1. Effective Exercise for Fall Prevention— Research and Implementation BC Injury Research & Prevention Unit Teleconference Series September 17, 2009 Judy A. Stevens, Ph.D. National Center for Injury Prevention & Control Centers for Disease Control & Prevention

2. Outline Background on falls & fall risk factors What research tells us about exercise for fall prevention Identifying & implementing effective exercise programs

3. Introduction 30-35% of people 65+ fall each year 1 Those who fall are 2-3 times more likely to fall again 2 10%-20% of falls cause serious injuries 3 __________ 1. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab, 2001 2. Tinetti, New Eng J Med, 1988; Teno, JAGS,1990 3. Sterling, J Trauma-Inj Infection & Critical Care, 2001

4. Leading Causes of Unintentional Injury Death Among People 65+, U.S., 2006 __________ NCHS, Vital Records, 2006 Total = 36,700 deaths

5. Fall Death Rates by Sex & Age, U.S., 2006 Men Women __________ NCHS, Vital Records, 2006

6. Trends in Age-Adjusted Fall Death Rates Men & Women 65+, U.S., 2000-2006 Men Women ___________ NCHS, Vital Records, 2006 35% 45%

7. Leading Causes of Nonfatal Injuries Among People 65+, U.S., 2007 __________ NEISS-AIP, 2007 Total = 3.1 million injuries N=1.9 million

8. Nonfatal Fall Injury Rates by Sex & Age, U.S., 2007 Men Women __________ NEISS-AIP, 2007

9. Trends in Age-Adjusted Nonfatal Fall Rates Men & Women 65+, 2001-2007 Men Women _________ NEISS-AIP 2001-2007 8% 6%

10. Where Do Falls Happen? At home, outside…….......35% At home, inside…………..23% Away from home, in a familiar place……………..23% Away from home, in an unfamiliar place………….19% ______ Berg WP, Age & Ageing, 1997

11. When Do Falls Happen? 30% 52% 14% 4% ______ Berg WP, Age & Ageing, 1997 0 25 50 75 100 MorningAfternoonEveningNight Time of Day Percent of Falls

12. Why Do Falls Happen? Slipped or tripped…..… 59% Misplaced step……..…. 12% Loss of balance……….. 9% Legs give way ….……... 4% Other……………………16% ______ Berg WP, Age & Ageing, 1997

13. Economic Impact In 2000, cost of fall injuries among people 65+: Total: ~ $19 billion  Fatal falls: $0.2 billion  Nonfatal injuries: $19 billion ___________ Stevens, Injury Prev, 2006

14. Costs of Nonfatal Injuries Sex Men…….........................$ 5 Women…………………..$14 Types of injury Fracture…………………$12 Superficial/contusion.....$ 3 Other injuries…………...$ 4

15. Quality of Life  20% - 36% fear falling 1  20% die within a year after hip fracture 2  25% in a nursing home one year later 3 ___________ 1. Vellas, Age & Aging, 1997; Friedman SM, JAGS, 2002 2. Lu-Yao, AJPH, 1994 3. Magaziner, J Gerontology: Medical Sciences, 2000

16. Fall Risk Factors Biological Behavioral Environmental __________ V. Scott, 2000

17. Leading Fall Risk Factors __________ Rubenstein, Age & Aging, 2006 Risk FactorRR Muscle weakness4.9 Balance problems3.2 Gait problems3.0 Poor vision2.8 Limited mobility2.5 Cognitive impairment2.4 Functional limitations2.0 Postural hypotension1.9

18. Cochrane Review ProFaNE exercise categories: Gait, balance or functional training Strength or resistance training Flexibility 3D (Tai Chi, dance, etc.) General physical activity Endurance Other _________ Gillespie, Cochrane Database of Systematic Reviews, 2009

19. Conclusions “Multiple-component exercise interventions are effective in reducing the rate and risk of falling.” “There is evidence for …3 different approaches…, multiple component group exercise, Tai Chi as a group exercise, & individually prescribed multiple component exercise carried out at home.”

20. What Kind of Exercise Works Best? Population Components: strength, balance, endurance, flexibility, walking Amount of supervision If progressive If modified during program Attendance rate Dose _________ Sherrington, JAGS, 2008 Systematic review & meta-analysis of 44 studies

21. Results Most effective programs: Challenged balance Used a high dose (50+ hrs) Did not include a walking program

22. Preventing Falls: What Works www.cdc.gov/HomeandRecreationalSafety/Falls/p reventfalls.htm

23. Effective Exercise Interventions StudyComponentsDose Barnett, 2003Balance, coordination, strength, reaction time, aerobic capacity 80+ hr Campbell, 1997 Balance & strength, walking78 hr Li, 2005Tai Chi78 hr Lord, 2003Balance, strength, coordination, gait 96 hr Rubenstein, 2000 Balance, strength, endurance, mobility 54 hr Wolf, 1997Tai Chi88 hr

24. Challenges Achieving a sufficient exercise dose Motivating older adults to participate in exercise to prevent falls 1 _________ Crombie, Age & Ageing, 2004

25. In Conclusion… Programs challenge balance Programs include 50+ hours of exercise Motivate older adults to participate Exercise can reduce fall rates if:

26. Thank You! jas2@cdc.gov