The Role of Physical Activity in Reducing Falls Debra J. Rose, PhD Co-Director Center for Successful Aging California State University, Fullerton and Fall Prevention Center of Excellence University of Southern California

Why is Physical Activity Important? Important risk factor for falls Reduced mobility increases fall risk in older adults with chronic medical conditions due to limited physiological reserves and fragility. More physically active older adults fall less!

What We Know! Stand-alone exercise interventions that target fall- related risk factors, lower fall risk as much as 50%. Different settings (community, home) Varied durations, intensity, frequency, and type of exercise Different levels of risk Group versus individually tailored home exercise programs

What We Know! Multifactorial intervention strategies, with exercise as a core component, are particularly effective in lowering fall rates in high risk groups. Additional factors targeted: Gait training and assistive device use Review and modification of medication Treatment of postural hypotension Modification of environmental hazards Treatment of cardiovascular disorders

Effective Exercise Interventions Include activities that specifically target balance and gait Also target other associated risk factors (e.g., muscle weakness, aerobic endurance) Exercise is performed at a moderate intensity or progresses from low to moderate intensity Introduce progressively more challenging practice environments

Alternative Forms of Exercise: Tai Chi Effective intervention strategy for lowering fall incidence rates in sedentary and “at-risk” groups. Less effective as stand- alone strategy in more frail groups. Well-suited for large- scale community-based fall prevention initiatives.

Practical Implications Form of tai chi selected is important. Important that instructor understands impact of age-associated changes on movement patterns Should emphasize movement components that become limited with age: Multi-directional weight-shifting Multi-segmental coordinative movements Body alignment Synchronized breathing

“There is NO One-Size-Fits-All Physical Activity Program”

“Walking with nordic poles promotes stability and increased energy Expenditure”

Best Type of Physical Activity? Low risk Any type of dynamic weight-bearing activity that elevates the heart rate for a sustained period of time, lubricates the joints, builds muscle, AND challenges balance. Moderate Risk Weight-bearing activities (with and without support) that build muscle AND progressively challenge balance. High Risk Seated activities that build muscle strength –to- standing activities that progressively challenge balance, build muscular endurance. Must be individualized based on specific impairments.