Home' Australian Pharmacist : December 2011 Contents Vol. 30 -- December #12, 2011
Obesity and injury
Obesity and injury are major health
burdens on society, and the two are
most likely linked, according to a
report released in November by the
Australian Institute of Health and
The report, Obesity and injury in
Australia: a review of the literature,
presents a summary of information
from the existing literature to
investigate obesity-injury relationships.
It shows that, while findings are mixed,
most evidence suggests that obesity
increases the risk of injury.
Professor James Harrison of the
AIHW's National Injury Surveillance
Unit said, 'The probability of falls,
trips or stumbles rises with obesity.
However, the increased risk of falls in
the obese may be somewhat offset by
the possible protective effects of body
fat as cushioning and of increased
bone density in weight-bearing joints.
'Sleep apnoea is also strongly
associated with obesity, and this
condition greatly increases the risk
of road injury, due to the fatigue
experienced by sufferers.
In children, the evidence suggests
that their risk of falls -- and
therefore likelihood of face, tooth
and musculoskeletal injuries -- also
increases with obesity. Obesity during
pregnancy is a risk factor for injury to
both mother and baby.
'Obesity can also have negative
effects in the workplace -- being
obese has been found to increase the
incidence of workplace injury. It is also
possibly risky for employees working
with obese people, such as nurses
who are required to lift patients,
Professor Harrison said.
The relationship between body mass
and injury risk during sport is difficult
to assess. Population-based body
mass index (BMI) measures are often
not appropriate for athletes, whose
increased BMI can be due to a higher
muscle mass rather than excess fat.
The outcomes of injury are also
affected by obesity.
'The average length of stay in hospital
is significantly longer for obese injured
patients than for patients who are not
' Professor Harrison said.
'They may also have greater
requirements for respiratory support,
and are more likely to suffer certain
complications of care, such as
pneumonia, renal failure and sepsis,
during their time in hospital.
Evidence base for exercise
programs for older people
Good balance and mobility are
essential to help perform most
activities involved in everyday life, as
well as many recreational pursuits.
Keeping your balance is a complex
task, involving the co-ordination
between a person's muscles and
sensors which detect balance and are
part of the nervous system. In older
people many factors such as reduced
muscle strength, stiff joints, delayed
reaction times and changes in the
sensory system all add up to reduce a
person's ability to keep in balance.
A previously published Cochrane
review indicated that regular exercise
helps older people improve their
balance and reduces their risk of
falling. After adding 62 new studies to
the pool of data, researchers say that
while some useful ideas are emerging,
there is still a need for high quality
evidence to determine which types of
exercise are the most effective.
By examining 94 studies that
involved a total of 9,917 participants,
researchers identified a list of different
types of exercises that had been
tested to improve balance.
Lead author Professor Tracey Howe,
who works in the School of Health and
Life Sciences at Glasgow Caledonian
University and is a Director of
Glasgow City of Science, said, 'The
information has helped to shed more
light on the different approaches to
exercise that have been undertaken in
studies to date.
The exercise programs identified
included one or more of the following
• exercise that targeted a person's
walking, balance and co-ordination;
• strengthening exercises;
• three-dimensional exercises,
including Tai Chi, dance and yoga;
• general physical activity such as
walking or cycling;
• computerised balance training that
uses visual feedback; and
• exercise involving vibrating
Prof Howe said, 'Although the duration
and frequency of these exercise
programs varied, in general the effective
programs ran three times a week for a
duration of three months and involved
exercises that challenged people's
balance while they were standing.
Interestingly we found that walking
and cycling generally do not improve
balance, although they have many other
The researchers found, however, that
much of the evidence was of poor
quality, and it was very difficult to
combine the results from different
pieces of work because of a lack of
consistency in the measurement
instruments used to test balance.
'If the research community identified
a core group of balance outcomes that
were used in all future studies, we
would be in a much stronger position to
combine individual studies and better
understand which type of exercise is
the most effective to improve balance,
Prof Howe said.
Full citation: Howe TE, Rochester L, Neil
F, et al. Exercise for improving balance
in older people. Cochrane Database of
Systematic Reviews 2011, Issue 11. Art.
No.: CD004963. DOI: 10.1002/14651858.
CD004963.pub3. On publication at:
Dancing their falls away
Foxtrot, salsa, rumba! Twice-weekly
ballroom dancing classes for senior
citizens could bring back the balance
and strength needed to prevent falls
in elderly Australians, according to
University of Sydney researchers.
A multi-centre project titled The
effectiveness of social dancing as a
strategy to prevent falls in older people:
a cluster randomised controlled trial,
has been funded by the National Health
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