Bibliographic Review Physical Activity Programs In Older Adults: Balance, Prevention Of Falls

Abstract

The objective has been to collect, compare and elaborate a reference with scientific evidence, about the effectiveness of physical activity programs that help prevent falls in healthy older adults. The methodology chosen was a literature review based on the databases: PubMed, Scielo, Science Direct, Web of Science and Scopus. After filtering based on the inclusion and exclusion criteria designed ad hoc for the study, a total of 23 scientific articles were rescued. Thus, the validity of numerous protocols for the prevention of falls for elderly people has been proven, mainly constituted through exercise programs, seeking the improvement, mainly, of strength, balance, functionality and, indirectly, of the quality of life of the patient. All this, acts in a synergistic manner decreasing the appearance of accidental falls. However, it has also been possible to see the existence of numerous activities such as Pilates, Yoga, adapted Judo, exercises carried out in aquatic means or even Contemporary Dance, which have benefits in terms of prevention of falls, also having the incentive to be very easy to improve adherence to the program, being able to be inserted without too many difficulties in its day to day, attending, at all times, to the characteristics and needs of the elderly.

Keywords: Agingelderly peopleprevention of fallsbalancephysical exercise

Introduction

The Spanish population ages as time passes and this fact is causing a profound modification in the population pyramid of our country. The assessment is that the world population is aging at tremendous rates, which specialized sources define as alarming. The real result is that society is undergoing an aging process, both in relative and absolute values. This silent revolution, this modification of the population structure, will bring changes in life habits in a few years, which will affect socio-geography, socio-economic conditions, business and even values of society as they are known today. The WHO estimates that between 2000 and 2050, the world population of people aged 60 years or older will double from 11% to 22%, which means in absolute terms that this population will go from 605 million to 2000 million inhabitants over the course of half a century. In addition, the number of people aged 80 years or older will increase almost four times to reach 395 million (WHO, 2015). Spain is one of the countries with the highest proportion of the oldest population in the European economic environment. According to data from the United Nations (2014), Spain is one of the countries with the oldest population on the planet. The causes of ageing show positive data, for example that Spain has one of the highest life expectancy rates, which is 83 years old. However, other aspects are not as favorable, such a low birth rate. As it can be seen in the literature in this regard, falls are the leading cause of death and injury in the elderly. Around 33% of the elderly fall at least once a year, and these falls represent a large part of emergency hospital visits ( Gama & Gómez-Conesa, 2008). Health can be a determining risk factor related to falls, but it is not the sole contributor under any circumstances, so knowing the multiple factors behind falls can make it easier to avoid them. According to the WHO report ( 2007) on prevention of falls among the elderly, falls have a multifactor component. In addition, the main risk factors reflect the multitude of health determinants that directly or indirectly effect well-being. Risk factors can be classified as intrinsic and extrinsic, or more specifically as biological, socioeconomic, behavioral and environmental, according to ( Rubenstein & Josephson, 2006; Terra et al., 2014; WHO, 2007).

Objective

The objective is to conduct a literature review focused on research for physical activity programs aimed at preventing falls in older adults without remarkable musculoskeletal disorders, mainly through balance training and specific physical activity to prevent falls and develop a reference based on the scientific evidence found in the PubMed, Scielo, Science Direct, Web of Science and Scopus databases, which correlates the articles related to physical activity in healthy older adults and falls, focusing on those physical activity programs that study the improvement of strength, balance and prevention of falls in older adults.

Material and Methods

Results

Below are a series of tables with the results obtained in each of the databases used, describing the search strategies used, and taking into account the inclusion and exclusion criteria set out above.

The data presented in table 02 , correspond to the Scopus.

The data presented in table 03 , correspond to the PubMed.

The data presented in table 04 , correspond to the Science Direct.

The data presented in table 05 , correspond to the Scielo.

The data presented in table 06 , correspond to the Web of Science.

Discussion

Two large research groups have been observed: those that focus on the prevention of falls through fitness exercises that are integrated into a strategic program of fall prevention and those that focus on assessing the potential of different physical activities, when it comes to fall prevention. With respect to the former, it has been observed that, these fitness programs significantly improve strength and balance in participants ( Arkkukangas Sundler, Soderlund, Eriksson, & Johansson, 2017; Bjerk, Brovold, Skelton, & Bergland, 2017; Hawley-Haghue, Roden, & Abbott, 2017; Papa, Foreman, & Dibble, 2015), which results in a general decrease in the risk of falling. Some of them also focus on patient functionality, which significantly improve, through these exercise plans ( Bjerk et al., 2017; Hawley-Haghue et al., 2017). We also found studies that talked about carrying out exercise programs as a weapon to fight against the appearance of falls in the elderly, paying special attention to individualization, meaning that each patient characteristics and particularities are taken into account, because what works well for one patient is not necessarily the best for another because, each person has their own specific needs, strengths and weaknesses ( Aliaga, Cuba, & Meza, 2016; Arkkukangas et al., 2017).

It is often observed in different studies, that it is necessary to integrate these fitness programs in the day-to-day life of patients, which in one way or another will lead to healthy aging ( Aliaga et al., 2016; Arkkukangas et al., 2017). The role of the professional in charge of carrying out the physical activity programs is highlighted in several studies, having been able to verify that, together with the figure of the medical specialist, they are key in the process of improving adherence to treatment, which in this type of program and according to the benefit sought, stands as a key variable ( Arkkukangas et al., 2017; Hawley-Haghue et al., 2017). In relation to the latter, Lacroix et al. ( 2016), carried out an intervention a 12-week intervention for balance and strength training (BST) among older adults, who were divided into two groups. One group implemented the program with the supervision of a professional and the other group without supervision. Physical improvements in balance and muscle power were found in both groups; however, the supervised BST was more effective. Therefore, they concluded that the supervised application of BST programs for older adults can counteract the intrinsic risk factors of falling. It was possible to observe a study where the authors affirmed that they could not categorically conclude that this type of fall prevention protocols based on physical exercises will be successful in 100% of the patients. Precisely, only one third of the programs evaluated showed significant differences in terms of decreased risk of falls ( Hawley-Haghue et al., 2017). The study carried out by Papa et al. ( 2015) obtained a key result, since it could verify that muscular fatigue had a significant influence on the risk of falling, a risk that decreased after 15 minutes of rest after the onset of fatigue. Thus, it could be concluded that both fatigue and stride shortening were two of the main risk factors in older patients in relation to the occurrence of involuntary falls. On the other hand, we have been able to observe different studies that focused on a specific activity instead of general fitness programs. Orenes and Carrasco ( 2016) evaluated the effectiveness of Pilates, having found positive results in the increase of isometric strength in the participants' hips, as well as an improvement in balance, which evidenced a significant increase in physical ability, reducing the risk of falling At the same time, in this study, a clear relationship could not be demonstrated between the variables: strength, balance and risk of falling. These results coincide with those found by Pucci, Neves and Saavedra, ( 2019). They carried out a systematic review on the effectiveness of the Pilates method in which they analyzed 41 studies and, from which they extracted as relevant data that the interventions studied varied between 4-24 weeks, 1-3 sessions /week and the most investigated variable was balance. In addition to the improvement of balance and muscle strength, they found improvements in flexibility, functional autonomy, muscular endurance, body composition and aerobic resistance. We have also found several studies that have evaluated the effect of Yoga on falls, observing small improvements in participants’ balance, and medium improvements in physical mobility, which led, in one way or another, to a reduction in the risk of suffering a fall, ( Hamrick, Mross, Christopher, & Smith, 2017; Youkhana, Dean, Wolff, Sherrington, & Tiedemann, 2016). Others have evaluated the effect that training in some martial arts such as Ving Tsun (TV) or TaiChi-Chuan can have on balance. One study determined that TV could be a potential exercise in preventing falls, with benefits in improving balance and confidence among the elderly. Regarding training through Tai Chi Chuan, no improvements were seen in any functional abilities or variables of balance, except in the components of LOS (stability limits) that tended to increase. These results contrast with others found in the scientific literature, where the potential of Tai Chi in the improvement of balance has been reflected ( Lip, Fong, Ng, Liu, & Guo, 2015; Rahal et al., 2015; Takeshima et al., 2017).

Another type of martial arts with a positive effect in reducing the fear of falling syndrome (FOF) is the adapted utilitarian Judo (JUA). Toronjo-Hornillo et al. ( 2018) carried out a study in which they observed a decrease of 11.9% in the fear of falling, being even greater in those older adults who had a greater fear of falling before the intervention.

A very popular activity among the population of our study is social dance. Merom et al. ( 2016) conducted a study to determine if social dance was effective in reducing the number of falls and improving physical and cognitive risk factors related to the falls. An intervention was carried out in 23 villages. They concluded that social dance did not prevent falls or their associated risk factors. On the other hand, contemporary dance, has showed obvious improvements for female gender and can be considered a valid activity to do in the field of fall prevention ( Britten, Addington, & Astill, 2017).

Conclusion

The truth is that falls make up a high percentage of the total fractures and even lethal accidents among older people. This is the main reason why it is necessary to develop effective protocols in the fight against unwanted falls. There are a large number of activities that offer numerous advantages in terms of preventing falls, mainly through the increase of strength in general and, of the lower body and, the improvement of balance and of functionality. That is why a qualified doctor should recommend to each patient, taking into account individualization, the activities that best suit their needs. The aim is to incorporate the activities into the patient’s day-to-day and therefore achieve good adherence to the protocol. Some activities that have proven their validity in the field of fall prevention are Taichi, Pilates, Yoga, Judo, Dance and to a lesser extent, aquatic activities. It is necessary to publish in detail the protocols or exercise programs that have given positive results in the different RCTs performed, as it is something that in very few studies is done and is a fact of great value when it comes to transferring all this to clinical practice.

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