Clinical Decision Making in Exercise Prescription for Fall Prevention

Abstract

Physical therapists with expertise in fall prevention adopted an individualized approach to exercise prescription that was based on physical assessment findings rather than "off-the-shelf" exercise programs commonly used in fall prevention research. Training programs for people who prescribe exercises for older adults at risk of falling should encompass these findings.

What Are the Characteristics of Home Exercise Programs That Older Adults Prefer?

“…24 Client preferences have not been found to be a major focus in the clinical decision-making process used by expert physiotherapists to prescribe exercises for falls prevention; rather, exercise prescription has largely been based on physical assessment findings. 25 In the context of optimizing adherence to home exercise interventions, the findings of this study indicate that psychosocial factors may be just as important for exercise prescription when the goal is to have high levels of adherence over time. Enjoyment derived from performing an exercise was a key perceived benefit of participation in a home exercise program.…”

“…Psychosocial approaches such as motivational interviewing to promote adherence to exercise interventions for falls prevention seem to be underused by physiotherapists. 25 Motivational interviewing is a Bdirective, client-centred approach to eliciting behavioural change by helping clients to explore and resolve ambivalence. [ 35 This may provide patients and clinicians with a framework to explore and resolve psychologic factors and patient preferences that may affect adherence to home exercise programs.…”

Clinical Markers of the Intensity of Balance Challenge: Observational Study of Older Adult Responses to Balance Tasks

“…Recent falls prevention research has focused on the use of exercise to improve balance and reduce falls in older adults with varying results 2 , however optimal exercise dosage for rehabilitation of balance is yet to be fully described 3 The universally recognized approach to exercise prescription utilizes the FITT principle, combining exercise frequency, intensity, type and time variables that are then manipulated in a standardized manner to elicit a dose response 4 . Despite this, a recent qualitative study of physical therapists specializing in falls and balance rehabilitation concluded that exercise prescription practices were highly individualized and lacked a standardized approach 5 . For example, the type of exercises prescribed by these expert falls and balance therapists were highly influenced by individual assessment findings and constrained by perceptions of safety and falls risk.…”

Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

“…It is for this reason that many individuals will do better with an exercise program customized by a physical therapist rather than attending a standardized group program [10,11]. There are often multiple types of exercise necessary to address different components of the balance problem.…”