Fall Prevention Exercise Research Articles

Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community-dwelling older people aged 70 and older

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 + . A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.

Analysis of the Effectiveness of a Fall Prevention Program Incorporating an Interprofessional Team Collaboration Model on Reducing Fall Risk in Elderly Living in Long-term Care Facilities

Concurrent with population ageing, falls have become a significantly more challenging public health issue among older adults. Three years of data collected recently from a nursing home in northern Taiwan reveals an increasing trend in fall density that is primarily associated with aging, physiological decline, chronic diseases, polypharmacy, osteoporosis, and lack of exercise. The percentage of nursing home residents at high risk of falls is currently at 12.6%, and the fall rate has been reported as reaching as high as 30% annually. A fall prevention program was implemented to reduce the fall incidence rate to 18%, with secondary goals of improving fall prevention awareness, behavior, self-efficacy, lower limb muscle strength, balance, and gait by 10% on average, respectively, between pre-test and post-test. From September 30, 2023 to February 29, 2024, a health promotion activity and fall prevention exercise course were implemented using an interdisciplinary team collaboration model over a six-week period, providing individualized exercise for the participants. The study included 20 older adults with an average age of 88 years. Most (90%; n = 18) had chronic diseases, 25% (n = 5) were on more than nine medications, 70% (n = 14) had reduced bone mass, and 40% (n = 8) were at high risk of falls, with a fall incidence rate of 30% during the immediately preceding year. Post-intervention, the fall incidence rate dropped to 5%, fall prevention awareness, behavior, and self-efficacy increased by 18.3%, and lower limb muscle strength, balance, and gait improved by 11.7%. The post-test results in fall prevention awareness, behavioral changes, self-efficacy, and lower limb strength, balance, and gait were all significantly better than pre-test results, with all results achieving statistical significance. The project results support the positive effects of the developed intervention effectively on elderly physical fitness and fall risk, providing valuable insights for the implementation of fall prevention strategies in nursing homes.

Understanding “Fear Of Falling” And How It Impacts Older Persons Motivation To Engage In Fall Prevention Exercise Interventions

Abstract Background Fear of falling can cause older persons to restrict their activities, which drives reduced strength and balance and increases their falls risk. Falls can have a significant effect on older persons in terms of loss of confidence, ongoing falls risk and ultimately, a poorer quality of life (Oliver et al, 2010). Fall prevention exercise interventions can help reduce the risk of falling in older adults by up to 34% (Sherrington et al, 2020). This study aims to explore the prevalence of fear of falling in older adults both before and after attending a community-based fall prevention exercise programme. The programme consisted of an evidence-based Physiotherapy led 10-week strength and balance class, followed by a 16-week exercise instructor led strength and balance class. Methods A 2-part qualitative study. Part 1: Prior to commencing the class each participant completed a rating of their fear of falling measured by ConfBal (a validated 10 item Balance Confidence scale). Part 2: Questionnaire assessing their experience of the classes and corresponding change in balance scores. Results 17 older adults completed the programme. Surveys were returned by 8/17 to date (47%). Mean pre-intervention ConfBal score of 20, mean post intervention score of 15 (8/17 participants to date), average 4-point improvement after intervention was statistically significant (p=0.008). Reported benefits of falls prevention exercise classes include peer-peer discussion of functional ability, gaining confidence by exercising in a group environment, practising functional exercises relating to day-to-day tasks, and building social relationships. Conclusion Fear of falling amongst community dwelling older adults is common but group exercise improves confidence as well as boosting social interactions. Participation in fall prevention exercise programmes can help to better support older people as they age which may influence better health outcomes in our communities.

Exercise for fall prevention in older adults

Background: Global population aging has significantly increased fall-related incidents among older adults, which is associated with major health risks and challenges for healthcare systems. Falls are a leading cause of injury, disability, and mortality in South Korea, which has shown rapid expansion of the elderly population. Development of effective fall-prevention strategies, including exercise-based interventions is important to address this issue.Current Concepts: Exercise-based fall prevention programs include several key types such as strength and functional movement training and balance exercises. Strength training includes resistance exercises and weightbearing activities to enhance muscle strength, which is essential for stability and fall prevention. Balance exercises improve stability and coordination, including standing on one leg and heel-to-toe walking. Functional movement training includes exercises that simulate daily activities and help individuals to improve their ability to safely perform routine tasks. Programs such as the Otago Exercise Program integrate these elements and offer a comprehensive approach to fall prevention. Such regimens combined with training in safe falling techniques are important to reduce fall risk and improve outcomes. Assessment tools, including the timed up-and-go and senior fitness tests, are useful to identify at-risk individuals and tailor interventions accordingly.Discussion and Conclusion: An effective fall prevention exercise program requires a multifaceted approach that combines various exercise types and focuses on improving muscle strength, balance, flexibility, and functional skills, as well as safe falling and floor recovery techniques. Tailoring these interventions to individual needs and regular risk assessments can enhance their usefulness.

Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community

BackgroundsFalls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. ObjectivesThis statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. Exercise prescription to prevent fallsExercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SummaryGlobal guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.

Factors influencing older adult community fall prevention exercise implementation: a scoping review.

Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. Scoping review. We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

Expert recommendations for an online, fall-prevention exercise program for older adults

ABSTRACT Introduction Uptake of fall-prevention programs by older adults prior to the COVID-19 pandemic was low. We identified a pre-pandemic need to develop an online, fall-prevention exercise program for community-dwelling older adults. Purpose The purpose of this qualitative study was to obtain recommendations from experts on exercise for fall prevention, fall prevention, and online education to inform the development of an online, fall-prevention exercise program for community-dwelling adults aged 65 years and older. Methods Three virtual focus groups were held to obtain recommendations from: 1) exercise experts (n = 4) on design of an exercise program intended to reduce falls among community-dwelling older adults, 2) fall-prevention experts (n = 6) on key considerations for fall prevention and transitioning to an online fall-prevention program, and 3) online education experts (n = 5) on online technical/design considerations. Data were analyzed using directed content analysis. Results Collectively, the experts recommended designing an online program that: 1) contained strengthening, balance, and stretching exercises; 2) was beta tested in older adults; 3) replicated a group dynamic; 4) included an instructional designer; 5) provided tailored feedback to participants; 6) made exercises portable/accessible across devices; 7) offered computer training; 8) monitored safety and exercise performance; 9) included strategies to sustain participant behavior; and 10) was delivered by health or fitness professionals. Conclusion This study generated expert recommendations to inform the development of an online, fall-prevention exercise program. Implementation of these recommendations has the potential to expand the reach of fall-prevention programs and protect the health and safety of older adults in a post-COVID-19 world.

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

The Use of Novel Instrumented Socks to Detect Changes in Daily Life Mobility During an Exercise Intervention in Prostate Cancer Survivors Treated with Androgen Deprivation Therapy

ObjectivesTo describe changes in daily life mobility in prostate cancer survivors treated with androgen deprivation therapy (ADT) after a 6-month exercise intervention using novel instrumented socks and to identify characteristics of participants who exhibited changes in daily life mobility. MethodsA subset of participants in a fall prevention exercise trial completed objective tests and patient-reported surveys of physical functioning, and wore instrumented socks for up to 7 days to measure daily life mobility. Changes in cadence, double support proportion, and pitch angle of the foot at toe-off were selected as measures of daily life mobility previously found to be different in men exposed to ADT for prostate cancer versus controls. Daily life mobility was compared from baseline to 6 months using paired t-tests. Characteristics of responders who improved their daily life mobility were compared to nonresponders using two-sample t-tests, Chi-squared proportion tests, or Fisher's Exact Tests. ResultsOur sample included 35 prostate cancer survivors (mean age 71.6 ± 7.8 years). Mean cadence, double support proportion, and pitch angle at toe-off did not change significantly over 6 months of exercise, but 14 participants (40%) improved in at least two of three daily life mobility measures (“responders”). Responders were characterized by lower physical functioning, lower cadence in daily life, fewer comorbidities, and better social and mental/emotional functioning. ConclusionsCertain daily life mobility measures potentially impacted by ADT could be measured with instrumented socks and improved by exercise. Men who start with lower physical functioning and better social and mental/emotional functioning appear most likely to benefit, possibly because they have more to gain from exercise and are able to engage in a 6-month intervention. Implications for Nursing PracticeTechnology-based approaches could provide nurses with an objective measure of daily life mobility for patients with chronic illness and detect who is responding to rehabilitation.

Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls.MethodA preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall’s prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events.ResultsPreliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance.ConclusionIn conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability.(Registration number: ACTRN 12621001620819).

Technology and Care: Starting From Human-Centered Compassion

The rapid development of technology in recent years has not only transformed everyday life but also profoundly impacted the fields of healthcare and caregiving. Approaches to care that are technology-based and human-centered may be used to provide care services that are more efficient, accurate, and personalized and that, ultimately, improve our quality of life and overall health. First, intelligent health monitoring systems can generate customized health management plans based on individual health conditions and needs, allowing chronic diseases to be managed more effectively and helping prevent disease onset. Examples of these systems include smart medication dispensers (Gargioni et al., 2024) and fall prevention exercise apps for older adult patients (Czuber et al., 2024). Also, in clinical settings, especially in the context of monitoring patients in operating rooms and intensive care units, visualization technologies are using psychology and cognitive neuroscience principles to leverage human sensory perception to improve caregiver understanding of information. Patient data are presented using different shapes, colors, and animation frequencies, which are more effectively perceived, integrated, and interpreted than other formats (e.g., numbers). This helps healthcare professionals effectively perceive and identify potential medical issues, enhancing their situational awareness, helping them make better decisions, and improving patient safety (Gasciauskaite et al., 2023). In the field of rehabilitation, Krishnan et al. (2024) developed a wearable rehabilitation device to facilitate gait rehabilitation in post-stroke patients that exhibits better durability, modularity, and usability than previous technologies. In addition, for patients with upper limb impairments who experience varying degrees of ability loss in performing activities of daily living, robotic platforms have been introduced to facilitate intensive and repetitive exercises that strengthen motor skills and neuroplasticity (Bucchieri et al., 2023). In conclusion, human-centered technology care is a field ripe with potential that combines the power of technology with human-centered care to improve support and service capabilities. Articles in this issue explore the application of social robots in nursing practice, the applicability of smart technology in cardiac and elderly care, and the opportunities for next-generation smart care. We look forward to seeing more human-centered technology care solutions in the future that further promote health, well-being, and comprehensive social development.

Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review

ObjectiveThe effect of fall prevention exercise programmes in residential aged care (RAC) is uncertain. This paper reports on an intervention component analysis (ICA) of randomised controlled trials (RCTs), from an...

The benefits of Tai Chi practice on standing balance in older adults during COVID-19 pandemic

BackgroundTai Chi has been recommended as a fall prevention exercise for older adults and may be particularly beneficial during the coronavirus (COVID-19) pandemic. This study aimed to investigate the benefits of regular Tai Chi practice on standing balance among older adults living in a nursing home during COVID-19 restrictions. MethodsA cross-sectional study was conducted with 38 older adults from a nursing home during COVID-19 extended restrictions. Participants were assigned to a Tai Chi group (n = 18, with more than five years of Tai Chi experience) and a control group (n = 20, with no Tai Chi experience). Postural sway during standing balance was assessed under four conditions: eyes open (EO); eyes closed (EC); eyes open with the right leg crossed forward (ER); and eyes open with the left leg crossed forward (EL). Furthermore, participants completed questionnaires face-to-face regarding their physical activity (PA) and sleep quality during the COVID-19 period. ResultsThe Tai Chi group exhibited significantly less postural sway than the control group, particularly under EO and EL conditions (p < 0.05). Both groups had similar sleep quality but different PA profiles. ConclusionRegular Tai Chi practice may help maintain standing balance in older adults, even with limited outdoor mobility due to COVID-19 restrictions. Tai Chi could be an effective home-based exercise for preventing balance decline and potential falls among older adults living in nursing homes during the pandemic. Future studies should investigate the long-term effects of Tai Chi on fall prevention in this population.

Human-Centered Design and Development of a Fall Prevention Exercise App for Older Adults in Primary Care Settings.

Falls in older adults are a serious public health problem that can lead to reduced quality of life or death. Patients often do not receive fall prevention guidance from primary care providers (PCPs), despite evidence that falls can be prevented. Mobile health technologies may help to address this disparity and promote evidence-based fall prevention. Our main objective was to use human-centered design to develop a user-friendly, fall prevention exercise app using validated user requirements. The app features evidence-based behavior change strategies and exercise content to support older people initiating and adhering to a progressive fall prevention exercise program. We organized our multistage, iterative design process into three phases: gathering user requirements, usability evaluation, and refining app features. Our methods include focus groups, usability testing, and subject-matter expert meetings. Focus groups (total n = 6), usability testing (n = 30) including a posttest questionnaire [Health-ITUES score: mean (standard deviation [SD]) = 4.2 (0.9)], and subject-matter expert meetings demonstrate participant satisfaction with the app concept and design. Overall, participants saw value in receiving exercise prescriptions from the app that would be recommended by their PCP and reported satisfaction with the content of the app. This study demonstrates the development, refinement, and usability testing of a fall prevention exercise app and corresponding tools that PCPs may use to prescribe tailored exercise recommendations to their older patients as an evidence-based fall prevention strategy accessible in the context of busy clinical workflows.

Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model.

Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of "Steady Feet" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.

Comparison of Nonimmersive Virtual Reality and Task-Oriented Circuit Training on Gait, Balance, and Cognition Among Elderly Population: A Single-Blind Randomized Control Trial.

Purpose: The purpose of this study was to determine the effects of nonimmersive virtual reality (VR) and task-oriented circuit training on gait, balance, cognitive domains, and quality of life among the elderly population. Methods: This is a single-blind randomized control trial in which 28 elderly individuals between 60 and 75 years were selected. The participants were divided into two groups, task-oriented circuit training and the other receiving nonimmersive VR treatment, with 14 participants in each group. To analyze the effects of both training on balance and gait time up and go test (TUGT), dynamic gait index (DGI), measures were used and for cognitive domains Montreal cognitive assessment (MoCA) scale was used. Short form 12 (SF-12) (along with two domains, Physical Component Summary and Mental Component Summary) was used for the measurement of quality of life. The treatment duration was 8 weeks for both groups. Both the pre-test and post-test readings were analyzed and compared. Results: The mean age of participants was 66.91 ± 3.79 years. Within-group comparison between the pre-test and post-test indicated that significant differences (P < 0.05) existed in all the outcome measures (TUGT, DGI, MoCA, and SF-12) in both groups. However, between-group comparison, significant differences were only found in TUGT and DGI in nonimmersive VR group. Conclusion: This study concluded that both interventions nonimmersive VR and task-oriented circuit training were beneficial for improving balance, gait, quality of life, and cognitive domains like memory, attention spans, executive functions, and so on in elderly population. However nonimmersive virtual reality training is a more effective, feasible, and safe alternative and can be proposed as a form of fall prevention exercise for the older adults. ClinicalTrials.gov Identifier: NCT05021432.

Effects of a fall prevention exercise regimen on physical and psychosocial outcomes in elderly community dwellers: a randomized comparative study.

There is a need for comprehensive programs that address both the physical and psychosocial aspects of fall prevention for the elderly. This study assessed the efficacy of the exercise regimen on various health metrics for elderly community dwellers. Forty-four participants were divided into experimental and control groups. The experimental group adhered to a 9-step core exercise regimen for fall prevention, practicing three times a week for 30 minutes across 10 weeks, while the control group maintained their regular daily activities without any specific exercise program. Before and after the intervention, participants underwent the timed up-and-go t est to evaluate the physical function, the berg balance scale (BBS) and one-legged stance test (OLST) for balance assessment, the activity-specific balance confidence scale for fall-related self-efficacy, and measures for health-related quality of life. Participants in the experimental group showed significant improvements in physical function (p = .04, Cohen's effect size (d) = 0.2). and balance ability on BBS (p < .01, d = 0.2) and OLST (p < .01, d = 1.3) compared to the control group. Furthermore, there was a notable enhancement in the quality of life indicators for this group, especially in areas such as physical function (p = .04, d = 0.2), physical-role limitation (p = .04, d = 0.2), mental health (p = .01, d = 0.3), vitality (p = .02, d = 0.4), body pain (p = .04, d = 0.5), and general health (p = .04, d = 0.4). These findings highlight the potential of the fall prevention exercise program in improving physical health aspects, but its influence on specific psychosocial elements remains to be determined.

Trajectories of adherence to a falls prevention exercise intervention in Singapore: A mixed methods study

BackgroundThe success of falls prevention exercise intervention is dependent on adherence. This study investigated the trajectories of adherence to an instructor-led, face-to-face, community group-based falls-prevention exercise intervention, baseline factors associated with these trajectories, and the impact of these adherence trajectories on post-intervention physical functioning. Qualitative interviews were also examined to gather insights into participants’ profiles. MethodsAttendance data from 144 older adults who participated in a 12-week falls prevention exercise intervention were used to assess adherence. Physical functioning was assessed at baseline and post-intervention using Short Physical Performance Battery. We used Latent Class Growth Modelling to identify the types of adherence trajectories. Multinomial logistic regression and multivariate linear regression were used to examine antecedents and consequences associated with the adherence trajectories. Content and cross-tabulation analysis were conducted on 30 semi-structured qualitative interviews. ResultsWe identified four types of adherence trajectories: high adherence, moderate adherence, low adherence, and non-adherence. Non-adherent participants were younger than those with a high adherence trajectory. Those with low adherence trajectory were younger, more likely to be an ethnic minority, and had lower exercise self-efficacy. Older adults with low or non-adherence trajectories had lower post-intervention physical functioning than those with high adherence trajectory. Qualitative analysis indicated that participants with low adherence trajectory had prioritized exercise lower than other life commitments and had frequent hospitalizations and multiple medical appointments. ConclusionNon and low adherence trajectories attenuate the impact of falls prevention exercise intervention. Findings from this study can be used to develop strategies to improve adherence.

Multiple Myeloma.

Multiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an estimated 12,590 people in 2023. Complications of the disease process include anemia, leukopenia, thrombocytopenia, renal failure, severe pain, bone loss, and hypercalcemia. Patients with MM have a high risk for pathological fractures. For most forms of MM there are effective treatments that may result in long-term remission using multi-drug regimens. Although the medications approved in the United States to treat MM generally produce good outcomes, they have serious, and potentially life-threatening adverse effects. In addition, patients with specific genetic variations are at high risk for relapse. Communication with the oncology team and early intervention in the event of adverse effects of medications, complications of the disease process, or evidence of relapse are important to obtain the best possible outcome. Patients are easily overwhelmed with a three- to four-drug treatment regimen with some drugs given intravenously and/or subcutaneously at the clinic, and others taken orally at home on specific days of each 28-day cycle. Home care nursing is needed to assess for tolerance, adverse effects, and to address patient concerns. Medication management and teaching are very important in guiding patients to safely manage a schedule that changes daily. In addition, the high risk of pathological fractures and serious injury if the patient should fall supports the need for physical and occupational therapy fall prevention and safety education and exercise programs to help avert decline in functional status and combat cancer-related fatigue.

Comparing Online and In-Person Delivery of a Fall Prevention Exercise Program for Older Adults.

Exercise is the single most effective strategy to reduce the risk of falls. Online classes have grown in popularity, but the benefits of online classes remain unknown. Zoomers on the Go is a peer-led 12-week exercise program offered twice weekly to adults 50+years old. The main outcome was lower body strength measured by the 30-s chair stand test. Other outcomes included dropout, attendance, balance, cardiorespiratory fitness, and perceived health. A total of 74 participants (age 66.3 ± 7.1years) in the online group and 84 participants in the in-person group (age 67.3 ± 7.2years) completed the program, with attendance for the online group. Both groups significantly improved their 30-s chair stand, cardiorespiratory fitness, and balance (p < .001) with no difference in functional benefits between groups. The in-person group improved their perceived health and significantly reduced levels of stress and depression, while no such changes were observed in the online group.