Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis

Hughes, Katie; Salmon, Nancy; Galvin, Rose; Casey, Bláthín; Clifford, Amanda

doi:10.1093/ageing/afy164

Cited by 45 publications

(43 citation statements)

References 25 publications

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“…Across different settings, multifactorial training, such as the combination of balance and strength exercises have shown to be most effective in reducing fall rates in older adults [4][5][6][7][8]. However, the "traditional" delivery of balance and strength exercises through structured training often entails low long-term adherence of participants [9][10][11]. Lifestyleintegrated training was developed as an alternative approach in order to increase long-term adherence through embedding functional exercises into daily life, that is, daily routines are enriched with small low-intensity bouts of activity with the aim to create new activity habits [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Kramer

Labudek

Jansen

et al. 2020

Pilot Feasibility Stud

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Background: The Lifestyle-integrated Functional Exercise (LiFE) programme is a fall prevention programme originally taught in a resource-intensive one-to-one format with limited feasibility for large-scale implementation. The aim of this paper is to present the conceptual framework and initial feasibility evaluation of a group-based LiFE (gLiFE) format developed for large-scale implementation. Methods: The conceptual gLiFE framework (part I) is based on three pillars, LiFE Activities and Principles, Theory of Behaviour Change and Behaviour Change Techniques, and Instruction. The feasibility of gLiFE was tested (part II) within a multimodal approach including quantitative questionnaires measuring safety, acceptability (1 = best to 7 = insufficient), and adherence to the LiFE activities (range = 0-14) as well as a focus group interview. Exploratory self-reported measures on behaviour change including self-determined motivation (range = 1-5), intention, planning, action control, and habit strength (range = 1-6) were assessed pre and post intervention. Data analyses were performed using descriptive statistics and qualitative content analysis. Results: The development process resulted in a manualised gLiFE concept containing standardised information on gLiFE's content and structure. Feasibility testing: Six older adults (median = 72.8 years, 5 female) completed the feasibility study and rated safety (median = 7.0, IQR = 0.3) and acceptability as high (median = 1, IQR = 1). Participants implemented 9.5 LiFE activities (IQR = 4.0) into their daily routines. No adverse events occurred during the study. In the focus group, the group format and LiFE activities were perceived as positive and important for maintaining strength and balance capacity. Self-determined motivation intention, planning, and habit strength were rated higher post intervention. Conclusion: The developed conceptual gLiFE framework represents the basis for a gLiFE format with potential for standardised large-scale implementation. Proof-of-concept could be demonstrated in a group of communitydwelling older adults at risk of falling. The public health potential of gLiFE in terms of (cost-)effectiveness is currently being evaluated in a large trial.

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Section: Introductionmentioning

confidence: 99%

Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Kramer

Labudek

Jansen

et al. 2020

Pilot Feasibility Stud

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“…Five studies evaluated the overall impact of VRSs on BADLs [ 33 , 34 , 35 , 36 , 37 ] and three studies examined IADLs [ 38 , 39 , 40 ]. We also identified six studies which assessed the effectiveness of VRSs on the capacity to make transfers and twenty-one studies which reported on their effectiveness in improving functional ambulation.…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies which assessed effectiveness on BADLs obtained a large effect (d > 0.8) [ 33 , 34 , 35 , 37 ] and two studies found a medium effect [ 33 , 38 ]. However, the effectiveness of VRSs was smaller for the three studies which assessed IADLs [ 38 , 39 , 40 ]. The total SMD was −0.34 (95% CI: −0.82; 0.15) and the effect found was small ( Figure 2 a).…”

Section: Resultsmentioning

confidence: 99%

“…VR and BE may help fall concern in older persons. Hughes 2014 [ 40 ] Level II n = 20 EC = 10 CC = 10 77.4 (72–83) 70% Female MYHAT Cognitive Classification Community-dwelling adults Pittsburgh, US Nintendo Wii Sports 24 weeks 1 time/week Without intervention CAMCI; CRSQ AIVD GAIT: 6 m No follow-up The experimental group improved in overall cognition, perceived cognitive ability and gait speed. Hung 2019 [ 42 ] Level I RCT n = 24 EC = 12 CC = 12 68 (66–72) 57% female >60 years; medical diagnoses of diabetes; independently ambulatory; MEC > 24 Community-dwelling adults Taipei, China Xavi Sport VR 6 weeks 3 times/week Without intervention TUG; BBS UST; MFES 6 weeks after the intervention VR showed positive effects on functional balance.…”

Section: Table A1mentioning

confidence: 99%

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Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People

Corregidor-Sánchez

Segura‐Fragoso

Criado-Álvarez

et al. 2020

IJERPH

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(1) This review aims to evaluate the effectiveness of treatments with virtual reality systems (VRSs) on the functional autonomy of older adults versus conventional treatment. (3) Methods: Systematic review and meta-analysis. An electronic data search was carried out, following the PRISMA statement, up to February 2020. We combined results from clinical trials using VRSs for the improvement of basic and instrumental activities of daily living. The guidelines of the Cochrane Handbook for Systematic Reviews of Interventions were followed for calculations and risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. (4) Results: The final analysis included 23 studies with a population of 1595 participants. A moderate, but clinically significant, effect was found for basic activities of daily living (BADLs), (Standard Medium Deviation, SMD 0.61; 95% CI: −0.15–1.37; P < 0.001). A small effect was found for instrumental ADLs (Instrumental Activities of daily living, IADLs) (SMD −0.34; 95% CI: −0.82–0.15; P < 0.001). Functional ambulation was the BADL which improved the most (SMD −0.63; 95% CI: −0.86, −0.40; P < 0.001). (5) Conclusion: The use of VRSs is an innovative and feasible technique to support and improve the functional autonomy of community-dwelling older adults. Due to the very low quality of the evidence for our main outcomes, the effects of a VRS on the BADLs and IADLs are uncertain. Clinical trials of a higher methodological quality are necessary to increase the level of knowledge of its actual effectiveness.

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“…In a review focused on how different interventions could improve adherence in fall prevention exercise interventions for older adults adherence rates between 27-97% was reported [34]. Variation in how adherence was measured limited the interpretation, and a valid objective measurement for both adherence and outcome was called for.…”

Section: Adherencementioning

confidence: 99%

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

Månsson

Lundin-Olsson

Skelton

et al. 2020

Preprint

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Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet.Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.Results: Sixty-seven participants, with mean age 77±4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p=.078). In both groups 50-59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p=.001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p=.026) degree of being content, and feeling supported by the programme (p=.044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p=.036).Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.Trial registration: ClinTrial: NCT02916849

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Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis

Cited by 45 publications

References 25 publications

Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People

Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet

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