Step training may reduce fall risk for the elderly

An elderly lady walks with her dog in Copacabana in Rio de Janeiro September 13, 2011. REUTERS/Ricardo Moraes (Copyright Reuters 2016)

Step training focused on improving gait and balance may help prevent falls among the elderly, a recent research review suggests.

The analysis of seven previous studies, with a combined total of 660 older adults, found that interventions to improve stepping skills cut the rate of falls roughly in half.

For fall prevention, elderly people may benefit from exercises designed to help maintain balance during everyday activities like getting out of a chair or avoiding obstacles on a sidewalk, said senior study author Stephen Lord of the University of New South Wales in Sydney. Workouts that improve the ability to recover when balance is lost so that trips or slips don't turn into falls may also be beneficial, Lord added.

"Strength and balance are both important for physical functioning," Lord said by email. "In terms of fall prevention, the best evidence is for balance and step training."

In addition to cutting the rate of falls, step training also helped cut the proportion of fallers across the studies roughly in half, Lord and colleagues report in the British Journal of Sports Medicine. This is important with the elderly because after one tumble people are more likely to have repeat accidents.

A pooled analysis of data from five studies found stepping interventions significantly improved decision-making and stepping reaction time, single leg stance and the time it took people to rise up from seated position and start moving.

Limitations of the results include the wide variation among the step programs and in the outcomes measured across the studies analyzed, many of which were fairly small, the authors note.

Even so, the findings suggest that step training should be a major component of exercise interventions to prevent falls, the authors conclude.

So-called functional training, or workouts tailored to skills needed for a very specific activity or sport, is becoming much more common in all age groups, not just the elderly, noted Dr. Elizabeth Joy, medical director for community health at Intermountain Healthcare in Salt Lake City.

"We are seeing training programs migrate into this 'functional' space, not only for older adults, but for others as well," Joy, who wasn't involved in the study, said by email.

"For an older adult trying to maintain independent living, they need function-specific training," Joy added. "Walking, getting up out of a chair, getting up off the floor, those are the activities they need to do."

While a wide variety of balance exercises is also important, exercises focused on walking are particularly crucial for fall prevention among the elderly, noted Saija Karinkanta, a scientist at the UKK Institute for Health Promotion Research in Tampere, Finland, who wasn't involved in the study.

"If you want to improve your walking ability, most of the exercises need to be done while walking - standing on one foot, reaching, shifting weight from one foot to the other, squatting, tandem walking, stair walking, walking on different surfaces and stepping," Karinkanta said by email.

"In addition, if you want to improve your reaction time, the exercises need to challenge your reactions," Karinkanta added. "Volitional stepping using a dance mat or other target where you need to hit quickly is a good way to improve reaction time."