70 Benefits and Potential Pitfalls of Exercise for Falls and Frailty

Group and home-based exercise programmes, delivered by trained professionals to those living in the community reduce rate of falls and risk of falling and are considered more cost effective than multifactorial or multi-component falls prevention strategies. However, the dose of highly challenging balance and progressive strength training needed to not only improve risk factors but also reduce falls means that most patients do not receive the required dose. The same can be said for interventions aimed at sarcopenia and frailty. What does this mean for their outcomes and would we do this with medications? The importance of exercise in the rehabilitation of a frailer older person for many outcomes should not be overlooked and the challenge now is to improve provision of effective interventions within practice, both in terms of linking falls prevention with bone health, increasing uptake and adherence to exercise interventions and in terms of exercise delivery. This lecture will present the evidence on falls prevention but highlight the difficulties in engaging frailer older people, who may be sarcopenic, have multiple co-morbidities and be fearful of activity in evidence based exercise. Unfortunately, frailer older people sit more and the growing evidence that sedentary behaviour has poor outcomes irrespective of activity, suggests this is a good place to start with frail fallers. Sit less, move more and progress to being strength and balance training to reduce fear of falling and progress on to meeting the physical activity guidelines for health.