Intended for healthcare professionals

CCBYNC Open access

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 doi: (Published 29 October 2013) Cite this as: BMJ 2013;347:f6234
  1. Fabienne El-Khoury, PhD candidate in epidemiology12,
  2. Bernard Cassou, professor of public health and geriatrician34,
  3. Marie-Aline Charles, senior researcher in epidemiology12,
  4. Patricia Dargent-Molina, senior researcher in epidemiology12
  1. 1Univ Paris-Sud, UMRS 1018, F-94807, Villejuif, France
  2. 2Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, F-94807, Villejuif, France
  3. 3Univ Versailles St-Quentin, EA 25-06, Laboratoire Santé-Environnement-Vieillissement, F-78035, Versailles, France
  4. 4AP-HP, Hôpital Sainte Périne, Centre de gérontologie, F-75016, Paris, France
  1. Correspondence to: F El-Khoury, Inserm, CESP équipe10, Hôpital Paul Brousse bâtiment 15-16, 16 avenue Paul Vaillant-Couturier, 94 807, Villejuif Cedex, France fabienne.khoury{at}
  • Accepted 23 September 2013


Objective To determine whether, and to what extent, fall prevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries.

Data sources Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013.

Study selection Randomised controlled trials of fall prevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures.

Data synthesis Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models.

Results 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I2=50%, P=0.04).

Conclusions Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.


  • We thank Jo Ann Cahn for her help with preparing the manuscript and Philippe Ravaud (Inserm U738, France; French Cochrane Centre, Paris, France) for his helpful comments and advice on some methodological aspects of our review.

  • Contributors: FEK and PAD conceived the study, performed the review, and drafted the manuscript. BC and MAC contributed to data quality assessment and outcomes classification and reviewed the manuscript for important intellectual content. FEK performed the data analysis. PAD is the guarantor.

  • Funding: This research received no specific funding.

  • Competing interests: The authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the review being reported; that no important aspects of the review have been omitted; and that any discrepancies from the review as planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text