Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis

Jens Eg Nørgaard; Martin Gronbech Jorgensen; Jesper Ryg; Jane Andreasen; Mathias Brix Danielsen; Daniel Kjærgaard Steiner; Stig Andersen

doi:10.1093/ageing/afab105

Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis

Age Ageing. 2021 Nov 10;50(6):1914-1924. doi: 10.1093/ageing/afab105.

Authors

Jens Eg Nørgaard^{1

2}, Martin Gronbech Jorgensen¹, Jesper Ryg^{3

4}, Jane Andreasen^{5

6}, Mathias Brix Danielsen^{1

2}, Daniel Kjærgaard Steiner¹, Stig Andersen^{1

2}

Affiliations

¹ Department of Geriatric Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
² Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark.
³ Department of Geriatric Medicine, Odense University Hospital, DK-5000 Odense, Denmark.
⁴ Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark.
⁵ Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
⁶ Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, DK-9000 Aalborg, Denmark.

PMID: 34120163
DOI: 10.1093/ageing/afab105

Abstract

Objective: falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults.

Methods: electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates.

Results: eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively.

Conclusions: our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion.

Protocol registration: PROSPERO; CRD42020191051.

Keywords: accident prevention; accidental falls; exercise; gait adaptability training; older people; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Accidental Falls* / prevention & control
Aged
Exercise Therapy
Fractures, Bone* / diagnosis
Fractures, Bone* / epidemiology
Fractures, Bone* / prevention & control
Gait
Humans
Independent Living