Combined group and home exercise programmes in community-dwelling falls-risk older adults: Systematic review and meta-analysis

Objectives The objectives of this review were to (a) determine the effectiveness of combined group and home exercise programmes on falls risk factors and falls in community-dwelling older adults at risk of falling compared to no exercise controls; and (b) explore adherence and the behaviour change techniques employed in delivering these interventions. Methods Five databases were selected to identify randomized controlled trials of exercise and/or physical activity interventions to prevent falls or to improve functional performance. PROSPERO CRD42018106111. Results Eighteen trials involving 5,960 participants were included. Meta-analyses showed significant improvements in mobility after combined programmes measured by five times sit to stand (-1.42 times, 95% confidence interval [CI] -2.00 to -0.83), timed up and go (-0.94 s, 95% CI -1.76 to -0.12), and gait speed (0.05 m/s, 95% CI 0.02 to 0.07), but not single leg stance time, compared to controls. Combined programmes reduced injurious falls rate (0.77, 95% CI 0.65 to 0.91, I-2 = 0%) but not rate of falls (0.86, 95% CI 0.68 to 1.08, I-2 = 66%) compared to controls. There was no change in physical activity. Adherence ranged from 55-96%, with variability in the method of measurement of adherence. There was no clear relationship between adherence and outcomes. Most interventions used the behaviour change techniques of instruction/rehearsal/demonstration and feedback/monitoring. Conclusion Group exercise with a home programme resulted in better functional performance and falls-related outcomes compared with a no exercise control group. Further research is needed to identify behaviour change techniques to improve adherence to exercise in this population.