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The Effects of Exercise Intervention for Fall Prevention in Persons with Arthritis: A Meta Analysis

Chun Hee Lee, MSN, RN1, Heeok Park, RN, Ph.D.2
Korean Journal of Adult Nursing 2017;29(6):587-603.
Published online: December 18, 2017

1Department of Nursing, Sunlin University, Pohang, Korea

2College of Nursing, Keimyung University, Deagu, Korea

Corresponding author: Park, Heeok College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3924, Fax: +82-53-580-3916, E-mail: hopark@kmu.ac.kr
• Received: July 21, 2017   • Accepted: December 8, 2017

© 2017 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was a meta-analysis of the effects of exercise intervention in preventing falls among persons with arthritis.
  • Methods
    The review consisted of searches from Pubmed, Ovid-MEDLINE, CINAHL, EMBASE and Korean DBs using PICO-SD format. Key words for searching included ‘ arthritis’, ‘ exercise’, ‘ fall’ and the articles published until January 2017 were selected for this study. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were ana-lyzed by the RevMan 5.3 program of Cochrane Library.
  • Results
    Nineteen clinical trials met the inclusion criteria with a total of 832 participants. There were significant differences in Tai Chi exercise (ES=0.76), exercise interventions performed over 60 minutes at one time(ES=0.98), exercise interventions provided once a week(ES=0.69) or 2~3 times a week (ES=0.65), exercise interventions provided for a total of 12 weeks or less (ES=0.86). The out-come measures such as balance (ES=0.66), fall efficacy (ES=0.70), and fear of falling (ES=-0.70) showed the significant difference, and their effect sizes were ranged from moderate to large
  • Conclusion
    The results of the study show that the exercise intervention is effective to prevent fall in persons with arthritis. It is necessary to include the comprehensive exercise interventions to enhance balance and fall efficacy and reduce fear of falling for the fall prevention program in persons with arthritis.
  • Key Words: Arthritis; Exercise; Falls; Meta-analysis
Figure 1.
Flowchart of study selection.
kjan-29-587f1.jpg
Figure 2.
Risk of bias.
kjan-29-587f2.jpg
Figure 3.
Forest plots of the effects of exercise related to fall prevention (3.1, 3.2).
kjan-29-587f3a.jpgkjan-29-587f3b.jpg
Figure 3.
Forest plots of the effects of exercise related to fall prevention (3.3).
kjan-29-587f3c.jpgkjan-29-587f3d.jpg
Table 1.
Characteristics of Articles Analyzed in the Study
No First author (Year) Location Study design Participants Setting Intervention (exercise) Outcome measures
Exp (n) Cont (n) Age (year) Type Min/session/ duration (wks) Physical Emotional
1 Fisken (2015) New Zealand RCT 13 12 71 Comm. Aquatic exercise 45~60/2/12 TUG 400 m walk test FES-l
2 Lin (2015) Netherland NRCT 12 12 64 Comm. Walked on a treadmill N/R   FES
3 Hale (2012) New Zealand RCT 20 15 74 Comm. Aquatic exercise 20~60/2/12 TUG  
4 Arnold (2011) Canada RCT 26 27 74 Hosp. Aquatic exercise 45/2/11 BBS TUG 6MWT MCTSIB ABC
5 Arnold (2010) Canada RCT 55 27 74 Comm. Aquatic exercise 45/2/11 BBS TUG 6MWT ABC
6 Song (2010) South Korea RCT 30 35 62 Comm. Tai Chi 60/1/24   SAFE
7 Lee (2015) South Korea NRCT 15 15 57 Comm. Aquatic exercise 50/5/8 Walking speed test Step test (number) TUG FES
8 Im (2014) South Korea NRCT 11 11 64 Comm. Aquatic exercise 60/3/12 Balance scale (sec)  
9 Han (2012) South Korea NRCT 10 9 66 Comm. Aquatic exercise 50/3/12 Gait speed (sec)  
10 Lee (2011) South Korea NRCT 24 24 74 Comm. LE MS 30/2/8   FES FOFQ
11 Jeong (2010) South Korea NRCT 20 20 62 Comm. AE 120/2/6 Balance scale (sec)  
12 Kim (2010) South Korea NRCT 18 18 54 Comm. BeHaS 65~90/1/12 Balance scale (sec) - Static balance - TUG Walking ability - Gait speed (sec) - Gait times (sec)  
13 Song (2009) South Korea RCT 30 39 61 Comm. TaiChi 60/1/24   SAFE
14 Lee (2008) South Korea NRCT 22 24 75 Comm. TaiChi 60/2/12 Balance scale (sec) TUG test FES FOFQ
15 Kim (2007) South Korea NRCT 31 24 70 Comm. BeHaS 65~80/2/8 Balance scale (sec) FES
16 Choi (2007) South Korea NRCT 19 21 66 Comm. TaiChi 60/1/6   FOFQ
17 Lee (2006) South Korea NRCT 32 29 50 Hosp. TaiChi 50/1/12 Balance scale (sec)  
18 Lee (2004) South Korea NRCT 15 13 66 Comm. TaiChi 60/1/8 Balance scale (score) Gait (score)  
19 Lim (2004) South Korea NRCT 27 27 49 Hosp. TaiChi 60/3/8 Balance scale (sec)  

ABC=activities-specific balance; BBS=berg balance scale; BeHaS=be happy and strong exercise; Cont=control group; Exp=experimental group; FES=falls efficacy scale; FES-I=falls efficacy scale-international; FOFQ=fear of falling questionnaire; MCTSIB=modified clinical test of sensory interaction and balance; N/R=not reported; NRCT=non-randomized controlled trials; RCT=randomized controlled trials; Comm.=Community; Hosp.=Hospital; LE=Lower extremity; MS=Muscle strength; AE=Aquatic exercise; TUG=timed up-and-go test; SAFE=survey of activities and fear of falling in the elderly; 6MWT=6~minute walk test.

Appendix 2. Search Strategies
PubMed
#1 Arthritis[MeSH]
#2 Osteo∗ OR Rheumatoid
#3 #1 AND #2
#4 Fall OR Fall∗ OR Fall∗ prevention
#5 Exercise[MeSH] OR Walking[MeSH] OR Walk∗ OR Muscle Contraction[MeSH] OR Strengthening OR Jogging[MeSH]
OR Running[MeSH] OR Run∗ OR Swimming [MeSH] OR Aquatic exercise OR Hydrotherapy[MeSH] OR Tai chi OR Tai ch∗
#6 #4 OR #5
#7 #3 AND #6
Ovid-MEDLINE
1 Arthritis
2 Osteo∗ OR Rheumatoid
3 1 AND 2
4 Fall OR Fall∗ OR Fall∗ prevention
5 Exercise OR Walking OR Walk∗ OR Muscle Contraction OR Strengthening OR Jogging OR Running OR Run∗ OR
Swimming OR Aquatic exercise OR Hydrotherapy OR Tai chi OR Tai ch∗
6 4 OR 5
7 3 AND 6
CINAHL
S1 Arthritis AND (Osteo$ OR Rheumatoid)
S2 Fall OR Fall$ OR Fall∗ prevention
S3 Exercise OR Walking OR Walk∗ OR Muscle Contraction OR Strengthening OR Jogging OR Running OR Run∗ OR
Swimming OR Aquatic exercise OR Hydrotherapy OR Tai chi OR Tai ch∗
S4 S2 OR S3
S5 S1 AND S4
EMBASE
1 Arthritis[EMTREE]
2 Osteo$ OR Rheumatoid
3 1 AND 2
4 Fall OR Fall$ OR Fall∗ prevention
5 Exercise OR Walking[EMTREE] OR Walk∗ OR Muscle Contraction[EMTREE] OR Strengthening exercise[EMTREE] OR
Jogging[EMTREE] OR Running[EMTREE] OR Run∗ OR Swimming[EMTREE] OR Aquatic exercise[EMTREE] OR
Hydrotherapy [EMTREE] OR Tai chi[EMTREE] OR Tai ch∗
6 4 OR 5
7 3 AND 6
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    The Effects of Exercise Intervention for Fall Prevention in Persons with Arthritis: A Meta Analysis
    Korean J Adult Nurs. 2017;29(6):587-603.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.587
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    The Effects of Exercise Intervention for Fall Prevention in Persons with Arthritis: A Meta Analysis
    Korean J Adult Nurs. 2017;29(6):587-603.   Published online December 31, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.6.587
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    The Effects of Exercise Intervention for Fall Prevention in Persons with Arthritis: A Meta Analysis
    Image Image Image Image
    Figure 1. Flowchart of study selection.
    Figure 2. Risk of bias.
    Figure 3. Forest plots of the effects of exercise related to fall prevention (3.1, 3.2).
    Figure 3. Forest plots of the effects of exercise related to fall prevention (3.3).

    Figure 1.

    Figure 2.

    Figure 3.

    Figure 3.

    The Effects of Exercise Intervention for Fall Prevention in Persons with Arthritis: A Meta Analysis

    Characteristics of Articles Analyzed in the Study

    No First author (Year) Location Study design Participants Setting Intervention (exercise) Outcome measures
    Exp (n) Cont (n) Age (year) Type Min/session/ duration (wks) Physical Emotional
    1 Fisken (2015) New Zealand RCT 13 12 71 Comm. Aquatic exercise 45~60/2/12 TUG 400 m walk test FES-l
    2 Lin (2015) Netherland NRCT 12 12 64 Comm. Walked on a treadmill N/R   FES
    3 Hale (2012) New Zealand RCT 20 15 74 Comm. Aquatic exercise 20~60/2/12 TUG  
    4 Arnold (2011) Canada RCT 26 27 74 Hosp. Aquatic exercise 45/2/11 BBS TUG 6MWT MCTSIB ABC
    5 Arnold (2010) Canada RCT 55 27 74 Comm. Aquatic exercise 45/2/11 BBS TUG 6MWT ABC
    6 Song (2010) South Korea RCT 30 35 62 Comm. Tai Chi 60/1/24   SAFE
    7 Lee (2015) South Korea NRCT 15 15 57 Comm. Aquatic exercise 50/5/8 Walking speed test Step test (number) TUG FES
    8 Im (2014) South Korea NRCT 11 11 64 Comm. Aquatic exercise 60/3/12 Balance scale (sec)  
    9 Han (2012) South Korea NRCT 10 9 66 Comm. Aquatic exercise 50/3/12 Gait speed (sec)  
    10 Lee (2011) South Korea NRCT 24 24 74 Comm. LE MS 30/2/8   FES FOFQ
    11 Jeong (2010) South Korea NRCT 20 20 62 Comm. AE 120/2/6 Balance scale (sec)  
    12 Kim (2010) South Korea NRCT 18 18 54 Comm. BeHaS 65~90/1/12 Balance scale (sec) - Static balance - TUG Walking ability - Gait speed (sec) - Gait times (sec)  
    13 Song (2009) South Korea RCT 30 39 61 Comm. TaiChi 60/1/24   SAFE
    14 Lee (2008) South Korea NRCT 22 24 75 Comm. TaiChi 60/2/12 Balance scale (sec) TUG test FES FOFQ
    15 Kim (2007) South Korea NRCT 31 24 70 Comm. BeHaS 65~80/2/8 Balance scale (sec) FES
    16 Choi (2007) South Korea NRCT 19 21 66 Comm. TaiChi 60/1/6   FOFQ
    17 Lee (2006) South Korea NRCT 32 29 50 Hosp. TaiChi 50/1/12 Balance scale (sec)  
    18 Lee (2004) South Korea NRCT 15 13 66 Comm. TaiChi 60/1/8 Balance scale (score) Gait (score)  
    19 Lim (2004) South Korea NRCT 27 27 49 Hosp. TaiChi 60/3/8 Balance scale (sec)  

    ABC=activities-specific balance; BBS=berg balance scale; BeHaS=be happy and strong exercise; Cont=control group; Exp=experimental group; FES=falls efficacy scale; FES-I=falls efficacy scale-international; FOFQ=fear of falling questionnaire; MCTSIB=modified clinical test of sensory interaction and balance; N/R=not reported; NRCT=non-randomized controlled trials; RCT=randomized controlled trials; Comm.=Community; Hosp.=Hospital; LE=Lower extremity; MS=Muscle strength; AE=Aquatic exercise; TUG=timed up-and-go test; SAFE=survey of activities and fear of falling in the elderly; 6MWT=6~minute walk test.
    Table 1. Characteristics of Articles Analyzed in the Study

    ABC=activities-specific balance; BBS=berg balance scale; BeHaS=be happy and strong exercise; Cont=control group; Exp=experimental group; FES=falls efficacy scale; FES-I=falls efficacy scale-international; FOFQ=fear of falling questionnaire; MCTSIB=modified clinical test of sensory interaction and balance; N/R=not reported; NRCT=non-randomized controlled trials; RCT=randomized controlled trials; Comm.=Community; Hosp.=Hospital; LE=Lower extremity; MS=Muscle strength; AE=Aquatic exercise; TUG=timed up-and-go test; SAFE=survey of activities and fear of falling in the elderly; 6MWT=6~minute walk test.

    Appendix 2. Search Strategies

    Table 1.

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