What Cardiopulmonary Rehabilitation Professionals Should Know About Fall and Fracture Prevention: A Narrative Review

PURPOSE: Fractures due to osteoporosis are common. Cardiovascular disease and osteoporosis share common risk factors (eg, age, smoking, high alcohol intake, diabetes). Some interventions used to treat cardiovascular disease or related risk factors could increase bone loss or fracture risk (eg, medications that increase fall risk, bariatric surgery-related weight loss). Thus, health care professionals delivering cardiopulmonary rehabilitation would benefit from understanding how to prevent falls and fractures. REVIEW METHODS: This narrative review will provide an overview of the evidence from clinical trials, meta-analyses, and guidelines related to exercise for fracture prevention and will provide practical tips for cardiopulmonary rehabilitation professionals on how to integrate fall and fracture prevention into assessment, education, and exercise prescription. SUMMARY: The cardiopulmonary rehabilitation setting represents an opportunity to identify people at risk of fragility fractures and implement strategies to reduce the risk of falls and fractures. Screen for fall and fracture risk using available guidelines, tools, and algorithms so that you can modify your approach to assessment and exercise prescription. Be aware of medications or comorbid health conditions that may increase fall and fracture risk. Emphasize the importance of resistance training for overall health and maintaining or increasing muscle and bone strength. There is very strong evidence that multicomponent exercise interventions that include balance and functional training can prevent falls, so recommend balance training exercises for all older adults. Take steps to tailor assessment and exercise prescription to minimize falls and fractures during cardiopulmonary rehabilitation sessions, and maximize improvements in balance, bone strength, and physical functioning.