fall injuries

fear falling

falls prevention

falls

muscle strength

fall prevention

falls risk

tai chi

JAMA

<h3>Importance</h3> Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. <h3>Objective</h3> To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. <h3>Design, Setting, and Participants</h3> A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic. <h3>Interventions</h3> Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. <h3>Main Outcomes and Measures</h3> The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. <h3>Results</h3> Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78;<i>P</i> = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90;<i>P</i> = .009). No adverse events related to the intervention were reported. <h3>Conclusions and Relevance</h3> Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly...

Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall