The e eff ffect ect of f exerc ercis ise e and phys ysic - - PowerPoint PPT Presentation

The e eff ffect ect of f exerc ercis ise e and phys ysic ical al tr training ining on fa falls ls and d physical ysical func nctio ion n in olde der r adults lts with th vision ision impa pairm irmen ent: t: An upda dated ed sys ystem tematic atic revie view and d meta ta-analy analysis sis

Lisa Dillon PhD Candidate 13th Australasian Injury Prevention and Safety Promotion Conference Co Co-aut utho hors: rs: Prof Lindy Clemson, Prof Pradeep Ramulu, Prof Catherine Sherrington & A/Prof Lisa Keay

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Overview erview

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Background Exercise and falls Previous Systematic Review Balance and strength Falls outcomes Updated Systematic Review Inclusion criteria Flow of studies Results Answering the Questions Where to from here?

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Backgrou ckground nd

Backgrou ckground nd

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• 30% of Australian’s over the age of 65 fall each year (Morris et al., 2013)
• Vision impairment increases the risk of falls (Ivers et al., 2002)
• Vision impairment reduces physical activity (Gleeson et al., 2014)

Backgrou ckground: nd: Exercise ercise and d falls ls

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Exercise alone can prevent falls in older community-dwelling adults by up to 21%, particularly: 1. Challenges balance 2. 3+ hours per week 3. 3. No pres escription cription of walking king (Sherrington et al., 2016) Vision Impairment?

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Prev evious ious sys ystematic tematic review view

Prev evious ious sys ystematic tematic review view

Pooled

• led estim

imates ates

Balance (Berg balance score) Strength (Timed up and go)

p = 0.013 p = 0.206

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Upda dated ted sys ystematic ematic review view

Upda dated ted sys ystematic ematic review view

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1. Does exercise or other physical training improve physica ysical l funct ction ion in older adults with vision impairment? 2. Does exercise or other physical training prevent falls ls in older adults with vision impairment?

Upda dated ted sys ystematic ematic review: view: Inclu clusi sion

• n crite

iteria ia

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Design Randomised controlled trials or trials with factorial design Participants Older adult’s ≥ 50 years of age Uncorrectable vision impairment Intervention Exercise Physical training other than exercise, such as Tai chi, Yoga and dance Outcome measures Measures of physical function with performance tests or questionnaires Falls with calendars or incident reports Comparisons Exercise program compared with control or usual care

Upda dated ted sys ystematic ematic review: view: Flow

• w of stud

udies ies

Records identified through database searching of February 2013 – July 2017, after removal of duplicates (n = 440) Papers included in review (n = 7) Papers included from original systematic review (n = 4) Papers from updated database search (n = 3) Papers included in Meta-analysis (n = 4) Papers included from original review (n = 2) Papers from updated database search (n = 2) Records in original review (n = 4) Records that could be included in current review due to updated age criteria (n = 0) Full-text articles assessed for eligibility (n = 7) Papers excluded after examination of full text (n = 4) Research design not RCT (n = 3) Physical function outcomes not measured with performance tests or questionnaires (n = 1) Records excluded after screening titles/abstracts (n = 433)

Upda dated ted sys ystematic ematic review: view: Inclu clude ded stud udies ies

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Otago Exercise Programme (Campbell et al. 2005; Chueng et al. 2008; Kovács et al. 2012; Waterman et al. 2016) Tai Chi (Chen et al. 2011) The Alexander Technique (Gleeson et al. 2015) Yoga (Jeter et al. 2015)

Upda dated ted sys ystematic ematic review: view: Res esults ults

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Physical function: Strength (Chair stand test) Fall outcomes

p = 0.20 p = 0.24

Answering swering the ques estio ions ns: : Phys ysic ical al function ction & falls ls

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Previous systematic review Updated systematic review Balance

p = 0.013 N/A

Strength

p = 0.21 p = 0.20

Falls Outcomes

N/A p = 0.24

1. Does exercise or other physical training improve physica ysical l funct ction ion in older adults with vision impairment? 2. Does exercise or other physical training prevent falls ls in older adults with vision impairment?

Key y messag ssages es

• Exercise can improve physical function in older people with vision impairment
• Walking may increase exposure to risk of falls
• There remains no proven fall prevention strategies for older people with vision

impairment

• Wide range of strategies: Tai Chi, Yoga, the Alexander Technique, Otago Exercise

Programme

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Where ere to from

• m here?

e?

Prev even enTin Ting g Fal alls ls in in a a hi high gh r ris isk, k, vis isio ion n im impa pair ired ed po popu pula lati tion

• n th

throu

• ugh

gh spe peci cialist alist ORien ientation tation an and d Mo Mobi bili lity ty serv ervices: ices: a r a ran ando domise mised d tr tria ial

Ack ckno nowledg ledgmen ents ts

Su Super ervisor: isor: A/Prof Lisa Keay Co Co-aut utho hors: rs: Prof Lindy Clemson, Prof Pradeep Ramulu, Prof Catherine Sherrington

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Ques estions? tions?

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