice (EBP) question is: For elderly patients (P),

how does exercise (I) in comparison to no exercise/sedentary lifestyle (C) reduce fall injuries (O)

within 3 months (T)? With the implementation of a consistent exercise routine in the hospital or

home setting, the expected outcome measure for clinical improvement is a decrease in fall

injuries seen in the elderly population. Physical therapy, occupational therapy, and a variety of

exercise programs that are also available outside of standard hospital care will decrease injuries

as well.

Literature Search
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EFFECTS OF EXERCISE AMONG THE ELDERLY

PubMed and JAMDA were used to find randomized controlled trials (RCT) related to

exercise and physical therapy for reduction in the number of falls seen among the elderly

population. Some of the key terms that were used in the search bar were exercise, physical

therapy, fall risk, hospital falls, recovery, and rehabilitation.

Literature Review

Upon assessment four RCTs found via PubMed and JAMDA were used to identify the

effectiveness of exercise and physical therapy and the improvement it has when it comes to the

number of falls seen in elderly patients. In a RCT, Hewitt et. al (2018) portrayed that high level-

balance and moderate intensity progressive resistance training helped reduce the rate of falls in

residents of aged care facilities. In order to identify the primary outcome, the rate of falls were

evaluated. Secondary outcomes included physical performance, quality of life, mobility, fear of

falling, and overall cognition. The design of the study was a RCT. The sample size was 221

participants (N = 221). These participants were from 16 different assisted living facilities. Those

who were diagnosed with a terminal illness, no medical clearance, wheelchair-bound status,

Parkinson’s, or insufficient cognition were excluded from the study. The participants were

randomized by a computer-generated sequence to receive their usual care or participate in the

Sunbeam strength and balance program. This program is a mixture of balance and resistance

training that has proven to reduce the rate of falls and improve overall physical performance in

elderly patients. Assessments of the residents were taken at baseline, after intervention, and at

the 12-month mark. There were significant decreases in the rate of falls (p < .45) and physical

performance (p < .02). Group randomization, random assignment of all participants, and single-

blinding from the providers were all strengths of the study. Also, there were follow up

assessments, correct analyzation of participants, multiple sites used, appropriately used control
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groups, and reliable tools. The only weakness of the study was that it failed to mention why

some participants did not complete the study.

Jahanpeyma et. al (2021) studied the effects of the Otago exercise program and its effects

on falls, balance, and physical performance in elderly patients who are identified as high fall

risks. The design of the study was a RCT which included a sample size of 72 participants (N =

72) who were over 65 years old and residing in a nursing home. The participants were randomly

assigned into either the Otago exercise program group or the control group, also known as the

walking group. The Otago exercise program group participated in 45 min of exercise 3 days a

week for a total of 12 weeks, plus a walking program. The control group only participated in 30

min of walking 3 days a week. Beforehand and at the end of the RCT all participants were

assessed by the number of falls, the Berg Balance Scale, a 6-min walk test, and the 30 s Chair

Stand Test. The results of the study showed a significantly greater reduction in the number of

falls at the end of the trial (p < .05). In this study some of the strengths included random

assignment, concealment from participants of the study, single blindness, follow up assessments,

instruments used for measurement, and an appropriate control group. As far as the weaknesses

this study had a small sample size and used participants from a single site.

On the other hand, Liu-Ambrose et. al (2019) examined the effect of a home-based

exercise program as a fall prevention strategy in older adults who were previously referred to a

fall prevention clinic after an index fall. The design of the study was a RCT. The sample size was

345 patients (N = 345), who were aged at least 70 years old and had a fall within the past 12

months. Although these patients were recruited from a fall prevention program, they were

randomized into an intervention group (n = 173) or a control group (n = 172). The patients that

were placed in the intervention group received their usual care with an at home exercise program
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that focused on strengthening and balance with a physical therapist. The control group only

received their usual care. The outcomes were self-reported by the participant based on the

number of falls they had over the past 12 months. Out of the original 345 participants, 296

completed the entire trial. At 338 days there were a total of 236 falls that happened amongst 172

participants in the intervention group. At 338 days there were a total of 366 falls among 172

participants in the control group. The estimated incidence rates of falls per person-year were 1.4

(95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2). As far as the absolute difference in fall incidence

there were 0.74 (95% CI, 0.04-1.78; P = .006) falls per person in the past year. The incident rate

ratio was 0.64 (95% CI, 0.46-0.90; p = .009). This study had many strengths which included

random assignment that was concealed from participants, the participants were blind to the group

assignments, follow-up assessments were long enough to fully study the effects, participants

were analyzed in the group that they were assigned to, and valid instruments were used to

measure the outcomes. Some weaknesses found throughout the RCT were that it was conducted

at a single site and there was no rationale provided to explain why the one participant did not

complete the study.

Upon further evaluation Matchar et. al (2017) investigated the effectiveness of a 3 month

customized physical therapy program that was tailored to high fall risk patients who were

recently discharged from the emergency department (ED). The design of the study was a RCT

with a 3-month intervention phase and a 6-month phase of maintenance. This study included 354

adults (N = 354) who were 65 years or older and were recently seen in the ED due to a fall and

were discharged to go home. The 354 adults (N = 354) were randomized into either the

intervention group or the control group. Those in the intervention group received a tailored

physical therapy program. This program focused on balance and coordination, walking gait, and
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EFFECTS OF EXERCISE AMONG THE ELDERLY

strength training. Throughout the 3 months, follow-ups and screenings were conducted to check

in on the participants. Those in the control group received usual care as part of the normal

practice and informative brochures regarding falls prevention for older adults. Each participant

was to self-report any falls they had experienced during the 9-month study period. The Short

Physical Performance Battery (SPPB) assessment tool was also utilized to evaluate their overall

mobility and strength. The authors concluded that the intervention group had significantly less

falls with injuries (OR=.56; 95% CI, .32-.98; P =.041). Some of the highlighted strengths seen

within this study were random assignment to both the control group and intervention group,

participants were blind to assignments, the follow up assessments were conducted within an

appropriate time frame (9 month study), all participants completed the full length of the study,

and valid instruments were used. This study was also a multi-cite study; this is seen as a strength.

No weaknesses were identified within this study.

Synthesis

In the first RCT, Hewitt et. al (2018) reflected that exercise reduces the rate of falls and

improves overall physical performance (p < .45). Next, Jahanpeyma et. al (2021) identified that

there was a greater reduction in the number of falls in the intervention group that utilized the

Otago exercise program (p < .05). Similarly, Liu-Ambrose et. al (2019) demonstrated that there

was a significant decrease in the rate of falls in those that participated in home-based exercise

programs. Lastly, Matchar et. al (2017) concluded that the intervention group had significantly

less falls with injuries (OR= .56; 95% CI, .32-.98; P = .041).

A major strength seen among all four of these studies were that the participants in each of

the studies were exceptional due to their age. Age is such an important factor when it comes to

these studies because the human body undergoes multiple age-related physiological changes that
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make them more prone to fall; a patient over the age of 65 is more likely to experience a fall

compared to a young adolescent. These findings allow nurses to advocate for their patients when

it comes to participating in physical therapy and educating them on the importance of adhering to

their exercise program post discharge.

Clinical Recommendations

After thorough investigation through all four RCTs, evidence from research suggests that

participating in some sort of exercise or physical therapy program is an effective way to reduce

the number of falls seen within the elderly population whether they are at home or in the

hospital. Therefore, doctors amongst other prescribers in the field of healthcare should

recommend exercise and physical therapy to their elderly patients as it has the ability to help

improve balance and coordination, activities of daily living, strength, and mobility. If the patient

is referred to physical therapy, they will be evaluated by their therapist and work together to

develop a care plan tailored to their needs and overall physical status. This alone is not only a

great way for elderly patients to become physically strong, but mentally as well.
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EFFECTS OF EXERCISE AMONG THE ELDERLY

References

Hewitt, J., Goodall, S., Clemson, L., Henwood, T., & Refshauge, K. (2018). Progressive

resistance and balance training for falls prevention in long-term residential aged care: A

cluster randomized trial of the sunbeam program. Journal of the American Medical

Directors Association, 19(4), 361–369. https://doi.org/10.1016/j.jamda.2017.12.014

Jahanpeyma, P., Kayhan Koçak, F. Ö., Yıldırım, Y., Şahin, S., & Şenuzun Aykar, F. (2021).

Effects of the Otago exercise program on falls, balance, and physical performance in

older nursing home residents with high fall risk: A randomized controlled trial. European

Geriatric Medicine, 12(1), 107–115. https://doi.org/10.1007/s41999-020-00403-1

Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., Hsu, C. L., & Khan,

K. M. (2019). Effect of a home-based exercise program on subsequent falls among

community-dwelling high risk older adults after a fall: A randomized clinical trial.

JAMA,

321(21), 2092-2100. https://doi.org/10.1001/jama.2019.5795

Matchar, D.B., Duncan, P. W., Lien, C. T., Ong, M., Lee, M., Gao, F., Sim, R., & Eom, K.

(2017). Randomized controlled trial of screening, risk modification, and physical therapy

to prevent falls among the elderly recently discharged from the emergency department to

the community: The steps to avoid falls in the elderly study. Archives of Physical

Medicine and Rehabilitation, 98(6), 1086-1096.

https://doi.org/10.1016/j.apmr.2017.01.014