Citation

Skelton DA. Age Ageing 2023; 52(11): afad209.

Copyright

(Copyright © 2023, Oxford University Press)

DOI

10.1093/ageing/afad209

PMID

37962417

Abstract

The study by Kwok et al. [1] reminds us that frailty and limitations in physical function change movement behaviours and moderate the association between physical activity and injurious falls. This study looked both cross-sectionally and prospectively at the self-report data from women in two waves of the Australian Longitudinal Study on Women's Health and found a clear dose response relationship--the more moderate and vigorous activity a person does, the less chance of having injurious falls, but only in those without functional limitations or frailty. For those who have physical function limitations or are frail, there is an increased risk of injurious falls with increased activity. There are intrinsic and extrinsic risk factors for falls, but there is also exposure to risk [2]. Those with functional limitations are essentially exposing themselves to more risk by being on their feet more, but they do not have the required parameters of fitness (such as strength, power, balance, reaction time and flexibility) to stay upright if they trip [3].

The authors go on to recommend the promotion of physical activity in those who are not frail or limited in function, but they advise caution when promoting activity to those with functional limitations, and they recommend exercise programmes specifically designed to improve their stability, strength and physical function [1]. This is in line with the World Falls Guidelines, that suggest that those who are at the lowest risk of a fall are encouraged to meet the physical activity guidelines and those at intermediate or high risk, or those with frailty, are offered evidence-based exercise programmes [4, 5].

The cohort of older people examined in this study were 65-70 years old and were followed for 3 years to look at prospective associations. There are time points in the life course where we can have distinct changes in our physical activity and sedentary behaviour patterns, such as on retirement, becoming a carer and following hospitalisation [6]. Indeed, falls start in middle age, 9% of 40-44-year-olds and nearly 30% of 60-64-year-old women had fallen across four population-based cohorts in Australia, Ireland, Netherlands and the UK [7]. Encouraging people at retirement to increase their physical activity to meet the activity guidelines for health (150 min/week moderate intensity activity) reduces their risk of falls aged 90 by around 35-40% compared to those doing less [8]. The early 60s seems to be a critical life stage for preventative interventions. But we need to be mindful of what we promote and to who. We need to consider peoples' abilities within our activity advice.

This study is just another reminder that not all activity is effective or safe for frailer older people...

Language: en

Keywords

Humans; Risk Factors; physical activity; frailty; falls; older people; *Exercise; injurious falls; physical function limitation