Empfehlungen für ein körperliches Training zur
                    Sturzprävention bei älteren, selbständig lebenden
                    Menschen

Daniel Schoene; Michaela Gross; Simon von Stengel; Matthias Kohl; Bernd Kladny; Markus Gosch; Cornel C Sieber; Stefan Peters; Eva Kiesswetter; Clemens Becker; Wolfgang Kemmler

doi:10.1055/a-2110-7105

Osteologie, Table of Contents

Osteologie 2023; 32(03): 183-195
DOI: 10.1055/a-2110-7105

Review

Empfehlungen für ein körperliches Training zur Sturzprävention bei älteren, selbständig lebenden Menschen

Recommendations on Physical Exercise and Fall Prevention in Older Community-Dwelling Adults

Authors

Daniel Schoene

¹Institut für Medizinische Physik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

²Geriatrie und Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
Michaela Gross

²Geriatrie und Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
Simon von Stengel

³Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
Matthias Kohl

⁴Department of Medical and Life Sciences, Hochschule Furtwangen – Campus Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
Bernd Kladny

⁵Fachbereich Orthopädie, m&i-Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
Markus Gosch

⁶Gerontologie und Geriatrie, Paracelsus Medizinische Privatuniversität - Nürnberg, Nürnberg, Deutschland

⁷Zentrum für Altersmedizin, Klinikum Nürnberg Nord, Nürnberg, Deutschland
Cornel C Sieber

⁸Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

⁹Kantonsspital Winterthur, Schweiz
Stefan Peters

¹⁰Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Hürth, Deutschland
Eva Kiesswetter

¹¹Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland
Clemens Becker

¹²Abteilung Digitale Medizin, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
Wolfgang Kemmler

¹Institut für Medizinische Physik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

³Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland

Abstract

Zusammenfassung

Stürze sind der wichtigste Risikofaktor für Frakturen im Alter. Epidemiologische Studien haben viele Risikofaktoren für Stürze identifiziert, die durch strukturiertes körperliches Training beeinflussbar sind. Dieser Artikel beschreibt die Evidenz zu Inhalten, Methoden und Belastungsdosierung eines körperlichen Trainings zur Vermeidung von Stürzen und zur Reduktion des Sturzimpaktes.

Die Ergebnisse zeigen hohe Evidenz, dass verglichen mit inaktiven Kontrollgruppen, multimodale Programme, Gleichgewichts-& Funktionstraining und Tai Chi wirksam sind, Stürze zu vermeiden. Insbesondere die Rolle anspruchsvollen Gleichgewichtstrainings kommt hier zum Tragen. Neuere Inhalte/Methodenvariationen sind auch wirksam. Hierzu zählen Stepping und Perturbationstraining. Letzteres scheint auch in kürzeren Zeiträumen beachtliche Effekte zu erzielen. Während einige Programme supervidiert werden müssen, existieren auch wirksame individuelle Heimtrainings. Mit Ausnahme von Perturbationstraining, sollten Programme 3mal/Woche über mind. 3 Monate durchgeführt werden. Ein ggf. periodisiertes, dauerhaftes Training gewährleistet langanhaltende Effekte. Für isoliertes Kraft-, Ausdauer- oder Beweglichkeitstraining, Training im Wasser, Tanzen und interaktive kognitiv-motorische Interventionen liegt keine hinreichende Evidenz vor, um sie als wirksame Trainings in der Sturzprävention zu empfehlen. Jedoch sind sie größtenteils effektiv, um Risikofaktoren zu beeinflussen oder einen Einstieg ins Training zu unterstützen.

Limitierte Evidenz existiert für die Beeinflussung des Sturzvorgangs durch Training. Bei gesunden, älteren Menschen sind Sturz-, Abfang-, Abrolltechniken sowie Stepping geeignet, den Impakt selbst-induzierter Stürze zu reduzieren. Keine diesbezüglichen Daten existieren für Verletzungen als Folge echter Stürze.

Abstract

Falls in older age are the most important risk factor for fractures. Epidemiological studies have identified numerous risk factors for falls, many of which are modifiable through structured physical training. This article describes the evidence on content and methods of physical training for preventing falls. It also addresses the dosing of exercise and the potential of such training for reducing the impact of falls.

Current results show high evidence that multimodal programs, balance and functional exercises, and Tai Chi are effective in preventing falls compared to inactive control groups. In particular, the role of challenging balance training is crucial. Newer training contents/method variations are also effective, including stepping programs and perturbation training. The latter seems to have notable effects in shorter periods. While some interventions must be supervised, effective individual home training programs also exist. Except for perturbation training, programs should be conducted three times a week for at least three months. A potentially periodized, permanent training ensures long-lasting effects. There is insufficient evidence to recommend isolated resistance, endurance, or flexibility training as well as aquatic exercise, dancing, and interactive cognitive-motor interventions as effective training in fall prevention. They are however, largely effective in influencing fall risk factors or facilitating an entry into training.

There is very limited evidence of the fall process being influenced by exercise. In healthy older adults, falling, catching, rolling techniques and stepping are suitable for reducing the impact of self-induced falls. In this regard, there are no data on real-life fall-related injuries.

Schlüsselwörter

körperliches Training - Sturzprävention - Sturzimpakt - Trainingsinhalte - ältere Menschen

Key words

exercise - fall prevention - fall impact - training components - aged

Full Text

References

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