‘Exercise Is Key to Falls Prevention’: Older Australians Urged to Decrease Fracture Risk Through Targeted Exercises

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Older Australians are being urged to get active following a study that found lower physical activity to be associated with higher fracture risk.

This comes after a study, led by Dana Bliuc from the Garvan Institute of Medical Research in Sydney, found that almost a quarter of a million Australians aged 45 and over were walking less than 1 kilometre (0.62 miles) every day, which was correlated with higher fracture risk.

Currently, one in three older Australians living in the community experiences a fall, 130,000 are hospitalised because of a fall, and 5,000 die from a fall.

A report by the Australian Institute of Health and Welfare (AIHW) found that half of the 233,000 hospitalisations from falls in 2022 involved a fracture.

“Walking limitation affected approximately 1 in 5 participants and was frequently associated with known fracture risk factors (ie., lower weight, falls, prior fracture),” the study’s authors wrote.

Significance of the Study’s Findings

The study examined 238,969 women and men aged 45 and over who self-reported their walking limitations over five years. The median age for women was 63 years, and 61 years for men.

Participants were categorised into four groups: no walking limitation, limitations at 1000 metres, 500 metres, and 100 metres.

Of the 238,969 women and men, 20 percent (39,324 women and 23,191 men) reported walking less than 1,000 metres daily.

Of this amount, 7,190 women and 4,267 men reported a fracture incident at 4 years.

This yielded 11.92 fractures per 1,000 women and 7.93 fractures per 1,000 men.

Additionally, the study showed that women who reported a lot of limitations showed more than a two-fold higher risk of hip and vertebral fractures.

Fracture risk increased by almost 20 percent for women who could walk only 1,000 metres, by 43 percent for those who could walk only 500 metres, and by 60 percent for 100 metres.

Similarly, for men, fracture risk increased by approximately 32 percent, 62 percent, and more than two-fold for 1,000 metres, 500 metres, and 100 metres, respectively.

Men who had a lot of limitations had a three-fold higher risk of a hip fracture and more than 2-fold higher risk of vertebral fracture.

Moreover, the authors also took into account the “complex geriatric constructs” associated with walking speed, such as frailty and sarcopenia (loss of muscle mass in older adults).

“Given the high prevalence and magnitude of association with fracture risk, approximately 66 percent of fractures were attributable to walking limitation,” the authors wrote.

The authors added that sedentary behaviour—a spiralling cycle to inactivity—is not only associated with reduced muscle strength and performance but also with a risk of fracture and falls.

“An inverse association between leisure physical activity and hip fracture risk was found for both women and men,” they wrote.

Additionally, the risk of osteoporotic fractures from osteoporosis, which is characterised by low bone mineral density or the deterioration of bone tissue, was estimated to affect around 6.2 million Australians over the age of 50 by 2022—translating to 183,000 fractures each year.

Targeted Exercise as a Solution

Jasmine Menant, a senior research scientist from NeuRA Falls’ Balance and Injury Research Centre and spokesperson for the Australian and New Zealand Falls Prevention Society, said that mobility and balance impairment are significant risk factors for falls in older adults.

“The study findings therefore reinforce the evidence of an urgent need to implement interventions to maintain and improve balance and mobility in older people so that we can prevent falls and injuries from falls,” Ms. Menant told The Epoch Times.

As such, the study highlights the importance of physical activity for Australians.

“Exercise is key to falls prevention: a Cochrane review of 108 trials found that exercise could reduce the rate of falls by 23 percent among older people living in the community,” she said.

Ms. Menant outlined a number of key recommendations by the ANZ Falls Society to reduce fall risks in older Australians.

These are:

• Aiming to complete 2 to 3 hours per week of exercises targeting balance and mobility and also including leg strength training. These are to be done on an ongoing basis. Older Australians at higher risk of falls should seek supervision from health professionals to exercise safely and effectively.
• Make the home safe by getting rid of trip and slip hazards and seeking the help of occupational therapists to do so.
• Have vision (and spectacle prescriptions) checked yearly and have cataract surgery for those with visual impairment from cataracts.
• Advise active older people to use single-lens distance glasses (rather than bifocal, multifocal, or progressive lenses) when undertaking outdoor activities.
• Having medication reviewed at least yearly by general practitioners and pharmacists and minimising the use of psychoactive medications and other fall-risk-increasing medications
• Ensuring older people wear safe shoes and manage their foot problems with the assistance of podiatrists, and
• Providing daily or weekly vitamin D supplements to older people if they are vitamin D deficient or have little sunlight exposure.

Ms. Menant said that there are specific recommendations for older Australians living in residential aged care that cover all risk factors, such as vision, balance, and medications.

These include providing individualised supervised exercise on an ongoing basis, ensuring adequate provision of dairy foods (at least 3 servings per day to meet daily protein and calcium requirements), administering daily or weekly vitamin D supplements, and prescribing bone treatments for older people with diagnosed osteoporosis or a history of low-trauma fractures.

Additionally, targeted strength training has been proven effective in maintaining physical function and quality of life, Rob Newton, a professor of exercise medicine at Edith Cowan University, told The Epoch Times. This would reduce the burden on the individual, carers, and society, he said.

National Guidelines on Falls Prevention to be Updated

Ms. Menant added that there has been no national strategy for preventing falls in Australia for nearly 10 years. The latest guidelines were published in 2009.

“A well-implemented fall prevention strategy will enhance longer-term benefits for health, quality of life and independence of older Australians,” she said.

In a statement to The Epoch Times, the Australian Commission of Safety and Quality in Health Care (ACSQHC) said that preventing falls, and harms from falls, forms part of the national standards it is working towards in addressing fall risks in older Australians.

The revised guidelines, in collaboration with the ACSQHS, the ANZ Falls Prevention Society, and NeuRA, are expected to be published late in 2024.