Combined group and home exercise programmes in community‐dwelling falls‐risk older adults: Systematic review and meta‐analysis

Objectives The objectives of this review were to (a) determine the effectiveness of combined group and home exercise programmes on falls risk factors and falls in community‐dwelling older adults at risk of falling compared to no exercise controls; and (b) explore adherence and the behaviour change techniques employed in delivering these interventions. Methods Five databases were selected to identify randomized controlled trials of exercise and/or physical activity interventions to prevent falls or to improve functional performance. PROSPERO CRD42018106111. Results Eighteen trials involving 5,960 participants were included. Meta‐analyses showed significant improvements in mobility after combined programmes measured by five times sit to stand (−1.42 times, 95% confidence interval [CI] −2.00 to −0.83), timed up and go (−0.94 s, 95% CI −1.76 to −0.12), and gait speed (0.05 m/s, 95% CI 0.02 to 0.07), but not single leg stance time, compared to controls. Combined programmes reduced injurious falls rate (0.77, 95% CI 0.65 to 0.91, I 2 = 0%) but not rate of falls (0.86, 95% CI 0.68 to 1.08, I 2 = 66%) compared to controls. There was no change in physical activity. Adherence ranged from 55–96%, with variability in the method of measurement of adherence. There was no clear relationship between adherence and outcomes. Most interventions used the behaviour change techniques of instruction/rehearsal/demonstration and feedback/monitoring. Conclusion Group exercise with a home programme resulted in better functional performance and falls‐related outcomes compared with a no exercise control group. Further research is needed to identify behaviour change techniques to improve adherence to exercise in this population.