# Falls among Older Adults: Screening, Identification, Rehabilitation, and Management
## 6 Rehabilitation and Management
### Physical Exercise  
Physical exercise is one of the primary rehabilitation modalities after falls, as it consistently reduces the risk of falls [58]. Physical exercise programs can be conducted in groups or can be home-based. To have a consistent effect, it is necessary to perform the workout at least three hours per week [59]. The rehabilitation exercises aim to recover motor function that has been impaired due to a fall. In general, exercise is a safe activity even in older people. However, it is most important to assess any problematic medical condition before starting the treatment, in particular, any uncontrolled condition that may put the patient at risk, such as some heart diseases or diabetes. In addition, especially at the beginning of the rehabilitation program, it is essential to monitor the patient before, during, and after physical activity to assess for any worrisome changes in heart rate and blood pressure. Exercise can achieve several goals: recovery of muscle strength, balance, improving aerobic capacity, and improving motor control and flexibility (Table 3). \begin{table}
\begin{tabular}{c c} \hline
**Component** & **Benefit** \\ \hline \multirow{3}{*}{**Physical Exercise**} & reduces the risk of falls, recover muscle strength, balance, improving aerobic capacity, improving motor control and flexibility, can be conducted in groups or home-based, improve several other conditions as well as global health improve health, balance control, physical function, mobility, cognition, more detailed and personalized program, quality of life improvement, can potentially be performed as home exercise \\  & enhance adherence and motivation to exercise, improve balance, group activities-based are effective in reducing social isolation and loneliness, potentially reduce Fear of Falling \\ \hline \end{tabular}
\end{table} 
Table 2: Examples of key rehabilitation intervention modalities. \begin{table}
\begin{tabular}{c c} \hline
**Type of Exercise Intervention** & **Description** \\ \hline \multirow{4}{*}{**Resistance training**} & 3 sets of 8 repetitions, starting with a minimum intensity and progressing increase to the maximum, for 3 times a week. \\  & Patient’s body can be used for resistance in exercises that simulate daily activities (such as the “sit to stand” exercise”). \\  & Walking with changes in pace and direction, stair climbing, tapis-roulant walking, stationary cycling. \\  & Tandem foot standing, multidirectional weight lifts, line walking, heel-toe walking, stepping practice, standing on one leg, weight transfer (from one leg to the other), Tai Chi exercises. \\  & Exercises based on balance, flexibility, reaction speed, coordination, resistance and endurance. \\ \hline \end{tabular}
\end{table} 
Table 3: Exercise interventions for the prevention of falls among older adults. Sarcopenia is a well-known phenomenon in older people; it contributes to the worsening of neuromuscular function associated with age [9; 60] and can be a potential limitation to the rehabilitation program. Exercises designed to improve muscle strength, both aerobic and endurance, and balance exercises improve stability. Some of these programs, referred to as functional exercises, use combinations to replicate everyday life activities [61]. In particular, strength and balance exercises were studied in the LiFE Study, from which the LiFE Program was created, as an alternative modality to traditional exercises for fall prevention [61]. A prerequisite of the LiFE program is the identification of selected and patient-tailored exercises that integrate with the patient's daily routine. LiFE program exercises are performed whenever the opportunity arises during the day, rather than at predetermined times during the week. It is still unclear whether one type of exercise is superior to another, so the choice is made on clinician decision and patient preference.