Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT) (original) (raw)
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BMC geriatrics, 2017
This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT). A complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls. Community-dwelling adults, aged 70 years and older, were recruited from primary care in the National Health Service (NHS), England. Development of the PreFIT MFFP intervention was informed by the existing evidence base and clinical guidelines for the assessment and management of falls in older adults. After piloting and modification, the final MFFP intervention includes seven falls risk factors: a detailed falls history interview wit...
Practical implementation of an exercise-based falls prevention programme
Muscle weakness and impaired balance are risk factors underlying many falls and fall injuries experienced by older people. Fall prevention strategies have included exercise programmes that lower the risk of falling by improving strength and balance. We have developed an individually tailored, home-based, strength and balance retraining programme, which has proven successful in reducing falls and moderate fall injuries in people aged 80 years and older. Here we describe a simple assessment of strength and balance and the content and delivery of a falls prevention exercise programme.
Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis
Journal of the American Geriatrics Society, 2000
OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included. SETTING: Older people. PARTICIPANTS: General community and residential care. MEASUREMENTS: Fall rates. RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR) 5 0.83, 95% confidence interval (CI) 5 0.75-0.91, Po.001, I 2 5 62%). The greatest relative effects of exercise on fall rates (RR 5 0.58, 95% CI 5 0.48-0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (450 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program. CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.
Contemporary Clinical Trials, 2018
Approximately one-third of older adults fall each year and fall-related injuries are a leading cause of death and disability among this rapidly expanding age group. Despite the availability of bisphosphonates to reduce fractures, concerns over side effects have dramatically reduced use, suggesting that other treatment options are needed. Though many smaller studies have shown that physical activity programs can reduce falls, no study has been adequately powered to detect a reduction in fall-related injuries. We present the design of a three-year randomized controlled clinical trial of 1130 adults age 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The main aim is to determine the impact of a community-based multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers (or delivered via DVD) and accompanied by coaching and oversight, by telephone and in-person, by a fitness professional. The main outcome measure is serious fall-related injuries. Secondary outcomes include health care utilization, bone and muscle mass, loneliness, health-related quality of life and mood. The study represents the first large clinical trial of a comprehensive physical activity program to reduce secondary injuries among patients with a history of fragility fracture.
Journal of General Internal Medicine, 2021
BackgroundFalls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare.ObjectiveTherefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling.Design and SettingIn the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156).Intervention and MeasurementsPatients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls ove...
2021
The Finnish population is rapidly aging. It is estimated that by 2050 the number of Finnish citizens over 65 years old will represent about 30% of the whole population. Aging is related to a progressive decrease in overall physiological component including muscle strength. Moreover, this loss of lower extremities strength is considered to lead to a higher risk of falls among elderly. The rate of falls, fall-related injuries, and fall-associated costs continue to increase along with the rise of the aging population. Community-based fall prevention interventions for the elderly are surging, in an attempt to address this health burden. Prevention strategies vary widely in their aim, ranging from single intervention program to comprehensive multifactorial strategies among groups of community-dwelling elderly adults. The purpose of this Bachelor thesis was to develop an evidence-based training program for elderly with focus on balance. The main research question of this thesis was “How a Multicomponent Physical Exercise Program (MPEP) can affect fall-related physical performance including balance, muscle strength and gait in older people?” The aim of this study was also to raise awareness about the existence of fall among elderly in the community of Satakunta, and the potential positive impact that physical activity can have in order to prevent these events. In addition, the whole project can function as a beneficial tool for the authors of this thesis in their future working life as physiotherapist. Seven community living residents of the Satakunta region in Finland (mean age = 68 years old) with specific fall risk factors (i.e., fear of falling, history of falls or impaired gait or balance) were assigned to a 10 weeks group exercise program (n=20). The 60-minutes exercise sessions were held twice a week, Monday and Friday from 8th of June to 17th August 2020 focused on increasing strength and balance. The outcome measurements included three physical performance tests, namely: the Timed up and Go Test, the 30 Seconds Chair Stand Test and the 4 Stage Balance Test. The aim was to assess Gait Speed, Strength and Balance among the participants. Exercisers showed postintervention improvement in measurements of gait speed by 16,1%, lower limb strength by 19,6% and static balance by 23%. The authors realized that a MPEP can affect fall-related physical performance such as strength in lower limb and balance with this sample of people. The data collected do also reinforce the notion that a MPEP is a safe and effective way to increase physiological components such muscle strength in this population. This study provided an effective, evidence-based falls prevention program that can be implemented in community settings to improve physical fitness and might reduce fall risks among this sample group
Journal of Science and Medicine in Sport, 2011
Falls affect a significant number of older Australians and present a major challenge to health care providers and health systems. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription of exercise for older community-dwelling people with the goal of preventing falls. Falls in older people are not random events but can be predicted by assessing a number of risk factors. Of particular importance are lower limb muscle strength, gait and balance, all of which can be improved with appropriate exercise. There is now extensive evidence to demonstrate that many falls are preventable, with exercise playing a crucial role in prevention. Research evidence has identified that programs which include exercises that challenge balance are more effective in preventing falls than those which do not challenge balance. It is important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Other (non-exercise) interventions are necessary for certain people with complex medical conditions or recent hospitalisation and risk factors relating to vision and the use of psychotropic medications. Qualified exercise professionals are well placed to implement the research evidence and to prescribe and supervise specific exercise aimed at preventing falls in both healthy older community-dwelling people and those with co-morbidities.
PLOS ONE, 2022
Background Falls and fall-related injuries in older adults are a leading cause of disability and death. Evidence has shown the benefits of exercises in improving functional outcomes and reducing fall rates among community-dwelling older adults. However, there is lack of effective community-based single exercise intervention for a broad population of older adults who are at high risk for falls. We aim to evaluate the effectiveness of Steady Feet (SF), a 6-month tailored community fall prevention exercise programme for improving functional outcomes. SF classes are facilitated by community fitness instructors and an exercise video. The main outcome is between-group changes in short physical performance battery (SPPB) scores. Secondary outcomes include balance confidence, fear of falling, quality of life, fall rates, and cost effectiveness. Methods We present the design of a 6-month randomised controlled trial of 260 older adults (� 60 years old). Individuals will be randomised in a 1:1 allocation ratio to the SF group or usual care group. Participants will be assessed at baseline, 3-month, and 6-month. Data on sociodemographics, co-morbidities, balance confidence, fear of falling, quality of life, physical activity level, rate of perceived exertion, fall(s) history, healthcare utilisation and cost, and satisfaction levels will be collected. Participants will also undergo functional assessments such as SPPB. Moreover, providers' satisfaction and feedback will be obtained at 3-month.
BMJ Open, 2016
Falls are the leading cause of accident-related mortality in older adults. Injurious falls are associated with functional decline, disability, healthcare utilisation and significant National Health Service (NHS)-related costs. The evidence base for multifactorial or exercise interventions reducing fractures in the general population is weak. This protocol describes a large-scale UK trial investigating the clinical and cost-effectiveness of alternative falls prevention interventions targeted at community dwelling older adults. A three-arm, pragmatic, cluster randomised controlled trial, conducted within primary care in England, UK. Sixty-three general practices will be randomised to deliver one of three falls prevention interventions: (1) advice only; (2) advice with exercise; or (3) advice with multifactorial falls prevention (MFFP). We aim to recruit over 9000 community-dwelling adults aged 70 and above. Practices randomised to deliver advice will mail out advice booklets. Practice...