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Quality Indicators for Management and Prevention of Falls
- Laurence Z. Rubenstein, MD, MPH;
- Christopher M. Powers, PhD, PT; and
- Catherine H. MacLean, MD, PhD
- Sepulveda Veterans Affairs Medical Center; Sepulveda, CA 91343 University of Southern California; Los Angeles, CA 90033 RAND; Santa Monica, CA 90407
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IN RESPONSE:
Exercise is one of the most potent interventions for both fall prevention and improvement of mobility dysfunction. Dr. Pierre is concerned that we omitted discussion of tai chi as being one of the best types of exercises for these purposes. We agree that tai chi is a beneficial form of exercise and discussed tai chi positively in the context of the variety of exercise regimens tested. However, although meta-analysis has confirmed the value of various types of exercises in preventing falls, tai chi has not yet been shown to be superior to other types of balance, strengthening, and endurance exercises.
The fact that fewer fall-prevention trials of all types have shown reduction in injurious falls than falls in general is mostly related to issues of sample size. Only about 10% to 15% of falls result in significant injury, and most fall-prevention trials were powered only to show reductions in total falls. Larger studies would probably have shown statistically significant reductions in injurious falls that paralleled the reduction in total falls.
Although we also agree with Dr. Pierre that exercise regimens introduced early in life will probably have lasting benefits into old age and will most likely increase the chance that older persons will remain active and fall-free, the evidence behind this assertion is thus far lacking in longitudinal or intervention trials. Nonetheless, we believe in the benefit of most forms of exercise at any age, not only for fall prevention but also for improving many other aspects of health and well-being.
Laurence Z. Rubenstein, MD, MPH
Sepulveda Veterans Affairs Medical Center
Sepulveda, CA 91343
Christopher M. Powers, PhD, PT
University of Southern California
Los Angeles, CA 90033
- Copyright ©2004 by the American College of Physicians
