SLR - February 2018 - Lisa D. Breshears

Exercise Interventions for the Improvement of Falls-Related Outcomes Among Older Adults with Diabetes Mellitus: A Systematic Review and Meta-Analyses

Reference: Chapman, A., Meyer, C., E. R., Hill, K. D., & Browning, C. J. (2016). Exercise Interventions for the Improvement of Falls-related Outcomes Among Older Adults with Diabetes Mellitus: A Systematic Review and Meta-Analyses. Journal of Diabetes and Its Complications.

Scientific Literature Review

Reviewed By: Lisa D. Breshears, DPM
Residency Program: Chino Valley Medical Center, Chino, CA

Podiatric Relevance: The purpose of the study was to perform a systematic review and meta-analysis of exercise interventions to decrease the risk of falls in elderly adults living with diabetes. According to the International Diabetic Federation, there are 94.2 million elderly adults living with diabetes. Falls in this specific group leads to a major impact on their overall health and quality of life. For the general elderly population, approximately one in three fall each year, but with the addition of the diagnosis of diabetes, the risk of falls increases by 67 percent. These types of falls in people living with diabetes are twice as likely to cause injuries.  

Methods: This article was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic database search included Medline, PsycInfo, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and Scopus. Inclusion criteria were English language peer-reviewed articles, included years up to September 2015, were experimental, used exercise interventions and had a mean sample age of > 60 years old with Type 1 or Type 2 diabetes. Exclusion criteria included those studies with a combination of chronic diseases that did not separate diabetes alone.    

Results: Sixteen qualitative studies and 10 quantitative studies were included. All articles were published after 2003. The mean sample size was 56 ± 55, and mean age was 68.3 ± 7.7 years. The mean duration of diabetes was 12.3 ± 7.3 years. Six outcome measures were used to assess fall-related outcomes. Static balance was assessed with postural sway or a one-leg stance test, and five studies (n = 268) showed that exercise was more beneficial than control. Functional performance with dynamic balance was assessed, and six studies (n = 298) showed no significant difference between the exercise group versus the control group. Five studies (n = 267) showed no significant difference between the exercise group and the control group for functional performance testing. For lower-limb strength, six studies (n = 277) showed that exercise was more beneficial than the control. Gait speed and cadence in the exercise group was more beneficial than the control in five studies (n = 214). Fall rates and risks had insufficient randomized control trials to support a meta-analysis; however, one randomized control trial showed that lower-extremity strengthening, balance and walking exercises did not differ from the control group over a trial period of 12 months. All categories, except for the gait component, showed significant heterogeneity.  

Conclusion: Exercise interventions were more effective than the control conditions for improving static balance, lower-limb strength and gait measures. These are all vital in maintaining postural stability. A decrease in the ability to maintain postural stability is a risk factor for falls. Patients living with diabetes have a higher risk of falls, are at an increased risk of recurrent falls and have an increased risk of fractures with these falls. Elderly patients living with diabetes have the potential to benefit from exercise programs that focus on balance, lower-limb strength and gait.  

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