The e eff ffect ect of f exerc ercis ise e and phys ysic - PowerPoint PPT Presentation

The e eff ffect ect of f exerc ercis ise e and phys ysic ical al tr training ining on fa falls ls and d physical ysical func nctio ion n in olde der r adults lts with th vision ision impa pairm irmen ent: t: An upda dated ed sys ystem tematic atic revie view and d meta ta-analy analysis sis Lisa Dillon PhD Candidate 13 th Australasian Injury Prevention and Safety Promotion Conference Co Co-aut utho hors: rs: Prof Lindy Clemson, Prof Pradeep Ramulu, Prof Catherine Sherrington & A/Prof Lisa Keay Lisa Dillon AIPN 21/11/2017 1 Private & Confidential

Overview erview Background Exercise and falls Previous Systematic Review Balance and strength Falls outcomes Updated Systematic Review Inclusion criteria Flow of studies Results Answering the Questions Where to from here? Lisa Dillon AIPN 21/11/2017 2 Private & Confidential

Backgrou ckground nd Lisa Dillon AIPN 21/11/2017 3 Private & Confidential

Backgrou ckground nd 30% of Australian’s over the age of 65 fall each year (Morris et al., 2013) • Vision impairment increases the risk of falls (Ivers et al., 2002) • Vision impairment reduces physical activity (Gleeson et al., 2014) • Lisa Dillon AIPN 21/11/2017 4 Private & Confidential

Backgrou ckground: nd: Exercise ercise and d falls ls Exercise alone can prevent falls in older community-dwelling adults by up to 21%, particularly: 1. Challenges balance 2. 3+ hours per week 3. 3. No pres escription cription of walking king (Sherrington et al., 2016) Vision Impairment? Lisa Dillon AIPN 21/11/2017 5 Private & Confidential

Prev evious ious sys ystematic tematic review view Lisa Dillon AIPN 21/11/2017 6 Private & Confidential

Prev evious ious sys ystematic tematic review view

Pooled oled estim imates ates Balance (Berg balance score) p = 0.013 Strength (Timed up and go) p = 0.206

Upda dated ted sys ystematic ematic review view Lisa Dillon AIPN 21/11/2017 9 Private & Confidential

Upda dated ted sys ystematic ematic review view 1. Does exercise or other physical training improve physica ysical l funct ction ion in older adults with vision impairment? 2. Does exercise or other physical training prevent falls ls in older adults with vision impairment? Lisa Dillon AIPN 21/11/2017 10 Private & Confidential

Upda dated ted sys ystematic ematic review: view: Inclu clusi sion on crite iteria ia Design Randomised controlled trials or trials with factorial design Participants Older adult’s ≥ 50 years of age Uncorrectable vision impairment Intervention Exercise Physical training other than exercise, such as Tai chi, Yoga and dance Outcome measures Measures of physical function with performance tests or questionnaires Falls with calendars or incident reports Comparisons Exercise program compared with control or usual care Lisa Dillon AIPN 21/11/2017 11 Private & Confidential

Upda dated ted sys ystematic ematic review: view: Flow ow of stud udies ies Records in original review Records identified through database Records excluded after searching of February 2013 – July (n = 4) screening titles/abstracts (n = Records that could be 433) 2017, after removal of duplicates included in current review (n = 440) due to updated age criteria Full-text articles assessed for Papers excluded after (n = 0) eligibility (n = 7) examination of full text (n = 4) Research design not RCT (n Papers included in review (n = 7) = 3) Papers included from original Physical function outcomes systematic review (n = 4) not measured with Papers from updated database performance tests or search (n = 3) questionnaires (n = 1) Papers included in Meta-analysis (n = 4) Papers included from original review (n = 2) Papers from updated database search (n = 2)

Upda dated ted sys ystematic ematic review: view: Inclu clude ded stud udies ies Otago Exercise Programme (Campbell et al. 2005; Chueng et al. 2008; Kovács et al. 2012; Waterman et al. 2016) Tai Chi (Chen et al. 2011) The Alexander Technique (Gleeson et al. 2015) Yoga (Jeter et al. 2015) Lisa Dillon AIPN 21/11/2017 13 Private & Confidential

Upda dated ted sys ystematic ematic review: view: Res esults ults Physical function: Strength (Chair stand test) p = 0.20 Fall outcomes p = 0.24 Lisa Dillon AIPN 21/11/2017 14 Private & Confidential

Answering swering the ques estio ions ns: : Phys ysic ical al function ction & falls ls 1. Does exercise or other physical training improve physica ysical l funct ction ion in older adults with vision impairment? 2. Does exercise or other physical training prevent falls ls in older adults with vision impairment? Previous systematic Updated systematic review review Balance p = 0.013 N/A Strength p = 0.21 p = 0.20 Falls Outcomes N/A p = 0.24 Lisa Dillon AIPN 21/11/2017 15 Private & Confidential

Key y messag ssages es Exercise can improve physical function in older people with vision impairment • Walking may increase exposure to risk of falls • There remains no proven fall prevention strategies for older people with vision • impairment Wide range of strategies: Tai Chi, Yoga, the Alexander Technique, Otago Exercise • Programme Lisa Dillon AIPN 21/11/2017 16 Private & Confidential

Where ere to from om here? e? Prev even enTin Ting g Fal alls ls in in a a hi high gh r ris isk, k, vis isio ion n im impa pair ired ed po popu pula lati tion on th throu ough gh spe peci cialist alist ORien ientation tation an and d Mo Mobi bili lity ty serv ervices: ices: a r a ran ando domise mised d tr tria ial

Ack ckno nowledg ledgmen ents ts Su Super ervisor: isor: A/Prof Lisa Keay Co Co-aut utho hors: rs: Prof Lindy Clemson, Prof Pradeep Ramulu, Prof Catherine Sherrington Lisa Dillon AIPN 21/11/2017 18 Private & Confidential

Ques estions? tions? Lisa Dillon AIPN 21/11/2017 19 Private & Confidential