Fall Risk and the Use of Exercise as a Fall Prevention Strategy

Introduction

Despite the known benefits of physical activity on health and physical function with aging, the proportion of older adults meeting recommended physical activity remains low, being around 30% or below (Dipietro et al., 2019; Guthold, Stevens, Riley, & Bull, 2018). Therefore, in the last two decades, considerable evidence (including a significative number of guidelines) has emerged regarding the relative benefits of various modes or combinations of physical activity, such as progressive resistance training, multicomponent exercise, dual-task training, tai chi, yoga, dance, and balance for fall-related injury prevention and for specific physical function outcomes (e.g., strength, gait speed, balance, activities of daily living [ADL] function) (Erickson et al., 2019; Europeia, 2008; Jakicic et al., 2019).

Falls are partly a consequence, and to a great part cause of physical inactivity in older adults. Falls are defined as involuntary events that make you lose your balance and hit the body on the ground or another firm surface that stops it (Windle, Hughes, Linck, Russell, & Woods, 2013). Falls are the main cause of fatal and nonfatal injuries among the elderly according to a survey by the Behavioral Risk and Surveillance System, which was analyzed by the US Centers for Disease Control and Prevention (Center of Disease Control and Prevention, 2018). In this survey, in 2014, about 28.7% of older people reported falling at least one time in last year, what resulted in 29.0 million falls and about 7.0 million fall injuries only in United States (Bergen, Stevens, & Burns, 2016).

Moreover, the percentage of older people who fall increases with age, from 26.7% among people aged 65 to 74, to 29.8% among people aged 75 to 84, to 36.5% among older people over 85 years old (Florence et al., 2018). Of the older adults who fall, half have recurrent falls and 50% will fall again in the same year (Rebelatto, Castro, & Chan, 2007). The fall event is, therefore, a risk factor for suffering further falls. According to the Brazilian Ministry of Health, approximately one third of the elderly population suffers multiple falls each year (DATASUS, 2009) and in the USA one in each four elderly falls every year, these falls being the major and most common cause of fatal injuries and hospitalizations (Center of Disease Control and Prevention, 2018).

The severity of the fall injury can advocate the early onset of morbidity and mortality. From the total number analyzed by the US, 2.8 million were treated at emergency units for fall-related injuries and approximately 800.000 of those treated, were subsequently hospitalized, and approximately 27.000 died, with women being more likely to report falls and a fall injury than men (Bergen et al., 2016; Florence et al., 2018). These numbers kept growing, between 2007 to 2016, the falls related occur by 2030, which is pretty death in USA increasing by 30%. Within this scenario around 7 deaths/hour will dramatic and highly costly. And Europe goes in the same way, with the Western region with 8.4 million older adults attended in medical centers due to fall-related injuries in 2017 (Haagsma et al., 2020).

Also it should be emphasized that falls are the most common cause of traumatic brain injury in older adults (Center of Disease Control and Prevention, 2018). That can produce an increment in cognitive impairment and contribute to the acceleration of the loss of functionality and an increase of sedentary behaviors through the emergence of fear-of-falling (Erickson et al., 2019; Freiberger, Häberle, Spirduso, & Rixt Zijlstra, 2012).