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Cited by 186Balance, Gait, and Falls PreventionPhysical Activity and HealthFrailty in Older Adults

Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-analysis

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de Souto Barreto, Philipe, Rolland, Yves, Vellas, Bruno, Maltais, Mathieu·2019·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2018.5406PMC PMC6439708
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Abstract

Importance: Long-term exercise benefits on prevalent adverse events in older populations, such as falls, fractures, or hospitalizations, are not yet established or known. Objective: To systematically review and investigate the association of long-term exercise interventions (≥1 year) with the risk of falls, injurious falls, multiple falls, fractures, hospitalization, and mortality in older adults. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, SportDiscus, PsychInfo, and Ageline were searched through March 2018. Study Selection: Exercise randomized clinical trials (RCTs) with intervention length of 1 year or longer, performed among participants 60 years or older. Data Extraction and Synthesis: Two raters independently screened articles, abstracted the data, and assessed the risk of bias. Data were combined with risk ratios (RRs) using DerSimonian and Laird's random-effects model (Mantel-Haenszel method). Main Outcomes and Measures: Six binary outcomes for the risk of falls, injurious falls, multiple falls (≥2 falls), fractures, hospitalization, and mortality. Results: Forty-six studies (22 709 participants) were included in the review and 40 (21 868 participants) in the meta-analyses (mean [SD] age, 73.1 [7.1] years; 15 054 [66.3%] of participants were women). The most used exercise was a multicomponent training (eg, aerobic plus strength plus balance); mean frequency was 3 times per week, about 50 minutes per session, at a moderate intensity. Comparator groups were often active controls. Exercise significantly decreased the risk of falls (n = 20 RCTs; 4420 participants; RR, 0.88; 95% CI, 0.79-0.98) and injurious falls (9 RTCs; 4481 participants; RR, 0.74; 95% CI, 0.62-0.88), and tended to reduce the risk of fractures (19 RTCs; 8410 participants; RR, 0.84; 95% CI, 0.71-1.00; P = .05). Exercise did not significantly diminish the risk of multiple falls (13 RTCs; 3060 participants), hospitalization (12 RTCs; 5639 participants), and mortality (29 RTCs; 11 441 participants). Sensitivity analyses provided similar findings, except the fixed-effect meta-analysis for the risk of fracture, which showed a significant effect favoring exercisers (RR, 0.84; 95% CI, 0.70-1.00; P = .047). Meta-regressions on mortality and falls suggest that 2 to 3 times per week would be the optimal exercise frequency. Conclusions and Relevance: Long-term exercise is associated with a reduction in falls, injurious falls, and probably fractures in older adults, including people with cardiometabolic and neurological diseases.

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  • Long-term (> one year) physical exercise interventions have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care.

    “Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [284]

  • Long-term (> one year) physical exercise interventions have been shown to reduce risk of falls and improve muscle strength, balance, physical function, and cognition without increasing risk of health-related dropouts, mortality, or fractures compared to usual care.

    “Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”

    From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [284]

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Authors
de Souto Barreto, P., Rolland, Y., Vellas, B., & Maltais, M.
Affiliations
  • Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
  • Université Toulouse III - Paul Sabatier (FR)
  • Centre Hospitalier Universitaire de Toulouse (FR)
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2019-03-01
Volume
179
Issue
3
Pages
394
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2018.5406
PMC
PMC6439708
OpenAlex
W2906707737
Cited by
186
References
80
Citations by year
2026: 11 · 2025: 23 · 2024: 24 · 2023: 27 · 2022: 32 · 2021: 31 · 2020: 20 · 2019: 17 · 2012: 1
FWCI
3.30
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
long-term exercise training, older adults, falls, injurious falls, fracture, hospitalization, mortality, multicomponent exercise, resistance training, balance training, aerobic exercise, exercise safety, fall risk reduction, exercise frequency, exercise duration, exercise dose-response, exercise adherence facilitators
MeSH terms
Accidental Falls, Aged, Hospitalization, Humans, Mortality, Exercise, Randomized Controlled Trials as Topic, Fractures, Bone

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