Is complex obstacle negotiation exercise more effective than other exercise interventions in fall prevention?

Background. Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim. To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods. Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results. Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion. Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women’s and men’s preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

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Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

10.21203/rs.2.12118/v3 ◽

2020 ◽

Author(s):

Linda Mansson ◽

Lillemor Lundin-Olsson ◽

Dawn A Skelton ◽

Rebecka Janols ◽

Helena Lindgren ◽

...

Keyword(s):

Fall Prevention ◽

Exercise Duration ◽

Community Dwelling ◽

Falls Prevention ◽

Attrition Rate ◽

Home Exercise ◽

Intervention Period ◽

Exercise Interventions ◽

Significant Difference ◽

Exercise Programmes

Abstract Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet.Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.Results: Sixty-seven participants, with mean age 77±4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p=.078). In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p=.001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p=.026) degree of being content, and feeling supported by the programme (p=.044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p=.036).Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.Trial registration: ClinTrial: NCT02916849

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The effect of eHealth-based falls prevention programmes on balance in people aged 65 years and over living in the community: protocol for a systematic review of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2019-031200 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031200

Author(s):

Meghan Ambrens ◽

Anne Tiedemann ◽

Kim Delbaere ◽

Stephanie Alley ◽

Corneel Vandelanotte

Keyword(s):

Systematic Review ◽

Fall Prevention ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Community Dwelling ◽

Controlled Trials ◽

Exercise Interventions ◽

Prevention Interventions ◽

Randomised Controlled ◽

Community Dwellers

IntroductionBetween 20% and 28% of community-dwelling older people experience a fall each year. Falls can result in significant personal and socioeconomic costs, and are the leading cause of admission to hospital for an older person in Australia. Exercise interventions that target balance are the most effective for preventing falls in community-dwellers; however, greater accessibility of effective programmes is needed. As technology has become more accessible, its use as a tool for supporting and promoting health and well-being of individuals has been explored. Little is known about the effectiveness of eHealth technologies to deliver fall prevention interventions. This protocol describes a systematic review with meta-analysis that aims to evaluate the effect of eHealth fall prevention interventions compared with usual care control on balance in people aged 65 years and older living in the community.Methods and analysisWe will perform a systematic search of the following electronic databases: MEDLINE, CINAHL Complete, Embase and PsychINFO and citation search of Scopus, Web of Science, PubMed Central, Cochrane Database Central and PEDro for randomised controlled trials that use an eHealth technology to deliver a fall prevention intervention to community-dwellers aged ≥65 years, that are published in English, and include a balance outcome (primary outcome). The screening and selection of articles for review will be undertaken by two independent reviewers. The PEDro scale and Grading of Recommendations, Assessment, Development and Evaluations will be used to assess study quality. The results will be synthesised descriptively, and if sufficient data are available and the studies are not overly heterogeneous, a meta-analysis will be conducted using the random effects model.Ethics and disseminationAs this will be a systematic review, without involvement of human participants, there will be no requirement for ethical approval. The results of this systematic review will be disseminated through peer-reviewed publications, conference presentations and dissemination to policymakers and consumers to maximise health impact.PROSPERO registration numberCRD42018115098.

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Wearable Sensor-Based Exercise Biofeedback for Supporting Fall Prevention at Physiotherapy

European Journal of Public Health ◽

10.1093/eurpub/ckaa040.011 ◽

2020 ◽

Vol 30 (Supplement_2) ◽

Author(s):

A C Martins ◽

D Guia

Keyword(s):

Fall Prevention ◽

Inertial Sensors ◽

Pressure Sensors ◽

Exercise Program ◽

Prevention Programs ◽

Falls Prevention ◽

Technological Solution ◽

Exercise Interventions ◽

Biofeedback System ◽

Shifting Balance

Abstract Introduction Exercise interventions focused on strength and balance are effective for falls prevention in older people. Several fall prevention programs were developed with this intent, however there is often a lack of personalization in these solutions. Technological interventions namely biofeedback systems have been shown recently to have the ability to objectively assess therapeutic exercise in real time to improve quality performance. Objectives To describe a technological solution with biofeedback system to be used by physiotherapists at the clinic, to assist the learning process of a personalized and progressive strength and balance exercise program. Methodology The exercises are monitored by two wearable inertial sensors and a pressure platform for mobility, strength and balance measurements. In order to validate the system, a set of five exercises, from the Otago Exercise Program, were tested with a group of 16 older adults during several sessions. Spatial, temporal and balance metrics were extracted during the exercises, providing quantitative biofeedback during the exercise. Results Inertial and pressure sensors are suitable for exercise tracking during fall prevention exercises. Range of motion, weight distribution and shifting, balance and cycle identification were successfully monitored for all exercises. This system successfully automated the process of creating individualized and personalized exercise biofeedback systems to fall prevention programs. Conclusion This study demonstrates this technological solution holds promise in falls prevention. FallSensing Clinic is a feasible monitor and biofeedback tool that can be applied to clinical practice allowing people to better perform the exercise program.

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Fall Prevention in Adults With Cognitive Impairment: Systematic Review and Meta-Analysis

Innovation in Aging ◽

10.1093/geroni/igab046.2598 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 698-698

Author(s):

Megan Racey ◽

Maureen Markle-Reid ◽

Muhammad Usman Ali ◽

Hélène Gagné ◽

Susan Hunter ◽

...

Keyword(s):

Cognitive Impairment ◽

Fall Prevention ◽

Perceived Risk ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Exercise Interventions ◽

Moderate Cognitive Impairment ◽

Prevention Interventions ◽

Risk Of Falls

Abstract Cognitive impairment increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and there is a lack of evidence for effective fall prevention interventions for community-dwelling cognitively impaired adults. We conducted a systematic review and meta-analysis to investigate the effectiveness of fall prevention interventions in improving falls, perceived risk of falls, gait, balance, and functional mobility. We searched 7 databases for interventions involving community-dwelling adults ≥50 years with mild to moderate cognitive impairment. Reviewers screened citations, extracted data, assessed risk of bias and certainty of evidence (GRADE). We performed a meta-analysis of 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate cognitive impairment from 12 randomized controlled trails (8 exercise interventions, 3 multifactorial, and 1 providing medication). Interventions had medium significant effects on perceived risk of falls (SMD -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and timed up and go test (SMD -0.56 [-0.94, -0.17]) and small significant effects on gait speed and control (SMD 0.26 [0.08, 0.43]) with moderate certainty of evidence. There were no significant effects for falls. Sub-analysis showed that exercise and studies at low risk of bias remained significant for balance and perceived risk of falls. The effect of fall prevention interventions on falls remains unclear; exercise interventions are effective at addressing fall risk factors. However, high quality and longer studies with adequate sample sizes are needed to determine their effectiveness on falls.

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Older adults preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

10.21203/rs.2.12118/v1 ◽

2019 ◽

Author(s):

Linda Mansson ◽

Lillemor Lundin-Olsson ◽

Dawn A Skelton ◽

Rebecka Janols ◽

Helena Lindgren ◽

...

Keyword(s):

Fall Prevention ◽

Exercise Programme ◽

Community Dwelling ◽

Falls Prevention ◽

Attrition Rate ◽

Home Exercise ◽

Intervention Period ◽

Exercise Interventions ◽

Significant Difference ◽

Exercise Programmes

Abstract Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach to a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet. Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start at the introduction meeting, including a short introduction of the exercise programme, a short physical assessment and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences as well as post-assessments were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start. Results: Sixty-seven participants, with a mean age of 77±4 years were included, 72% were women, and 43% chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group. In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p=.001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p=.026) degree of being content, and feeling supported by the programme (p=.044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p=.036). Conclusions: This study showed that both the digital and paper programme could be used as a self-managed, independent fall prevention exercise programme. The digital programme seems to facilitate long-term maintenance in regular exercise.

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Fall Prevention in Community-Dwelling Adults with Mild to Moderate Cognitive Impairment: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-690152/v1 ◽

2021 ◽

Author(s):

Megan Racey ◽

Maureen Markle-Reid ◽

Donna Fitzpatrick-Lewis ◽

Muhammad Usman Ali ◽

Hélène Gagné ◽

...

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Fear Of Falling ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Functional Mobility ◽

Exercise Interventions ◽

Prevention Interventions ◽

Risk Of Falls

Abstract Background: Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods: We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.Results: 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [-0.94, -0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.Conclusion: The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

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Applying the RE-AIM implementation framework to evaluate fall prevention interventions in community dwelling adults with cognitive impairment: a review and secondary analysis

BMC Geriatrics ◽

10.1186/s12877-021-02376-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Racey ◽

M. Markle-Reid ◽

D. Fitzpatrick-Lewis ◽

M. U. Ali ◽

H. Gagné ◽

...

Keyword(s):

Cognitive Impairment ◽

Fall Prevention ◽

Feasibility Studies ◽

Community Dwelling ◽

Future Research ◽

Successful Implementation ◽

Limited Information ◽

Implementation Framework ◽

Exercise Interventions ◽

Prevention Interventions

Abstract Background Cognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment, very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation. Methods We examined the included studies from our systematic review, which searched 7 databases for primary and secondary fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework. Results Twelve randomized or clinical controlled trials (RCTs/CCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and 3 of these studies self-identified as “feasibility” studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authors. Conclusion Based on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully inform future research efforts.

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A Digital Health Fall Prevention Program for Older Adults: Feasibility Study (Preprint)

10.2196/preprints.30558 ◽

2021 ◽

Author(s):

Claire L Jacobson ◽

Lauren C Foster ◽

Hari Arul ◽

Amanda Rees ◽

Randall S Stafford

Keyword(s):

Older Adults ◽

Feasibility Study ◽

Fall Prevention ◽

Prevention Program ◽

Digital Health ◽

Fall Rate ◽

Exercise Interventions ◽

Fall Prevention Program ◽

Ratio Change

BACKGROUND About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. OBJECTIVE We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. METHODS Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. RESULTS The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. CONCLUSIONS The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults.

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