Implications for Falls Prevention of Lifetime Physical Activity and Control of Gait, Posture and Balance in Older Adults.

Abstract

Falls and fall-related injuries are among the most common, serious, and medically-expensive problems facing the growing older population. Regular physical activity has been proposed to reduce falls, but no research has examined the efficacy of compliance with official recommended amounts of physical activity over the adult life-course and falls in community dwelling older adults. From the development and implementation of a new questionnaire to assess guideline related lifetime physical activity levels and falls history with a sample of 314 community-dwelling older adults, it was identified that lifetime adherence to the 2004 Department of Health physical activity guidelines offered no protective benefit for reduction in falls, fear of falling or fall outcome. A sub-sample of the 314 participants was then invited to participate in three laboratory investigations. Biomechanical measures of stability were utilised in studies investigating quiet standing, straight line walking and performing a 360º standing turn with groups of young adults (n = 15), older non-fallers (n = 15), older single fallers (max n = 13) and older multiple fallers (n = 14). During standing, young adults placed their centre of mass (COM) anterior to their centre of pressure (COP), whilst older adults primarily placed their COM posterior to their COP. There were no differences between faller groups and it was therefore concluded that quiet standing was not a challenging enough task to differentiate faller status. During walking, multiple fallers displayed greater COM-COP separation than the non-fallers and single fallers, and greater COM acceleration than the non-fallers at heel strike in the antero-posterior direction thus identifying both measures as capable of i differentiating between faller status groups in similar populations. At the initiation of the 360º standing turn, multiple fallers demonstrated a significantly shorter latency between reorientation onset of the thorax and the pelvis compared to all the other groups and thus exhibited a more en-bloc strategy of turning. Therefore, the onset of body segment reorientation was identified as capable of differentiating between fallers and non-fallers in otherwise healthy, community dwelling older adults. Discussion of and conclusions drawn from the findings of the four empirical studies identify the need for future research to identify more appropriate falls-related physical activity recommendations for public health messages for adults, and recommend the use of biomechanical variables such as COM-COP separation, COM acceleration and the assessment of segment reorientation in future falls-related research and as outcome measures for the efficacy of physical activity intervention programmes for fall prevention