Keeping physically active

Impaired balance and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls. There is strong evidence from randomised controlled trials that group exercise classes, and exercises individually delivered at home, usually containing some balance and strength training, reduce falls, as does Tai Chi. 

Falls prevention exercise needs to focus on strengthening leg and ankle muscles and challenging balance. Activities should include resistance activities using the upper body and exercises done while standing. Falls prevention cannot be achieved solely through chair-based programmes and seated gym machines.

Minimising the amount of time spent sitting down for extended periods is crucial. Some older people may spend nine hours or more each day sitting. Advice to get up every 30 minutes and spend a few minutes standing or walking is a simple intervention. Measures to achieve greater mobility should be tailored to the current level of activity and the patients’ individual situation. Patients should regard them as part of their normal routine. These include: 

• Standing or walking around when on the phone
• Taking a walk break with every coffee or tea break
• Getting off the bus one stop early to build in a few minutes of walking
• Stand up and move during TV advert breaks
• Go outside and do short bursts of weeding or plant watering.

The aim should be to build up to about 30 minutes activity that gently raises heart rate and breathing rate and makes the person feel warmer on three to five occasions a week. As well as cardiovascular exercise it is important to improve muscle strength by activities (‘resistance exercises’) on at least two days a week, such as:

• Carrying or moving loads such as groceries
• Gardening jobs such as pushing a lawn mower, digging or collecting grass and leaves
• Activities that involve stepping and jumping such as dancing
• Chair-based exercises.Inform patients about local opportunities for suitable exercise including walking/rambling groups, Tai Chi and exercise classes designed for older people. The pharmacy should have a compendium of what is available locally in order to signpost patients to these.