Background and Purpose. This prospective clinical investigation examined the effects of a multidimensional exercise program on balance, mobility, and risk for falls in community-dwelling older adults with a history of falling. Factors used to predict adherence and a successful responseto exercise were identified. Subjects. A total of 105 community-dwelling older adults ( 1 6 5 years of age) with a history of two or more falls in the previous 6 months (no neurologic diagnosis) participated. They were classified into (1) a control group of fallers (n=21), (2) a fully adherent exercise group (n=52), and (3) a partially adherent exercise group (n=32). Methods. Followingevaluation, each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment. The control group received no intervention. Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups. Results. Both exercise groups scored better than the control group on all measures of balanceand mobility. Although both exercise groups showed a reduction in fall risk compared with the control group, the greatest reduction was found in the fully adherent exercise group. Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment. Conclusion and Discussion. Exercise can improve balance andmobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling. The amount of exercise needed to achieve these results, however, could not be determined from this study. [Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther.1997;77:46-57.1
Key Words: Balance, Exercise, Fall prevention.
Anne Shumway-Cook William Gmber Margaret Baldwin Shiquan Liao
Physical Therapy . Volume 77 . Number 1
. January 1997
lie risk for falls increases dramatically with age.'-3 Approximately 25% to 35% of people over the age of 65 years experiences one or more falls each The consequences of falls among older adults are devastating. Inpeople over the age of 65 years, falls are the leading cause of death from injury." Falls also lead to substantial morbidity among older adults. Nearly 70% of all emergency department visits by people over the age of 75 years are related to falls." Forty percent of hospital admissions in this age group are the result of fall-related injuries, resulting in an average length of stay of 11.6 days.6Approxi~nately one half of older adults hospitalized for fall-related injuries are discharged to nursing homes.7
Despite the apparent relationship between impaired balance and increased likelihood for falls among elderly individuals, studies examining the effects of exercise on improving balance and reducing risk for falls in this population have had mixed result^.^^-^^ One possible reason forthis inconsistency is the variation in exercise programs utilized in these studies. In addition, many researchers have incorporated exercise into a multifaceted intervention approach, making it difficult to determine the relative contribution of exercise to improving balance and decreasing fall risk.'
The purpose of this study was to prospectively examine the effects of a multidimensionalexercise program on balance, mobility, and risk for falls among communitydwelling older adults with a history of falls. The research Because of the devastating effects of falls among older questions were: (1) Does a multidimensional exercise adults, risk factors for predicting falls and fall-related program improve stance balance and mobility and injuries have been studied extensively."-" Factors...