Falls Risk in Relation to Activity Exposure in High-Risk Older Adults

Overview

Exercise programs have been developed as a result of the correlation between physical activity and health outcomes. However, many falls occur during walking, so promoting activity might paradoxically increase the risk of falls, causing injuries and worsening quality of life. There is no clear relationship between activity exposure and fall rates. Before and after an exercise program (V-TIME), we examined the relationship between walking activity (exposure to risk) and fall rates.

Methods:

We randomly assigned 199 older fallers, 38 fallers with mild cognitive impairment (MCI), and 128 fallers with Parkinson’s disease (PD) to one of two active interventions: treadmill training only or treadmill training combined with a virtual reality component. Before and after the interventions, participants were tested. Using an accelerometer positioned on the lower back for one week, we assessed free-living walking activity using volume, pattern, and variability. Based on the relationship between fall risk and activity, a normalized index was calculated in which fall rates were expressed relative to activity exposure (FRA index), with higher scores indicating a higher risk of falls per step taken.

Results:

At baseline, fallers with PD had a higher FRA index than those with MCI or older fallers. The walking activity for the groups did not change after the intervention, but the FRA index decreased significantly for all groups (p ≤ .035).

Conclusions:

Published in the Journal of Gerontology, the V-TIME interventions were shown to reduce falls risk without affecting walking activity concurrently. Future fall prevention studies should use the FRA index to better understand the nature of intervention programs.