Gender Perspective on Older People’s Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study

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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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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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/v2 ◽

2020 ◽

Cited By ~ 1

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.

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Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults: study protocol for the Safe Step randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-036194 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036194 ◽

Cited By ~ 1

Author(s):

Beatrice Pettersson ◽

Lillemor Lundin-Olsson ◽

Dawn A Skelton ◽

Per Liv ◽

Magnus Zingmark ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Exercise Intervention ◽

Controlled Trial ◽

Exercise Programme ◽

Community Dwelling ◽

Falls Prevention ◽

Ethical Review ◽

Exercise Interventions ◽

Educational Videos ◽

Randomised Controlled

IntroductionExercise interventions have a strong evidence base for falls prevention. However, exercise can be challenging to implement and often has limited reach and poor adherence. Digital technology provides opportunities for both increased access to the intervention and support over time. Further knowledge needs to be gained regarding the effectiveness of completely self-managed digital exercise interventions. The main objective of this study is to compare the effectiveness of a self-managed digital exercise programme, Safe Step, in combination with monthly educational videos with educational videos alone, on falls over 1 year in older community-dwelling adults.Methods and analysisA two-arm parallel randomised controlled trial will be conducted with at least 1400 community-living older adults (70+ years) who experience impaired balance. Participants will be recruited throughout Sweden with enrolment through the project website. They will be randomly allocated to either the Safe Step exercise programme with additional monthly educational videos about healthy ageing and fall prevention, or the monthly education videos alone. Participants receiving the exercise intervention will be asked to exercise at home for at least 30 min, 3 times/week with support of the Safe Step application. The primary outcome will be rate of falls (fall per person year). Participants will keep a fall calendar and report falls at the end of each month through a digital questionnaire. Further assessments of secondary outcomes will be made through self-reported questionnaires and a self-test of 30 s chair stand test at baseline and 3, 6, 9 and 12 months after study start. Data will be analysed according to the intention-to-treat principle.Ethics and disseminationEthical approval was obtained by The Regional Ethical Review Board in Umeå (Dnr 2018/433-31). Findings will be disseminated through the project web-site, peer-reviewed journals, national and international conferences and through senior citizen organisations’ newsletters.Trial registration numberNCT03963570.

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EXPERIENCES AND FACILITATORS OF FALLS PREVENTION AMONG ETHNICALLY DIVERSE OLDER ADULTS: A QUALITATIVE STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.3142 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S854-S854

Author(s):

Ladda Thiamwong ◽

Norma E Conner

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Fall Risk ◽

Fear Of Falling ◽

Ethnically Diverse ◽

Role Identity ◽

Community Dwelling ◽

Falls Prevention ◽

Facilitators And Barriers ◽

And Behaviors

Abstract Background: Falls increase as people age and decrease the quality of life. Even though fall interventions have received great attention, fall incidence rates have still arisen. In order for older adults to reap the benefits of evidence-based fall interventions, a challenge of implementation in the real world and right context must be met. Understanding experiences, facilitators, and barriers of fall prevention among four major ethnic groups in the Unites States could be extremely valuable. Objective: The aim of this study was to describe experiences and highlight facilitators and barriers on fall and fear of falling interventions among ethnically diverse community-dwelling older adults. Methods: Four ethnically specified (African American, Asian, Hispanic and Non-Hispanic White) focus groups were conducted. A total of 28 older adults and four family caregivers were interviewed. Interviews covered experiences on falls and fear of falling, attitudes, factors, consequences, risk assessment, and interventions. Data were organized and analyzed with the NViVo software. Results: Falls related experiences and behaviors were multifaceted and varied. Three themes related to falls experiences and behaviors were identified, 1) falls prevention versus fear of falling amplification; 2) role identity, culture and family considerations; and 3) take care of you, take care of me. Facilitators of fall prevention were integration of individual learning within a group meeting, providing appropriate assistive devices and promoting environmental safety. Barriers were inconsistent fall risk assessments, low fall risk awareness and acknowledgment, and balance and visual impairment.

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Development and Process Evaluation of a 5-Week Exercise Program to Prevent Falls in People after Stroke: The FALLS Program

Stroke Research and Treatment ◽

10.1155/2012/407693 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

H. J. R. van Duijnhoven ◽

D. De Kam ◽

W. Hellebrand ◽

E. Smulders ◽

A. C. H. Geurts ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Clinical Practice ◽

Process Evaluation ◽

Fall Prevention ◽

Health Care Professionals ◽

Exercise Program ◽

Community Dwelling ◽

Falls Prevention ◽

Common Complication

Falls are a common complication after stroke, with balance and gait deficits being the most important risk factors. Taking into account the specific needs and capacities of people with stroke, we developed the FALLS program (FALL prevention after Stroke), based on the “Nijmegen falls prevention program” (a proven-effective 5-week exercise program designed for community-dwelling elderly people). The program was tested in twelve community-dwelling persons with stroke, and a process evaluation was conducted with patients, trainers, health care professionals, and managers. The FALLS program was considered suitable and feasible by people with stroke in the study and relevant health care professionals, and recommendations for implementation in clinical practice have been suggested.

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111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions

Age and Ageing ◽

10.1093/ageing/afz164.111 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Pey June Tan ◽

Silvia Sim ◽

Noor Hafizah Ismail ◽

Jagadish Mallya ◽

Angelique Chan ◽

...

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Fall Risk ◽

Help Seeking ◽

Fear Of Falling ◽

Community Dwelling ◽

Falls Prevention ◽

Risk Level ◽

Prevention Interventions ◽

Aware Group

Abstract Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls. Results Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education. Discussion Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.

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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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‘We got more than we expected.’ Older people’s experiences of falls-prevention exercise interventions and implications for practice; a qualitative study

Primary Health Care Research & Development ◽

10.1017/s1463423619000379 ◽

2019 ◽

Vol 20 ◽

Author(s):

Natasher Lafond ◽

Asiya Maula ◽

Steve Iliffe ◽

Kavita Vedhara ◽

Sarah Audsley ◽

...

Keyword(s):

Older Adults ◽

Fear Of Falling ◽

Controlled Trial ◽

Well Being ◽

Target Population ◽

Exercise Programme ◽

Falls Prevention ◽

Exercise Interventions ◽

Exercise Programmes ◽

Randomised Controlled

Abstract Aim: To explore the experiences of older adults participating in strength and balance exercise programmes and understand participants’ rationale for programme uptake and completion. Background: Regular physical activity, specifically strength and balance exercises, has been shown to improve health and well-being and reduce the risk of falling in older adults. With the number of people living into older age increasing, understanding older people’s experiences of strength and balance programmes and what encourages their take-up and completion is extremely important. This paper reports on the qualitative experiences of older adults that previously participated in ProAct65+, a randomised controlled trial of Falls Management Exercise (FaME) programme and Otago Exercise Programme (OEP) versus usual care. Methods: Ten general practices in Nottinghamshire and Derbyshire, England, who participated in the ProAct65+ trial were approached to take part. Using maximum variation sampling (age, gender, falls history, fear of falling and trial arm) we recruited, via the practices, 30 people that had participated in the FaME (n = 15) or OEP (n = 15) trial arms. Participants were interviewed in their own homes. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings: We identified five themes: choice of exercise programme; commitment, discipline and motivation; benchmarking, feedback and monitoring; benefits of the exercise programmes and reactions to the end of the programmes. There were four sub-themes within the benefits theme: pleasure and boredom, social interaction and isolation, physical benefits, and knowledge and understanding. This study has outlined the experiences and identified specific barriers and facilitators to uptake and completion of falls-prevention exercises by older adults. The perspective and experiences of these participants is important if programmes are to be designed to meet the needs of the target population. Insights from this study will enable commissioners to develop and provide appropriate falls-prevention exercise programmes that encourage high uptake and programme completion.

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