Research has shown that falls reduction programs that include exercise are most effective for reducing falls risk. It is often assumed that these programs are effective because they improve physical performance, such as greater muscle strength and balance. A team of researchers at the University of British Columbia propose a different explanation for the effectiveness of exercise for falls reduction. In a forthcoming commentary in the British Journal of Sports Medicine, they hypothesize that the improved cognitive function that can result from exercise has a greater role in falls prevention than do balance and strength. They refer to this hypothesis as the “central benefit model.”
This model is based on a meta-analysis of four clinical trials of a specific falls reduction program, and on neuroimaging and neuropsychological studies of falls risk. In the meta-analysis, the occurrence of falls was reduced greatly by the falls reduction program, while there were little to no measurable physical performance effects. In other words, it appeared that the program reduced the risk of falls by some means other than improved strength or balance. How else might exercise reduce the risk of falls?
The central benefit model posits that exercise has a positive effect on cognitive function, especially executive functions (the higher order cognitive activities around planning, organization, and attention control). According to this model, poor executive function increases falls risk through various direct and indirect pathways, such as difficulty with integrating various sensory information while walking, loss of motivation, and overall decrease in physical activity. All of these lead to decreased physical function and increased difficulty with maintaining balance and gait. Since physical activity has been shown to maintain and improve cognitive function, including executive function, the central benefit model suggests that exercise would lead to falls reduction through various pathways related to executive function.
It should be noted that the researchers’ meta-analysis only included one specific falls reduction program, so it may be true that other programs can reduce falls risks through improved physical function—perhaps in addition to the cognitive benefits of exercise. Physical function and environment play an important role in falls risk, whatever the role of executive cognitive function. However, this model highlights the role that cognition and cognitive assessment may play in falls reduction.