Many patients that attend CR & PR are at an elevated risk for falls and fractures during their participation in rehabilitation, and the consequences of fractures in these patients can be life-altering and can lead to premature death. The newly published JCRP article “What Cardiopulmonary Rehabilitation Professionals Should Know About Fall and Fracture Prevention: A Narrative Review” aims to help programs identify and reduce the risk of falls and fractures for CR & PR patients.

This clinically applicable review article summarizes and synthesizes a variety of clinical trials, meta-analyses, and guidelines on the topic to provide programs with real-life strategies to help identify patients at risk of falls and fractures and program adaptations that can be made to help reduce the likelihood of falls and fractures for patients found to be at risk.    

The article advocates for assessing patient fall risk by screening for falls within the past year, conducting Timed UP and Go or gait speed physical tests, and asking about patient dizziness, particularly in patients on medications that can lead to increased dizziness. If the results of these assessments indicate that the patient has a high risk of falls, it may be appropriate to consult with their primary care provider for additional strategies to help combat the likelihood of this type of injury.

The author also advocates for conducting fracture risk assessments by reviewing patient age, sex, history of conditions that increase fractures like rheumatoid arthritis, parental hip fracture history, BMI, history of smoking and alcohol use, and use of medications that can make fractures more likely. The article also highlights tools like FRAX, that can be employed in programs to help assess the risk of fracture in patients. 

Patients should also receive a nutrition screening, with a special focus on malnutrition and protein, calcium, and vitamin D intake, as malnutrition and inadequate protein, calcium and vitamin D can increase the likelihood of fracture risk.

So you’ve determined you have a patient at risk of falls and fractures. Now what? The article lays out practical steps that programs can take to help reduce this risk. Patients should be counseled on dietary choices that can help contribute to bone density and strength. Programs can also adapt assessments and exercises to reduce the risk of falls and injuries by focusing on safe transitions, slow and controlled movements, and adjusting exercises to avoid axial loading, twisting of the spine, or other rapid, repetitive, weighted, or sustained movements. Exercise prescriptions  can also be adapted to help reduce fall and fracture risk.  Incorporating exercises focused on balance, strength, and resistance training and exercises that help improve the flexibility of joints can help reduce the patient’s risk of falls and fractures more than just moderate- to vigorous-intensity physical activity alone.  As noted in Figure 3 of the article, for every 1000 people participating in exercises that target balance and strength, 107 falls and 27 fall-related injuries are prevented!