The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis. Physical activity, muscle function, falls and fractures Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people. Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes Effect of different types of exercise on postural balance in elderly women: a randomized controlled trial. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women Exercise for fall risk reduction in community-dwelling older adults: a systematic review. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. Risk factors for falls among elderly persons living in the community. Effects of a Randomized Controlled Recurrent Fall Prevention Program on Risk Factors for Falls in Frail Elderly Living at Home in Rural Communities Yale FICSIT: risk factor abatement strategy for fall prevention. A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Risk Factors for Major Injurious Falls among the Home-Dwelling Elderly by Functional Abilities Fall prevention exercise program for fall risk factor reduction of the community-dwelling elderly in Korea. Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: a randomised controlled trial.
OBJECTIVE To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis ( OA ) . METHOD Seventy-nine adults , 65 years of age or older with hip OA and at least 1 fall risk factor , were r and omly assigned to 1 of 3 groups : aquatics and education ( AE ; aquatic exercise twice a wk with once-a-wk group education ) , aquatics only ( A ; 2 wk aquatic exercise ) and control ( C ; usual activity ) . Balance , falls efficacy , dual-task function , functional performance ( chair st and s ) , and walking performance were measured pre- and postintervention or control period . RESULTS There was a significant improvement in fall risk factors ( full-factorial MANCOVA , baseline values as covariates ; p = .038 ) ; AE improved in falls efficacy compared with C and in functional performance compared with A and C. CONCLUSION The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking BACKGROUND Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions . To prevent falls , the reception conditions for sensory information need to be improved . OBJECTIVES To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people . METHODS This was a prospect i ve r and omized clinical study in which the variables were assessed before and after the training program . Thirty-six elderly people were evaluated using four tests : the Berg Balance Scale , Dynamic Gait Index , gait speed and t and em gait . The participants were r and omized into three groups : aquatic exercise group , non-aquatic exercise group and control group . The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks . The participants were reevaluated after six weeks . The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention . RESULTS The program for lower-limb muscle endurance significantly increased balance ( p<0.05 ) in the evaluation tests after the training program . CONCLUSION The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people . It was also possible to infer that this improvement occurred regardless of the environment , i.e. aquatic or non-aquatic . Article registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) under the number ACTRN 12609000780257 Balance becomes more precarious with age , and even without pathological disorders , the physiological decline in balance that occurs with age is a factor that also favors falls . So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation , compared to a control group , in improving balance in elderly patients with postural instability . 139 elderly patients with high risk of falls were included and r and omized to one of the following study arms : computer dynamic posturography ( CDP ) training , optokinetic stimulus , exercises at home , or control group . Patients were assessed with objective and subjective outcome measures . The individuals that trained using CDP improved significantly more than the control group on the average balance score ( p < 0.001 ) and reducing the number of falls in the sensorial organization test ( p < 0.001 ) . In addition , the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group ( p < 0.001 ) . In our present study , supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment . An increased age did not affect the potential for improvement after training . So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls , mainly injuries and psychological consequences due to fear of falling again Background : Falls are a major cause of morbidity in old age . A small number of fall prevention trials in cognitively intact community-dwelling older people have been effective . This study set out to examine the preventability of falls in older people living in institutional care . Objective : To evaluate the effectiveness of falls risk factor assessment /modification and seated balance exercise training in reducing falls among elderly people living in residential care . Methods : 133 residents with a mean age of 84± ( SD ) 6.8 years were allocated at r and om by home to receive either a 6-month falls risk factor assessment /modification and seated balance exercise training programme ( n = 77 ) or 6 months of reminiscence therapy ( n = 56 ) . The risk factors targeted were postural hypotension , polypharmacy , visual acuity , and ambient lighting levels . Falls risk factor assessment s and recommendation for modifications were performed at baseline in the intervention group and assessment s repeated at 6 months . Functional reach , reaction time , timed up- and - go , grip strength , spinal flexibility , and Philadelphia Geriatric Centre Morale Scale and Mini-Mental State Examination scores were determined at baseline and at 6 months by a ‘ blind ’ observer . Falls and fractures were then monitored in both groups during a 7- to 12-month falls-monitoring follow-up period . Results : Only 90 of 133 ( 67.7 % ) residents completed the 6-month intervention period , and 84 ( 63.2 % ) completed the 7- to 12-month falls-monitoring follow-up period . Both prevalence of postural hypotension ( p = 0.0005 ) and poor visual acuity ( p = 0.04 ) were reduced in the intervention group . There was no difference between the groups in the number of falls sustained , the risk of falling [ odds ratio 0.45 ( 95 % CI 0.19–1.14 ) ] , or in the risk of recurrent falling [ odds ratio 1.07 ( 95 % CI 0.40–2.97 ) ] . No significant differences were found between the groups with regard to change in other outcome measures . Conclusions : The high drop-out rate reduced the power of this study to detect any effect of the interventions used . It is possible that either the exercises were not sufficiently vigorous or that to improve balance exercises must be performed st and ing . Further research is required to identify effective fall prevention strategies for elderly people in residential setting Different types of exercise are indicated for the elderly to prevent functional capacity limitations due to aging and reduce the risk of falls . This study aim ed to evaluate the effect of three different exercises ( mini-trampoline , MT ; aquatic gymnastics , AG and general floor gymnastics , GG ) on postural balance in elderly women . Seventy-four physically independent elderly women , mean age 69±4 years , were r and omly assigned to three intervention groups : ( 1 ) MT ( n=23 ) , ( 2 ) AG ( n=28 ) , and ( 3 ) GG ( n=23 ) . Each group performed physical training , including cardiorespiratory , muscular strength and endurance , flexibility and sensory-motor exercises for 12 weeks . To determine the effects on each intervention group , five postural balance tasks were performed on a force platform ( BIOMEC 400 ) : the two-legged st and with eyes open ( TLEO ) and two-legged st and with eyes closed ( TLEC ) ; the semi-t and em st and with eyes open ( STEO ) and semi-t and em st and with eyes closed ( STEC ) and the one-legged st and . Three trials were performed for each task ( with 30s of rest between them ) and the mean was used to compute balance parameters such as center of pressure ( COP ) sway movements . All modalities investigated such as the MT , AG and GG were significantly ( P<0.05 ) efficient in improving the postural balance of elderly women after 12 weeks of training . These results provide further evidence concerning exercise and balance for promoting health in elderly women Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin , New Zeal and The benefit was most noticeable in elderly people who fell PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling BACKGROUND Since falling is associated with serious morbidity among elderly people , we investigated whether the risk of falling could be reduced by modifying known risk factors . METHODS We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling : postural hypotension ; use of sedatives ; use of at least four prescription medications ; and impairment in arm or leg strength or range of motion , balance , ability to move safely from bed to chair or to the bathtub or toilet ( transfer skills ) , or gait . These subjects were given either a combination of adjustment in their medications , behavioral instructions , and exercise programs aim ed at modifying their risk factors ( intervention group , 153 subjects ) or usual health care plus social visits ( control group , 148 subjects ) . RESULTS During one year of follow-up , 35 percent of the intervention group fell , as compared with 47 percent of the control group ( P = 0.04 ) . The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 ( 95 percent confidence interval , 0.52 to 0.90 ) . Among the subjects who had a particular risk factor at base line , a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of re assessment , as follows : at least four prescription medications , 63 percent versus 86 percent , P = 0.009 ; balance impairment , 21 percent versus 46 percent , P = 0.001 ; impairment in toilet-transfer skills , 49 percent versus 65 percent , P = 0.05 ; and gait impairment , 45 percent versus 62 percent , P = 0.07 . CONCLUSIONS The multiple-risk-factor intervention strategy result ed in a significant reduction in the risk of falling  among elderly persons in the community . In addition , the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group , as compared with the control group . Thus , risk-factor modification may partially explain the reduction in the risk of falling To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity , death , immobility , hospitalization , and early entry to long-term care facilities . The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas . Material / Methods This study adopted an assessor-blinded , r and omized , controlled trial methodology . Subjects were enrolled in a 12-week recurrent fall prevention program , which comprised strength training , balance training , and patient education .  Muscle strength and endurance of the ankles and the lower extremities , static balance , dynamic balance , depression , compliance with preventive behavior related to falls , fear of falling , and fall self-efficacy at baseline and immediately after the program were assessed . Sixty-two subjects ( mean age 69.2±4.3 years old ) completed the program – 31 subjects in the experimental group and 31 subjects in the control group . Results When the results of the program in the 2 groups were compared , significant differences were found in ankle heel rise test , lower extremity heel rise test , dynamic balance , depression , compliance with fall preventative behavior , fear of falling , and fall self-efficacy ( p<0.05 ) , but no significant difference was found in static balance . Conclusions This study shows that the fall prevention program described effectively improves muscle strength and endurance , balance , and psychological aspects in elderly women with a fall history Based on finding a strong association between number of impairments and risk of falling in earlier studies , Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits ( SV ) and a targeted risk abatement intervention ( TI ) strategy in reducing falls among at risk community elderly persons . Subjects include members of a participating HMO who are > or = 70 years of age , cognitively intact , not terminally ill , not too physically active , and possess at least one fall risk factor . The targeted risk factors include postural hypotension ; sedative use ; at least four targeted medications ; upper and lower extremity strength and range of motion impairments ; foot problems ; and balance , gait , and transfer dysfunctions . The interventions include medication adjustments , behavioral change recommendations , education and training , and home-based exercise regimens targeting the identified risk factors . The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects ' homes . The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students . The primary outcome is occurrence of falls during the 12-month followup . Secondary outcomes include change in mobility performance and fall-related efficacy Background With increasing age neuromuscular deficits ( e.g. , sarcopenia ) may result in impaired physical performance and an increased risk for falls . Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline . Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice . Thus , the objective of the present trial is to assess the effects of a  fall prevention program that was developed by an interdisciplinary expert panel on measures of balance , strength / power , body composition , cognition , psychosocial well-being , and falls self-efficacy in healthy older adults . Additionally , the time-related effects of detraining are tested . Methods / Design Healthy old people ( n = 54 ) between the age of 65 to 80 years will participate in this trial . The testing protocol comprises tests for the assessment of static / dynamic steady-state balance ( i.e. , Sharpened Romberg Test , instrumented gait analysis ) , proactive balance ( i.e. , Functional Reach Test ; Timed Up and Go Test ) , reactive balance ( i.e. , perturbation test during bipedal stance ; Push and Release Test ) , strength ( i.e. , h and grip strength test ; Chair St and Test ) , and power ( i.e. , Stair Climb Power Test ; countermovement jump ) . Further , body composition will be analysed using a bioelectrical impedance analysis system . In addition , question naires for the assessment of psychosocial ( i.e. , World Health Organisation Quality of Life Assessment -Bref ) , cognitive ( i.e. , Mini Mental State Examination ) , and fall risk determinants ( i.e. , Fall Efficacy Scale – International ) will be included in the study protocol . Participants will be r and omized into two intervention groups or the control / waiting group . After baseline measures , participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week , with each training session lasting 30 min . ( actual training time ) . One intervention group will complete an extensive supervised training program , while the other intervention group will complete a short version ( ' 3 times 3 ’ ) that is home-based and controlled by weekly phone calls . Post-tests will be conducted right after the intervention period . Additionally , detraining effects will be measured 12 weeks after program cessation . The control group / waiting group will not participate in any specific intervention during the experimental period , but will receive the extensive supervised program after the experimental period . Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance , strength / power , body composition , cognitive function , psychosocial well-being , and falls self-efficacy of older adults . In addition , information regarding fall risk assessment , dose – response-relations , detraining effects , and supervision of training will be provided . Further , training-induced health-relevant changes , such as improved performance in activities of daily living , cognitive function , and quality of life , as well as a reduced risk for falls may help to lower costs in the health care system . Finally , practitioners , therapists , and instructors will be provided with a scientifically evaluated feasible , safe , and easy-to-administer exercise program for fall prevention . Trial registration Clinical Trials.gov Identifier : PURPOSE Despite the decreased gravitational loading that is experienced in an aquatic environment , little research has been conducted on this exercise medium for women with osteoporosis ( OP ) .  Aquatic exercise ( AE ) may improve function and balance , thus ultimately decreasing fall risk and the potential for hip fractures in this high-risk population . METHOD A total of 68 women with OP , aged 60 years or older , were recruited into a r and omized clinical trial evaluating the impact of AE , l and exercise ( LE ) , and no exercise ( NE ) on balance , functional mobility , and quality of life ( QOL ) . RESULTS Only one balance measure ( backward t and em walk ) significantly improved with AE compared to LE , but this did not translate into a greater improvement in self-report function . There were no significant differences between the exercise interventions and NE , except for in ratings of global change , where participants in the AE group were three times more likely to report improvement than those in the NE group . CONCLUSION There were no differences in balance , function , or QOL in women with OP who followed an AE or LE programme compared to those in an NE control group . However , the significant differences in backward t and em walk between the AE and LE groups and self-reported global change between the AE and NE groups warrant further investigation . Significant improvements in balance and global change suggest that AE is a viable alternative for older women with OP who have difficulty exercising on l and Background : In order to identify the risk factors essential for preventing major injurious falls , the associations between injurious falls and certain factors were assessed among disabled and independent elderly , respectively , who had fallen during a 2-year period . Methods : A prospect i ve population -based study was conducted in five rural northern Finnish municipalities . The series consisted of all inhabitants aged 70 years or over , initially 979 persons . During a 2-year follow-up period , all injurious falls were recorded on the basis of telephone contacts , diary reporting and a review of the medical records of the participants . Results : Thirty percent of the subjects having fallen sustained a major injury . The multivariate model applied to the disabled elderly showed the following variables to be related to a high risk for major injurious falls : divorced , widowed or unmarried marital status ( odds ratio = 2.2 ) , a low body mass index ( odds ratio = 3.1 ) , incomplete step continuity ( odds ratio = 2.2 ) , poor distant visual acuity ( odds ratio = 2.3 ) and the use of long-acting benzodiazepines ( odds ratio = 2.4 ) . Among the independent elderly , the risk of a fall result ing in major injury was high among the subjects who had peripheral neuropathy ( odds ratio = 2.5 ) or were suffering from insomnia ( odds ratio = 4.1 ) . Conclusions : The risk factors for major injuries in fall occurrences differ between the disabled and independent elderly . Preventive measures should be targeted according to the disabilities of the population A r and omized comparison of pre- and post-experimental design was used to examine the effects of a fall prevention exercise program ( FPEP ) on muscle strength , ankle flexibility , balance , instrumental activities of daily living ( IADLs ) , and depression for the community-dwelling elderly in Korea . Twenty-two subjects were assigned to an experimental group and twenty-three to a control group . The experimental group participated in a 4-day-per week FPEP of 8 weeks duration , twice a week by direct instruction and twice a week with videotaped instruction by the program instructor at each senior center . The eight-week FPEP turned out to be significantly effective in enhancing muscle strength , ankle flexibility and balance , and in reducing depression , after intervention among community-dwelling elderly in Korea .  IADLs , however , was not changed by the intervention . Further research with a larger sample and longer follow up period is needed to exp and our underst and ing about the effects of FPEP . Future study is also recommended to differentiate between the effects of FPEP by direct instruction and by videotaped BACKGROUND Diabetes in elderly adults is associated with an increased risk of  fall . The aim of study was to determine whether a virtual reality exercise ( VRE ) program would improve balance , strength , gait , and falls efficacy in elderly adults with diabetes . SUBJECTS AND METHODS Fifty-five subjects with diabetes mellitus over 65 years of age were r and omly assigned to a VRE group ( VREG ) ( n=27 ) and a control group ( CG ) ( n=28 ) . The VREG received the VRE program and diabetes education , whereas the CG received only the diabetes education . The VRE program used video gaming ( PlayStation ( ® ) 2 ; Sony , Tokyo , Japan ) and was conducted for 50 min twice a week for 10 weeks . Balance , muscle strength , gait , and falls efficacy were measured at baseline and after intervention . Measurements were taken using a clinical tests ( the one-leg-st and ing test , the Berg Balance Scale , the functional reach test , the timed up- and -go test , and the sit-to-st and test ) , and gait analysis . A self-administered question naire was used to measure falls efficacy . RESULTS After training , the VREG showed significantly improved balance , decreased sit-to-st and times , and increased gait speed , cadence , and falls efficacy . CONCLUSIONS The VRE program was to maximize the effects of exercise by triggering players was to be fully immersed into the games and enhanced major influential factors on the falls of subject . This study suggests VRE programs are feasible and effective for reduced the risk of falls in elderly adults with type 2 diabetes BACKGROUND Falls and related injuries are a major public health concern in elderly people .  Multifactorial interventions may result in significant reduction in falls but their effectiveness in prevention of fall-induced injuries at centre-based falls clinics is unclear . This study assessed the effectiveness of the multifactorial Chaos Clinic Falls Prevention Programme on rate of falls and related injuries of home-dwelling older adults . METHODS This study was a pragmatic , r and omised controlled trial concentrating on high risk individuals and their individual risk factors of falling . Home-dwelling elderly people aged 70 years or more were recruited to the Chaos falls clinics in the cities of Lappeenranta and Tampere in Finl and between January 2005 and June 2009 . 1314 participants with high-risk for falling and fall-induced injuries and fractures were r and omised into  intervention group ( n=661 ) and control group ( n=653 ) . A multifactorial , individualized 12-month falls prevention programme concentrating on strength and balance training , medical review and referrals , medication review , proper nutrition ( calcium , vitamin D ) , and home hazard assessment and modification was carried out in the intervention group . The main outcome measures were rates of falls , fallers , and fall-induced injuries . RESULTS During the one-year follow-up , 608 falls occurred in the intervention group and 825 falls in the control group . The rate of falls was significantly lower in the intervention group ( 95 falls per 100 person-years ) than in the controls ( 131 falls per 100 person-years ) , the incidence rate ratio ( IRR ) being 0.72 ( 95 % confidence interval ( CI ) 0.61 - 0.86 , p<0.001 , NNT 3 ) . In the intervention group 296 participants fell at least once . In the controls the corresponding number was 349 . The hazard ratio ( HR ) of fallers in the intervention group compared with the control group was 0.78 ( 95 % CI 0.67 - 0.91 , p=0.001 , NNT 6 ) . The number of fall-induced injuries in the intervention group was 351 with the corresponding rate ( per 100 person-years ) of 55 . In the control group , these figures were higher , 468 and 75 . The IRR of fall-induced injuries in the intervention group compared with the control group was 0.74 ( 95 % CI 0.61 - 0.89 , p=0.002 , NNT 5 ) . CONCLUSIONS The multifactorial Chaos Clinic Falls Prevention Programme is effective in preventing falls of older adults .  The programme reduces the rate of falls and related injuries by almost 30 %
However , aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling .
Conclusions There is limited , low- quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling .
Background According to the World Health Organization , the elderly are at the highest risk of injury or death from a fall .
Age-related changes in strength , balance and flexibility are degenerative factors that may increase the risk of falling , and an aquatic training may offer a favourable environment to improve these modifiable risk factors .
Methods A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors .