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

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

› Author Affiliations

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

Literatur
1 Järvinen TL, Sievänen H, Khan KM. et al. Shifting the focus in fracture prevention from osteoporosis to falls. BMJ 2008; 336: 124-126
2 Parkkari J, Kannus P, Palvanen M. et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 1999; 65: 183-187
3 Masud T, Morris RO. Epidemiology of falls. Age Ageing 2001; 30: 3-7
4 Lord S, Sherrington C, Hicks C. Epidemiology of Falls and Fall-Related Injuries. In: Lord S, Sherrington C, Naganathan V (Eds.), Falls in Older People: Risk Factors, Strategies for Prevention and Implications for Practice. Cambridge: Cambridge University Press; 2021; 3–22.
5 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35: ii37-ii41
6 Rapp K, Freiberger E, Todd C. et al. Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods. BMC Geriatr 2014; 14: 105
7 Gribbin J, Hubbard R, Smith C. et al. Incidence and mortality of falls amongst older people in primary care in the United Kingdom. QJM 2009; 102: 477-483
8 Kannus P, Parkkari J, Niemi S. et al. Fall-induced deaths among elderly people. Am J Public Health 2005; 95: 422-424
9 Stevens JA, Hasbrouck LM, Durant TM. et al. Surveillance for injuries and violence among older adults. Morbidity and Mortality Weekly Report: CDC Surveillance Summaries 1999; 27-50
10 Sylliaas H, Idland G, Sandvik L. et al. Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study. Eur J Epidemiol 2009; 24: 351-355
11 Scott V, Pearce M, Pengelly C. Technical report: Hospitalizations due to falls among Canadians age 65 and over an analysis of data from the Discharge Abstract Database as presented in: Report on Seniors’ falls in Canada (section 2.2). British Columbia: 2005
12 Harvey LA, Close JC. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury 2012; 43: 1821-1826
13 Rubenstein LZ, Josephson KR. Causes and prevention of falls in elderly people. In: Vellas B, Toupet M, Rubenstein LZ et al., Hrsg. Falls, ballance and gait disorders in the elderly. Paris: Elsevier; 1992: 21-38
14 Rubenstein LZ, Robbins AS, Schulman BL. et al. Falls and instability in the elderly. J Am Geriatr Soc 1988; 36: 266-278
15 Sattin RW. Falls among older persons: A public health perspective. Annu Rev Public Health 1992; 13: 489-508
16 Stubbs B, Perara G, Koyanagi A. et al. Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study. J Am Med Dir Assoc 2020; 21: 1893-1899
17 Tinetti ME, Speechley M, Gintner SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701-1707
18 Snow CM. Fall related factors in the elderly. Osteoporos Int 1999; 9: S13
19 Evans WJ. After a fall: consequences and implications of falls by old people. In: Vellas B, Toupet M, Rubenstein LZ et al., Hrsg. Falls, balance, and gait disorders in the elderly. Paris: Elsevier; 1992
20 Kannus P. Preventing osteoporosis, falls, and fractures among elderly people. Promotion of lifelong physical activity is essential. BMJ 1999; 318: 205-206
21 Kannus P. Fall-induced injuries and death among older adults. JAMA 1999; 271: 1895-1899
22 Pinilla TP, Boardman KC, Bouxsein ML. et al. Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss. Calcif Tissue Int 1996; 58: 231-235
23 Sturnieks DL. Biomechanics of Balance and Falling. Falls in Older People: Risk Factors. Strategies for Prevention and Implications for Practice 2021; 105
24 Komisar V, Robinovitch SN. The Role of Fall Biomechanics in the Cause and Prevention of Bone Fractures in Older Adults. Curr Osteoporos Rep 2021; 19: 381-390
25 Kiel DP, O’Sullivan P, Teno JM. et al. Health care utilization and functional status in the aged following a fall. Med Care 1991; 221-228
26 Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998; 53: M112-M119
27 Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age Ageing 1999; 28: 121-125
28 Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997; 337: 1279-1284
29 Aoyagi K, Ross PD, Davis JW. et al. Falls among community-dwelling elderly in Japan. J Bone Miner Res 1998; 13: 1468-1474
30 Scheffer AC, Schuurmans MJ, Van Dijk N. et al. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008; 37: 19-24
31 Donoghue OA, Cronin H, Savva GM. et al. Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults. Gait Posture 2013; 38: 120-124
32 Vellas BJ, Wayne SJ, Romero LJ. et al. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997; 26: 189-193
33 Murphy SL, Williams CS, Gill TM. Characteristics associated with fear of falling and activity restriction in community-living older persons. J Am Geriatr Soc 2002; 50: 516-520
34 Wijlhuizen GJ, de Jong R, Hopman-Rock M. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Prev Med 2007; 44: 260-264
35 Salkeld G, Ameratunga SN, Cameron I. et al. Quality of life related to fear of falling and hip fracture in older women: a time trade off studyCommentary: older people’s perspectives on life after hip fractures. BMJ 2000; 320: 341-346
36 Schoene D, Heller C, Aung YN. et al. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?. Clin Interv Aging 2019; 14: 701-719
37 Thiem U, Klaaßen-Mielke R, Trampisch U. et al. Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study. Health Qual Life Outcomes 2014; 12: 1-7
38 Montero-Odasso M, van der Velde N, Martin FC. et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51
39 Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75: 51-61
40 Deandrea S, Lucenteforte E, Bravi F. et al. Risk factors for falls in community-dwelling older people:" a systematic review and meta-analysis". Epidemiology 2010; 658-668
41 Lord SR, Sherrington C, Naganathan V. Falls in Older People. Cambridge University Press; 2021
42 Becker C, Roigk P, Groß M. Sturzprävention. In: Liener UC, Becker C, Rapp K et al., Hrsg. Weißbuch Alterstraumatologie und Orthogeriatrie. Stuttgart: Kohlhammer; 2022
43 Mikos M, Winnicki K, Henry BM. et al. Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence. Pol Arch Intern Med 2021; 131: 369-376
44 Ziere G, Dieleman JP, Hofman A. et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006; 61: 218-223
45 Dhalwani NN, Fahami R, Sathanapally H. et al. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open 2017; 7: e016358
46 van der Jagt-Willems HC, de Groot MH, van Campen JP. et al. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr 2015; 15: 34
47 Morrison S, Colberg SR, Parson HK. et al. Walking-Induced Fatigue Leads to Increased Falls Risk in Older Adults. J Am Med Dir Assoc 2016; 17: 402-409
48 Feng C, Adebero T, DePaul VG. et al. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther 2022; 102
49 Fu Q, Vangundy TB, Shibata S. et al. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension 2011; 58: 167-175
50 Katzman WB, Vittinghoff E, Lin F. et al. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017; 28: 2831-2841
51 Krogh J, Nordentoft M, Sterne JA. et al. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry 2011; 72: 529-538
52 Nystoriak MA, Bhatnagar A. Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med 2018; 5: 135
53 Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia, USA: Lippincott Williams and Wilkins; 2007
54 Todd C, Skelton D. What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? World Health Organization. Regional Office for Europe. 2004
55 Lamb SE, Becker C, Gillespie LD. et al. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials 2011; 12: 125
56 Caristia S, Campani D, Cannici C. et al. Physical exercise and fall prevention: A systematic review and meta-analysis of experimental studies included in Cochrane reviews. Geriatr Nurs 2021; 42: 1275-1286
57 Sherrington C, Fairhall N, Kwok W. et al. Evidence on physical activity and falls prevention for people aged 65+years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020; 17: 144
58 Sherrington C, Michaleff ZA, Fairhall N. et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 2017; 51: 1750-1758
59 Tricco AC, Thomas SM, Veroniki AA. et al. Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis. JAMA 2017; 318: 1687-1699
60 Sherrington C, Fairhall NJ, Wallbank GK. et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1: CD012424
61 Dautzenberg L, Beglinger S, Tsokani S. et al. Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis. J Am Geriatr Soc 2021; 69: 2973-2984
62 Wang Q, Jiang X, Shen Y. et al. Effectiveness of exercise intervention on fall-related fractures in older adults: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatrics 2020; 20: 322
63 Zhao R, Bu W, Chen X. The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr 2019; 19: 341
64 Finnegan S, Seers K, Bruce J. Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis. Physiotherapy 2019; 105: 187-199
65 Li F, Harmer P, Eckstrom E. et al. Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis. Age Ageing 2021; 50: 1557-1568
66 Bruce J, Hossain A, Lall R. et al. Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess 2021; 25: 1
67 Liu-Ambrose T, Davis JC, Best JR. et al. Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial. JAMA 2019; 321: 2092-2100
68 Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing 2010; 39: 681-687
69 Sherrington C, Whitney JC, Lord SR. et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56: 2234-2243
70 Hamed A, Bohm S, Mersmann F. et al. Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis. Sports Med Open 2018; 4: 56
71 Sun M, Min L, Xu N. et al. The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health 2021; 18
72 Sibley KM, Thomas SM, Veroniki AA. et al. Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis. Exp Gerontol 2021; 143: 111151
73 Gillespie LD, Robertson MC, Gillespie WJ. et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 9: CD007146
74 Granacher U, Gollhofer A, Hortobagyi T. et al. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med 2013; 43: 627-641
75 Kümmel J, Kramer A, Giboin L-S. et al. Specificity of balance training in healthy individuals: a systematic review and meta-analysis. Sports Med 2016; 46: 1261-1271
76 Berg WP, Alessio HM, Mills EM. et al. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 1997; 26: 261-268
77 Cali CM, Kiel DP. An epidemiologic study of fall-related fractures among institutionalized older people. J Am Geriatr Soc 1995; 43: 1336-1340
78 Norton R, Campbell AJ, Lee-Joe T. et al. Circumstances of falls resulting in hip fractures among older people. J Am Geriatr Soc 1997; 45: 1108-1112
79 Granacher U, Muehlbauer T, Gschwind Y. et al. Diagnostik und Training von Kraft und Gleichgewicht zur Sturzprävention im Alter. Z Gerontol Geriatr 2014; 47: 513-526
80 Gschwind YJ, Kressig RW, Lacroix A. et al. 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. BMC Geriatr 2013; 13: 105
81 Muehlbauer T, Roth R, Bopp M. et al. An exercise sequence for progression in balance training. J Strength Cond Res 2012; 26: 568-574
82 Mattle M, Chocano-Bedoya PO, Fischbacher M. et al. Association of Dance-Based Mind-Motor Activities With Falls and Physical Function Among Healthy Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3: e2017688
83 Zhong D, Xiao Q, Xiao X. et al. Tai Chi for improving balance and reducing falls: An overview of 14 systematic reviews. Ann Phys Rehabil Med 2020; 63: 505-517
84 Winser SJ, Tsang WW, Krishnamurthy K. et al. Does Tai Chi improve balance and reduce falls incidence in neurological disorders? A systematic review and meta-analysis. Clin Rehabil 2018; 32: 1157-1168
85 Wehner C, Blank C, Arvandi M. et al. Effect of Tai Chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2021; 7: e000817
86 Zheng X, Wu X, Liu Z. et al. The influences of tai chi on balance function and exercise capacity among stroke patients: A meta-analysis. Evid Based Complement Alternat Med 2021; 2021: 6636847
87 Yu X, Wu X, Hou G. et al. The impact of Tai Chi on motor function, balance, and quality of life in Parkinson’s disease: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2021; 2021: 6637612
88 Xu D, Hong Y, Li J. et al. Effect of tai chi exercise on proprioception of ankle and knee joints in old people. Br J Sports Med 2004; 38: 50-54
89 Tsang W, Hui-Chan C. Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf. Med Sci Sports Exerc 2004; 36: 658-667
90 McGibbon CA, Krebs DE, Parker SW. et al. Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: preliminary report. BMC Neurology 2005; 5: 1-12
91 Li JX, Xu DQ, Hong Y. Changes in muscle strength, endurance, and reaction of the lower extremities with Tai Chi intervention. J Biomech 2009; 42: 967-971
92 Li F, Fisher KJ, Harmer P. et al. Falls self-efficacy as a mediator of fear of falling in an exercise intervention for older adults. J Gerontol B Psychol Sci Soc Sci 2005; 60: P34-P40
93 Gatts SK, Woollacott MH. Neural mechanisms underlying balance improvement with short term Tai Chi training. Aging Clin Exp Res 2006; 18: 7-19
94 Wayne PM, Walsh JN, Taylor-Piliae RE. et al. Effect of Tai Chi on Cognitive Performance in Older Adults: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2014; 62: 25-39
95 Huang Z-G, Feng Y-H, Li Y-H. et al. Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open 2017; 7: e013661
96 Eyigor S, Karapolat H, Durmaz B. et al. A randomized controlled trial of Turkish folklore dance on the physical performance, balance, depression and quality of life in older women. Arch Gerontol Geriatr 2009; 48: 84-88
97 Merom D, Mathieu E, Cerin E. et al. Social Dancing and Incidence of Falls in Older Adults: A Cluster Randomised Controlled Trial. PLoS Med 2016; 13: e1002112
98 Trombetti A, Hars M, Herrmann FR. et al. Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med 2011; 171: 525-533
99 Fernández-Argüelles EL, Rodríguez-Mansilla J, Antunez LE. et al. Effects of dancing on the risk of falling related factors of healthy older adults: a systematic review. Arch Gerontol Geriatr 2015; 60: 1-8
100 Hwang PW-N, Braun KL. The effectiveness of dance interventions to improve older adults’ health: a systematic literature review. Altern Ther Health Med 2015; 21: 64
101 Marmeleira J, Pereira C, Cruz-Ferreira A. et al. Creative dance can enhance proprioception in older adults. J Sports Med Phys Fitness 2009; 49: 480-485
102 Claudino JG, Afonso J, Sarvestan J. et al. Strength Training to Prevent Falls in Older Adults: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10
103 Bischoff-Ferrari HA, Freystätter G, Vellas B. et al. Effects of vitamin D, omega-3 fatty acids, and a simple home strength exercise program on fall prevention: the DO-HEALTH randomized clinical trial. Am J Clin Nutr 2022; 115: 1311-1321
104 Bischoff-Ferrari HA, Vellas B, Rizzoli R. et al. Effect of vitamin D supplementation, omega-3 fatty acid supplementation, or a strength-training exercise program on clinical outcomes in older adults: the DO-HEALTH randomized clinical trial. JAMA 2020; 324: 1855-1868
105 Bean JF, Leveille SG, Kiely DK. et al. A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more?. J Gerontol A Biol Sci Med Sci 2003; 58: M728-M733
106 Reid KF, Fielding RA. Skeletal muscle power: a critical determinant of physical functioning in older adults. Exerc Sport Sci Rev 2012; 40: 4
107 Steib S, Schoene D, Pfeifer K. Dose-response relationship of resistance training in older adults: a meta-analysis. Med Sci Sports Exerc 2010; 42: 902-914
108 Kim Y, Vakula MN, Bolton DA. et al. Which exercise interventions can most effectively improve reactive balance in older adults? a systematic review and network meta-analysis. Front Aging Neurosci 2022; 13: 992
109 Latham NK, Anderson CS, Lee A. et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003; 51: 291-299
110 Borde R, Hortobagyi T, Granacher U. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med 2015; 45: 1693-1720
111 Kemmler W, Kohl M, Froehlich M. et al. Effects of High Intensity Resistance Training on Fitness and Fatness in Older Men with Osteosarcopenia. Front Physiol 2020; 11: 1014
112 Kemmler W, Kohl M, Jakob F. et al. Effects of High Intensity Dynamic Resistance Exercise and Whey Protein Supplements on Osteosarcopenia in Older Men with Low Bone and Muscle Mass. Final Results of the Randomized Controlled FrOST Study. Nutrients 2020; 12: 2341
113 Ebrahim SB, Thompson PW, Baskaran V. et al. Randomized placebo controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Aging 1997; 26: 252-260
114 Voukelatos A, Merom D, Sherrington C. et al. The impact of a home-based walking programme on falls in older people: the Easy Steps randomised controlled trial. Age Ageing 2015; 44: 377-383
115 Okubo Y, Osuka Y, Jung S. et al. Walking can be more effective than balance training in fall prevention among community-dwelling older adults. Geriatr Gerontol Int 2016; 16: 118-125
116 Sherrington C, Tiedemann A, Fairhall N. et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 2011; 22: 78-83
117 Beyer N, Simonsen L, Bulow J. et al. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training. Aging Clin Exp Res 2007; 19: 300-309
118 Freiberger E, Menz HB, Abu-Omar K. et al. Preventing falls in physically active community-dwelling older people: a comparison of two intervention techniques. Gerontology 2007; 53: 298-305
119 Means KM, Rodell DE, O’Sullivan PS. Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. Am J Phys Med Rehabil 2005; 84: 238-250 10.00002060-200504000-00002 [pii]
120 Morone G, Paolucci T, Luziatelli S. et al. Wii Fit is effective in women with bone loss condition associated with balance disorders: a randomized controlled trial. Aging Clin Exp Res 2016; 28: 1187-1193
121 Suzuki T, Kim H, Yoshida H. et al. Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. J Bone Miner Metab 2004; 22: 602-611
122 Weineck J. Optimales Training. Erlangen: Spitta-Verlag;; 2019
123 Carrasco C, Tomas-Carus P, Bravo J. et al. Understanding fall risk factors in community-dwelling older adults: A cross-sectional study. Int J Older People Nurs 2020; 15: e12294
124 McCrum C, Bhatt TS, Gerards MHG. et al. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living 2022; 4: 1015394
125 Okubo Y, Sturnieks DL. Volitional and Reactive Step Training. Falls in Older People: Risk Factors. Strategies for Prevention and Implications for Practice 2021; 271
126 Tokur D, Grimmer M, Seyfarth A. Review of balance recovery in response to external perturbations during daily activities. Hum Mov Sci 2020; 69: 102546
127 Grabiner MD, Crenshaw JR, Hurt CP. et al. Exercise-based fall prevention: can you be a bit more specific?. Exerc Sport Sci Rev 2014; 42: 161-168
128 Devasahayam AJ, Farwell K, Lim B. et al. The effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysis. Phys Ther 2023; 103: pzac154
129 Pai YC, Bhatt T, Yang F. et al. Perturbation training can reduce community-dwelling older adults’ annual fall risk: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2014; 69: 1586-1594
130 Nørgaard JE, Andersen S, Ryg J. et al. Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2023; 6: e238422
131 Lurie JD, Zagaria AB, Ellis L. et al. Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial. Phys Ther 2020; 100: 1153-1162
132 DePasquale L, Toscano L. The Spring Scale Test: a reliable and valid tool for explaining fall history. J Geriatr Phys Ther 2009; 32: 159-167
133 Okubo Y, Schoene D, Caetano MJ. et al. Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests. Ageing Res Rev 2021; 66: 101238
134 Nørgaard JE, Jorgensen MG, Ryg J. et al. Effects of gait adaptability training on falls and fall-related fractures in older adults: a systematic review and meta-analysis. Age Ageing 2021; 50: 1914-1924
135 Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med 2017; 51: 586-593
136 Shigematsu R, Okura T, Nakagaichi M. et al. Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial. J Gerontol A Biol Sci Med Sci 2008; 63: 76-82
137 Shigematsu R, Okura T, Sakai T. et al. Square-stepping exercise versus strength and balance training for fall risk factors. Aging Clin Exp Res 2008; 20: 19-24
138 Yamada M, Higuchi T, Nishiguchi S. et al. Multitarget stepping program in combination with a standardized multicomponent exercise program can prevent falls in community-dwelling older adults: A randomized, controlled trial. J Am Geriatr Soc 2013; 61: 1669-1675
139 Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord 2013; 28: 1520-1533
140 Boisgontier MP, Beets IA, Duysens J. et al. Age-related differences in attentional cost associated with postural dual tasks: increased recruitment of generic cognitive resources in older adults. Neurosci Biobehav Rev 2013; 37: 1824-1837
141 Anstey KJ, Wood J, Kerr G. et al. Different cognitive profiles for single compared with recurrent fallers without dementia. Neuropsychology 2009; 23: 500
142 Mirelman A, Herman T, Brozgol M. et al. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One 2012; 7: e40297
143 Schoene D, Delbaere K, Lord SR. Impaired response selection during stepping predicts falls in older people – a cohort study. J Am Med Dir Assoc 2017; 18: 719-725
144 Bolton DA, Richardson JK. Inhibitory control and fall prevention: why stopping matters. Frontiers in Neurology 2022; 13: 853787
145 Okubo Y, Duran L, Delbaere K. et al. Rapid inhibition accuracy and leg strength are required for community-dwelling older people to recover balance from induced trips and slips: an experimental prospective study. J Geriatr Phys Ther 2022; 45: 160-166
146 de Bruin ED, Schoene D, Pichierri G. et al. Use of virtual reality technique for the training of motor control in the elderly: some theoretical considerations. Z Gerontol Geriatr 2010; 43: 229-234
147 Eggenberger P, Theill N, Holenstein S. et al. Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. Clin Interv Aging 2015; 1711-1732
148 Schoene D, Valenzuela T, Toson B. et al. Interactive cognitive-motor step training improves cognitive risk factors of falling in older adults – a randomized controlled trial. PLoS One 2015; 10: e0145161
149 Kwok BC, Pua YH. Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: a randomised control trial. Age Ageing 2016; 45: 621-627
150 Fu AS, Gao KL, Tung AK. et al. Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls. Arch Phys Med Rehabil 2015; 96: 2096-2102
151 Mirelman A, Rochester L, Maidan I. et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet 2016; 388: 1170-1182
152 Duque G, Boersma D, Loza-Diaz G. et al. Effects of balance training using a virtual-reality system in older fallers. Clin Interv Aging 2013; 257-263
153 Lauzé M, Martel DD, Aubertin-Leheudre M. Feasibility and effects of a physical activity program using gerontechnology in assisted living communities for older adults. J Am Med Dir Assoc 2017; 18: 1069-1075
154 Montero-Alía P, Miralles-Basseda R, López-Jiménez T. et al. Controlled trial of balance training using a video game console in community-dwelling older adults. Age Ageing 2019; 48: 506-512
155 Schoene DS, Sturnieks DL. Cognitive-Motor Interventions and Their Effects on Fall Risk in Older People. In: Falls in Older People: Risk Factors, Strategies for Prevention and Implications for Practice. 2021. 287.
156 Nyman SR, Victor CR. Older people’s recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review. Age Ageing 2011; 40: 430-436
157 Nyman SR, Victor CR. Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2012; 41: 16-23
158 Valenzuela T, Okubo Y, Woodbury A. et al. Adherence to technology-based exercise programs in older adults: a systematic review. J Geriatr Phys Ther 2018; 41: 49-61
159 Collado-Mateo D, Lavín-Pérez AM, Peñacoba C. et al. Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: an umbrella review. Int J Environ Res Public Health 2021; 18: 2023
160 Bundesministerium_der_Justiz_und_für_Verbraucherschutz, 2019.
161 Avelar NC, Bastone AC, Alcântara MA. et al. Efetividade do treinamento de resistência à fadiga dos músculos dos membros inferiores dentro e fora d‘água no equilíbrio estático e dinâmico de idosos. Braz J Phys Ther 2010; 14: 229-236
162 Moreira LDF, Fronza FCAO, dos Santos RN. et al. High-intensity aquatic exercises (HydrOS) improve physical function and reduce falls among postmenopausal women. Menopause 2013; 20: 1012-1019
163 Simmons V, Hansen PD. Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. J Gerontol A Biol Sci Med Sci 1996; 51: M233-M238
164 Terrens AF, Soh S-E, Morgan P. The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson’s disease: a single blind pilot trial. PLoS One 2020; 15: e0236391
165 Volpe D, Giantin MG, Maestri R. et al. Comparing the effects of hydrotherapy and land-based therapy on balance in patients with Parkinson’s disease: a randomized controlled pilot study. Clin Rehabil 2014; 28: 1210-1217
166 Martinez-Carbonell Guillamon E, Burgess L, Immins T. et al. Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review. BMC Geriatr 2019; 19: 1-16
167 Simas V, Hing W, Pope R. et al. Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis. Open Access J Sports Med 2017; 8: 39-60
168 Arnold CM, Busch AJ, Schachter CL. et al. A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Physiother Can 2008; 60: 296-306
169 da Cunha MF, Lazzareschi L, Gantus MC. et al. The physical therapy influence in the prevention of falls in elderly in the community: comparative study. Motriz 2009; 15: 527-536
170 de Oliveira MR, da Silva RA, Dascal JB. et al. Effect of different types of exercise on postural balance in elderly women: a randomized controlled trial. Arch Gerontol Geriatr 2014; 59: 506-514
171 Irandoust K, Taheri M, Mirmoezzi M. et al. The Effect of Aquatic Exercise on Postural Mobility of Healthy Older Adults with Endomorphic Somatotype. Int J Environ Res Public Health 2019; 16
172 Terrens AF, Soh SE, Morgan P. The safety and feasibility of a Halliwick style of aquatic physiotherapy for falls and balance dysfunction in people with Parkinson’s Disease: A single blind pilot trial. PLoS One 2020; 15: e0236391
173 Wang TJ, Lee SC, Liang SY. et al. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. J Clin Nurs 2011; 20: 2609-2622
174 Aveiro MC, Avila MA, Pereira-Baldon VS. et al. Water- versus land-based treatment for postural control in postmenopausal osteoporotic women: a randomized, controlled trial. Climacteric 2017; 20: 427-435
175 Nissim M, Livny A, Barmatz C. et al. Effects of aquatic physical intervention on fall risk, working memory and hazard-perception as pedestrians in older people: a pilot trial. BMC Geriatr 2020; 20: 74
176 Oh S, Lim JM, Kim Y. et al. Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: a single-blind, randomized controlled trial. Arch Gerontol Geriatr 2015; 60: 288-293
177 Simmons V, Hansen PD. Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. J Gerontol A Biol Sci Med Sci 1996; 51: M233-M238
178 Jansen CP, Gross M, Kramer-Gmeiner F. et al. Empfehlungspapier für das körperliche Gruppentraining zur Sturzprävention bei älteren, zu Hause lebenden Menschen. Aktualisierung des Empfehlungspapiers der Bundesinitiative Sturzprävention von 2009. Z Gerontol Geriat 2021; 54: 229-239
179 Gross M, Jansen C-P, Blessing U. et al. Empfehlungspapier für das körperliche Training zur Sturzprävention als Einzelangebot bei älteren, zu Hause lebenden Menschen. Physioscience 2020; 16: 176-183
180 Lacroix A, Hortobagyi T, Beurskens R. et al. Effects of Supervised vs. Unsupervised Training Programs on Balance and Muscle Strength in Older Adults: A Systematic Review and Meta-Analysis. Sports Med 2017; 47: 2341-2361
181 Hoffmann I, Shojaa M, Kohl M. et al. Exercise reduces the number of overall and major osteoporotic fractures in adults. Does supervision make a difference? Systematic review and meta-analysis. J Bone Miner Res 2022; 37: 2132-2148
182 Gardner MM, Buchner DM, Robertson MC. et al. Practical implementation of an exercise-based falls prevention programme. Age Ageing 2001; 30: 77-83
183 Yang Y, Wang K, Liu H. et al. The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review. Front Public Health 2022; 10: 953593
184 Kyrdalen IL, Moen K, Røysland AS. et al. The Otago Exercise Program performed as group training versus home training in fall-prone older people: a randomized controlled Trial. Physiother Res Int 2014; 19: 108-116
185 Jansen CP, Nerz C, Labudek S. et al. Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial. Int J Behav Nutr Phys Act 2021; 18: 115
186 Weber M, Belala N, Clemson L. et al. Feasibility and Effectiveness of Intervention Programmes Integrating Functional Exercise into Daily Life of Older Adults: A Systematic Review. Gerontology 2018; 64: 172-187
187 Brahms CM, Hortobágyi T, Kressig RW. et al. The interaction between mobility status and exercise specificity in older adults. Exerc Sport Sci Rev 2021; 49: 15-22
188 Schaun GZ, Bamman MM, Alberton CL. High-velocity resistance training as a tool to improve functional performance and muscle power in older adults. Exp Gerontol 2021; 156: 111593
189 Fröhlich M. Überlegungen zur Trainingswissenschaft. Sportwissenschaft 2012; 1-9
190 Lesinski M, Hortobagyi T, Muehlbauer T. et al. Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis. Sports Med 2015; 45: 1721-1738
191 Modaberi S, Saemi E, Federolf PA. et al. A Systematic Review on Detraining Effects after Balance and Fall Prevention Interventions. J Clin Med 2021; 10
192 Steele J, Fisher J, Giessing J. et al. Clarity in Reporting Terminology and Definitions of Set End Points in Resistance Training. Muscle Nerve 2017; 10: 368-374
193 Kemmler W, Bebenek M, Kohl M. et al. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 2015; 26: 2491-2499
194 El-Khoury F, Cassou B, Charles MA. et al. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: f6234
195 Kiel DP. New strategies to prevent hip fracture. Hosp Pract 1994; 29: 47-54
196 Sabick MB, Hay JG, Goel VK. et al. Active responses decrease impact forces at the hip and shoulder in falls to the side. J Biomech 1999; 32: 993-998 S0021-9290(99)00079-2 [pii]
197 DeGoede KM, Ashton-Miller JA. Fall arrest strategy affects peak hand impact force in a forward fall. J Biomech 2002; 35: 843-848
198 Abdolshah S, Rajaei N, Akiyama Y. et al. Longitudinal rollover strategy as effective intervention to reduce wrist injuries during forward fall. IEEE Robot Autom Lett 2018; 3: 4187-4192
199 Moon Y, Sosnoff JJ. Safe landing strategies during a fall: systematic review and meta-analysis. Arch Phys Med Rehabil 2017; 98: 783-794
200 Robinovitch SN, Dojnov A, Komisar V. et al. Protective responses of older adults for avoiding injury during falls: evidence from video capture of real-life falls in long-term care. Age Ageing 2022; 51
201 Groen BE, Smulders E, de Kam D. et al. Martial arts fall training to prevent hip fractures in the elderly. Osteoporos Int 2010; 21: 215-221
202 Arkkukangas M, Strömqvist Bååthe K, Ekholm A. et al. High challenge exercise and learning safe landing strategies among community-dwelling older adults: a randomized controlled trial. Int J Environ Res Public Health 2022; 19: 7370
203 Weerdesteyn V, Rijken H, Geurts AC. et al. A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology 2006; 52: 131-141
204 Ciaccioni S, Pesce C, Capranica L. et al. Effects of a judo training program on falling performance, fear of falling and exercise motivation in older novice judoka. Ido Mov Culture J Martial Arts Anthrop 2021; 21: 9-17
205 Moon Y, Bishnoi A, Sun R. et al. Preliminary investigation of teaching older adults the tuck-and-roll strategy: can older adults learn to fall with reduced impact severity. J Biomech 2019; 83: 291-297
206 Robinovitch SN, Brumer R, Maurer J. Effect of the “squat protective response” on impact velocity during backward falls. J Biomech 2004; 37: 1329-1337