Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial

Abstract

Background: Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence.

Methods: The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up).

Discussion: Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy.

Trial registration: ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Keywords: Exercise-adherence; Falls; Home-based exercises programmes; Older adults; Quality of life.

Fig. 1

Recommendations for create your home-based exercise-programme

Fig. 2

Patient Flow. FES-I: Falls Efficacy Scale - International; MMSE: Mini Mental State Examination; OPQOL-3: Older People’s Quality of Life Questionnaire; TUG: Timed Up and Go test; FR: Functional Reach Test; FSBT: Four Stage Balance Test; FTSTS: Five Times Site To Stand test; SMWT: Six Meters Walk Test; BSW: Base of Support Width