LiFE was effective in reducing recurrent falls in this at-risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long-term efficacy, mechanisms of benefit and clinical significance of this new intervention.

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The Lifestyle-integrated Functional Exercise (LiFE) program has been proven effective in reducing the risk of falls and in improving capacity for functional everyday activity. Balance and strength, particularly ankle strength, can be markedly improved and maintained if the LiFE program becomes part of daily routines. The LiFE activities have all been designed to help you keep active and reduce your chance of falling. The program was developed and piloted as part of a University of Sydney Bridging Grant and the program was tested in a randomised trial funded by a National Health & Medical Research project grant ID 402682. The results of this trial were published in the British Medical Journal, 2012. See section on 'References' on page 107 for full bibliographic details. We acknowledge the contribution to manual development by Anita Bundy and Trish O'Loughlin and the other therapists of the LiFE research project. vi Contents iv Introduction viii Walking with confidence Balance training LiFE principles of balance training LiFE balance activities Balance activities More ways to challenge your balance Strength training LiFE principles of strength training LiFE strength activities Strength activities Changing your life with LiFE Help yourself to remember to do the activities Recording your activities Increasing your physical activity Stories and quotes Notes References Index vii Habits can be changed gradually by thinking about what you do and how you do it. There are many opportunities in our everyday life to incorporate balance practice and strength training. You will learn the principles behind improving your balance and strength and apply these principles to daily activities. You will look for ways that you can turn your daily tasks into opportunities for improving your strength and balance. Instead of looking for ways to avoid doing things, you will look for ways to add these activities into your daily routine. As your balance and strength improve you will be able to do more walking and other physical activities. You should think about ways that you can increase the amount of physical activity that you do. You can increase your physical activity in some simple ways: • Use the stairs whenever possible. Shuffling felt 'safe'. But now I understand that shuffling won't necessarily prevent me from falling. It may even cause me to trip more easily because I'm not lifting my feet. (Dorothy) When I saw what 'normal' walking was supposed to look like, I could see how my walking had really gone downhill. (Robert) Key points-the LiFE program • You will learn the balance and muscle strengthening principles. These form the basis of this program. You will learn these principles and how to apply them to your life and daily activities. • To improve your balance you need to practise activities that challenge your balance. You need to keep progressing to more challenging activities. You should 'let go but keep up the flow'. • To improve your strength you need to make your muscles work harder. You should 'load your muscles' whenever...

Objectives-As part ofthe Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out. Methods-The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength ofrecommendation using a scale published in the UK national epidemiologically based needs assessment programme. Results-The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches. Conclusions-Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved. (Injury Prevention 1995; 1: 249-255)

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