Abstract
BackgroundFalls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour.MethodsCross-sectional study of 1680 men aged 71–92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days.ResultsAmong the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties.ConclusionsFalls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity.
Highlights
Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences
moderate to vigorous physical activity (MVPA) had an excess of zero counts so was transformed, but patterns of results did not differ from analyses using untransformed data, so the latter are presented for ease of interpretation
We found that lower quality of life, lower exercise self-efficacy, leaving the house on fewer days, and, to a lesser extent, mobility difficulties outdoors and lower expectations of benefits of exercise were potential mediators between falls or Fear of falling (FOF) and activity levels
Summary
Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. In the UK only 9% of men and 6% of women over 75 years [1] report achieving recommended levels of moderate to vigorous physical activity (MVPA) of 150 minutes per week [2,3] These low PA levels have deleterious effects on a wide range of health outcomes [4]. The lower activity levels may in turn decrease strength and balance and initiate a downward cycle towards losing independence and entering long-term care
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