Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial
Abstract Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-04-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-022-03050-2 |
| _version_ | 1828262443023859712 |
|---|---|
| author | Amanda Bates Susan Furber Cathie Sherrington Paul van den Dolder Karen Ginn Adrian Bauman Kirsten Howard Michelle Kershaw Lisa Franco Cathy Chittenden Anne Tiedemann |
| author_facet | Amanda Bates Susan Furber Cathie Sherrington Paul van den Dolder Karen Ginn Adrian Bauman Kirsten Howard Michelle Kershaw Lisa Franco Cathy Chittenden Anne Tiedemann |
| author_sort | Amanda Bates |
| collection | DOAJ |
| description | Abstract Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits by health professionals can prevent falls however this strategy would be costly to deliver at scale. We developed a new approach to teach home exercise through group-based workshops delivered by physiotherapists. The primary aim was to determine the effect of this approach on the rate of falls among older community-dwelling people over 12 months. Secondary outcomes included the proportion of people falling, fear of falling, physical activity, lower limb strength, balance and quality of life. Methods A randomised controlled trial was conducted among community-dwelling people aged ≥65 in New South Wales, Australia. Participants were randomised to either the intervention group (exercise targeting balance and lower limb strength) or control group (exercise targeting upper limb strength). Results A total of 617 participants (mean age 73 years, +SD 6, 64% female) were randomly assigned to the intervention group (n = 307) or control group (n = 310). There was no significant between-group difference in the rate of falls (IRR 0.91, 95% CI 0.64 to 1.29, n = 579, p = 0.604) or the number of participants reporting one or more falls (IRR 0.99, 95% CI 0.76 to 1.29, n = 579, p = 0.946) during 12 month follow-up. A significant improvement in the intervention group compared to control group was found for fear of falling at 3, 6 and 12 months (mean difference 0.50, 95% CI 0.2 to 0.8, p = 0.004; 0.39, 95% CI 0.001 to 0.8, p = 0.049; 0.46, 95% CI 0.006 to 0.9, p = 0.047, respectively), and gait speed at 3 months (mean difference 0.09 s, 95% CI 0.003 to 0.19, p = 0.043). No statistically significant between-group differences were detected for the other secondary outcomes. Conclusions There was no significant intervention impact on the rate of falls, but the program significantly reduced fear of falling and improved gait speed. Other exercise delivery approaches are needed to ensure an adequate intensity of balance and strength challenge and dose of exercise to prevent falls. |
| first_indexed | 2024-04-13T03:54:47Z |
| format | Article |
| id | doaj.art-a3b6d95150844d45afb9b3cfbe92dd41 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-13T03:54:47Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-a3b6d95150844d45afb9b3cfbe92dd412022-12-22T03:03:40ZengBMCBMC Geriatrics1471-23182022-04-0122111310.1186/s12877-022-03050-2Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trialAmanda Bates0Susan Furber1Cathie Sherrington2Paul van den Dolder3Karen Ginn4Adrian Bauman5Kirsten Howard6Michelle Kershaw7Lisa Franco8Cathy Chittenden9Anne Tiedemann10Health Promotion Service, Illawarra Shoalhaven Local Health DistrictHealth Promotion Service, Illawarra Shoalhaven Local Health DistrictInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health DistrictPrimary Care and Community Health, Nepean Blue Mountains Local Health DistrictSchool of Medical Sciences, Faculty of Medicine and Health, The University of SydneySchool of Public Health, Faculty of Medicine and Health, The University of SydneySchool of Public Health, Faculty of Medicine and Health, The University of SydneyHealth Promotion Service, Illawarra Shoalhaven Local Health DistrictHealth Promotion Service, Illawarra Shoalhaven Local Health DistrictDepartment of Physiotherapy, Illawarra Shoalhaven Local Health DistrictInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health DistrictAbstract Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits by health professionals can prevent falls however this strategy would be costly to deliver at scale. We developed a new approach to teach home exercise through group-based workshops delivered by physiotherapists. The primary aim was to determine the effect of this approach on the rate of falls among older community-dwelling people over 12 months. Secondary outcomes included the proportion of people falling, fear of falling, physical activity, lower limb strength, balance and quality of life. Methods A randomised controlled trial was conducted among community-dwelling people aged ≥65 in New South Wales, Australia. Participants were randomised to either the intervention group (exercise targeting balance and lower limb strength) or control group (exercise targeting upper limb strength). Results A total of 617 participants (mean age 73 years, +SD 6, 64% female) were randomly assigned to the intervention group (n = 307) or control group (n = 310). There was no significant between-group difference in the rate of falls (IRR 0.91, 95% CI 0.64 to 1.29, n = 579, p = 0.604) or the number of participants reporting one or more falls (IRR 0.99, 95% CI 0.76 to 1.29, n = 579, p = 0.946) during 12 month follow-up. A significant improvement in the intervention group compared to control group was found for fear of falling at 3, 6 and 12 months (mean difference 0.50, 95% CI 0.2 to 0.8, p = 0.004; 0.39, 95% CI 0.001 to 0.8, p = 0.049; 0.46, 95% CI 0.006 to 0.9, p = 0.047, respectively), and gait speed at 3 months (mean difference 0.09 s, 95% CI 0.003 to 0.19, p = 0.043). No statistically significant between-group differences were detected for the other secondary outcomes. Conclusions There was no significant intervention impact on the rate of falls, but the program significantly reduced fear of falling and improved gait speed. Other exercise delivery approaches are needed to ensure an adequate intensity of balance and strength challenge and dose of exercise to prevent falls.https://doi.org/10.1186/s12877-022-03050-2Accidental fallsAgedExerciseFalls preventionRandomised controlled trial |
| spellingShingle | Amanda Bates Susan Furber Cathie Sherrington Paul van den Dolder Karen Ginn Adrian Bauman Kirsten Howard Michelle Kershaw Lisa Franco Cathy Chittenden Anne Tiedemann Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial BMC Geriatrics Accidental falls Aged Exercise Falls prevention Randomised controlled trial |
| title | Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial |
| title_full | Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial |
| title_fullStr | Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial |
| title_full_unstemmed | Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial |
| title_short | Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial |
| title_sort | effectiveness of workshops to teach a home based exercise program best at home for preventing falls in community dwelling people aged 65 years and over a pragmatic randomised controlled trial |
| topic | Accidental falls Aged Exercise Falls prevention Randomised controlled trial |
| url | https://doi.org/10.1186/s12877-022-03050-2 |
| work_keys_str_mv | AT amandabates effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT susanfurber effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT cathiesherrington effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT paulvandendolder effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT karenginn effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT adrianbauman effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT kirstenhoward effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT michellekershaw effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT lisafranco effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT cathychittenden effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial AT annetiedemann effectivenessofworkshopstoteachahomebasedexerciseprogrambestathomeforpreventingfallsincommunitydwellingpeopleaged65yearsandoverapragmaticrandomisedcontrolledtrial |