Exercise for reducing fear of falling in older people living in the community

Kendrick, Denise; Kumar, Arun; Carpenter, Hannah; Zijlstra, G. A. Rixt; Skelton, Dawn A.; Cook, Juliette; Stevens, Zoe; Belcher, Carolyn; Haworth, Deborah; Gawler, Sheena; Gage, Heather; Masud, Tahir; Bowling, Ann; Pearl, Mirilee; Morris, Richard W; Iliffe, Steve; Delbaere, Kim

doi:10.1002/14651858.cd009848.pub2

Cited by 214 publications

(131 citation statements)

References 198 publications

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“…Similar improvements in FES-I scores to those at 12 months were seen at 8 weeks and 6 months, despite the absence of intervention for the final 6 months of follow-up, and our study was powered on the basis of a 4-point reduction in FES-I scores. Although there are no definitions of minimal clinically significant changes in FES-I or any other fear of falling measure, 25 our FES-I effect size is among the highest reported, with recent randomised studies on interventions in fear of falling using the FES-I reporting significant decreases in scores ranging from 0.53 to 3.7. [118][119][120] Dropouts from the study were at variable time points and tended to be triggered by activities arising from the study (e.g.…”

Section: Summary Of Main Findings Of the Phase II Randomised Controllmentioning

confidence: 60%

“…24 More recently, a Cochrane review of exercise (three-dimensional exercise, such as t'ai chi and yoga, balance training or strength and resistance training) for reducing fear of falling in older people living in the community found that exercise 'probably' reduces fear of falling to a limited extent immediately after intervention, with inadequate evidence of an effect in the longer term. 25 The authors called for further evidence, with priority being given to the establishment of core outcomes, including fear of falling, in all trials of exercise intervention in community-dwelling elders.…”

Section: Falls and Fear Of Fallingmentioning

confidence: 99%

“…12,25,43 Single-item questions are sometimes used, but have been criticised for their inability to measure variability in degrees of fear of falling. 12 We included a single-item, 11-point rating scale of fear of falling (see next section) in our battery of outcomes, but felt that a multi-item scale would be a more appropriate primary outcome measure.…”

Section: Primary Outcome Measurementioning

confidence: 99%

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Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

122

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BackgroundFalls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is ‘fear of falling’, seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive–behavioural therapy (CBT) approach.ObjectivesPrimary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling.Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention.DesignPhase I CBTi development.Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone.SettingMultidisciplinary falls services.ParticipantsConsecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale–International (FES-I) score of > 23.InterventionsPhase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting.Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care.Main outcome measuresThese were assessed at baseline, 8 weeks, 6 months and 12 months.Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months.Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial.ResultsFour hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [–4.02; 95% confidence interval (CI) –5.95 to –2.1], single-item numerical fear of falling scale (–1.42; 95% CI –1.87 to 1.07) and HADS (–1; 95% CI –1.6 to –0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective.ConclusionsOur new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures.Further workFurther work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists.Trial registrationCurrent Controlled Trials ISRCTN78396615.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.

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Section: Summary Of Main Findings Of the Phase II Randomised Controllmentioning

confidence: 60%

Section: Falls and Fear Of Fallingmentioning

confidence: 99%

Section: Primary Outcome Measurementioning

confidence: 99%

See 1 more Smart Citation

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

122

View full text Add to dashboard Cite

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“…Though interventions designed to improve balance outcomes in older people have demonstrated limited effectiveness [29], community-based exercise programs designed to improve functional capacity and reduce the risk of falls have been shown to reduce the rate of falls and risk of falling [30] and possibly fallrelated injuries [31]. There remains a lack of evidence that such interventions are effective in reducing fear of falling among older adults in general [32] and patients with LL amputation in particular.…”

Section: Balance Confidencementioning

confidence: 99%

Balance confidence and activity of community-dwelling patients with transtibial amputation

Mandel¹,

Paul

Paner

et al. 2016

J Rehabil Res Dev

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Abstract-The purpose of this study was to examine the relationship between balance confidence and community-based physical activity. Twenty-two community-dwelling patients with right or left unilateral transtibial amputation who reported no falls in the past 6 mo completed the Activities-Specific Balance Confidence Scale (ABC) and wore a StepWatch Activity Monitor for 7 consecutive d in the community. Subjects were subsequently stratified as low (<3,000 steps/d) or high (3,000 steps/ d) activity groups. Balance confidence was significantly lower among the low activity weekday group (LAG) (70.8 +/-12.0 vs 88.9 +/-8.7, t(20) = 3.97, p = 0.001). Further, correlation analysis revealed a positive correlation between ABC score and step total (r = 0.55, p < 0.01). It is unknown whether the LAG limited ambulation as an intentional strategy of fall-risk avoidance. Although clinicians routinely inquire about falls in the community among patients with lower-limb amputation, the results of this study emphasize the importance of contextualizing recent fall history relative to activity level. Clinicians can use this contextual information when considering the inclusion of appropriate fall-risk mediation strategies relative to activity levels and counseling patients on the benefits of physical exercise for maintaining functional capacity and general health.

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“…Tai Chi, yoga and strength training are helpful in reducing the levels of FOF and thus minimizes the chances of falling [21][22][23][24][25], but others also have no significant relationship [26,27]. Though it is proposed that sports can imply significant beneficial effects in the elderly population, there is still no agreement on the individualistic impacts of different sports exercises on specific traits of physical abilities of the elderly.…”

Section: Introductionmentioning

confidence: 99%

Effect of Pilates Exercise on Fear of Falling in Iranian Elderly Women

Badiei

Shahboulaghi

Hosseini

et al. 2017

IRJ

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Objectives:The aim of this study was to determine the effect of Pilates exercise on Fear of Falling (FOF) among elderly women. Methods:The present study is a clinical trial that was conducted on 44 elderly women aged between 60-80 years. Subjects were recruited through the convenience sampling method and were then randomly divided into two groups of inference viz. pilates exercise group, the members of which underwent Pilates exercise training along with the routine sanatorium exercises and the control group in which members stuck with (routine exercise only. Data was gathered by using demographic questionnaire and Fall Efficacy Scale-International (FES-I). For the intervention group, Pilates training was done for 8 weeks, three times a week (1 hour per session) under the supervision of a trained coach. Data were analyzed by the SPSS software v.16. Results:The findings indicated that the means of FES-I scores in Pilates group improved from 32.90 to 22.18 (MD=10.72) after the intervention. According to the independent t-test, there was a significant difference in the means of post intervention FES-I scores, between the two groups (P<0.001). In the Pilates group, the effect size of intervention was much more than the control group (ES=0.89). Discussion:Pilates training could decrease the FOF and may thus be implemented as an effective interventional method for fall prevention in elderly women.

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Exercise for reducing fear of falling in older people living in the community

Cited by 214 publications

References 198 publications

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Balance confidence and activity of community-dwelling patients with transtibial amputation

Effect of Pilates Exercise on Fear of Falling in Iranian Elderly Women

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