The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults

Abstract

BackgroundIt is estimated one in two adults age 80 and over fall each year, resulting in substantial morbidity and mortality rates among this oldest-old population. The Otago Exercise program (OEP) is an evidence-based fall prevention program shown to reduce falls by 35% among high-risk older adults. The OEP was designed to be delivered in the home by physical therapists. This model has encountered multiple implementation challenges in the United States health-care system, which has resulted in the development and testing of innovative models to support a broader reach and dissemination of this program.MethodsThe Northwest Senior and Disability Services is an Area Agency on Aging (AAA) serving a five-county region in Oregon. This AAA developed a model where a Certified Occupational Therapy Assistant (COTA) and exercise physiologist delivered the OEP with a physical therapist available to consult on all cases. Physical function assessments and self-reported perceptions about physical function were collected at baseline and 6 months.ResultsBaseline measures were collected on 239 participants enrolled in the OEP, and 62 participants at 6 months. Those who completed 6 months of the OEP demonstrated significant improvements in all physical function assessments and self-perceived functional improvements. A subset of this group that demonstrated improvements in the ability to rise from a chair also reported significantly fewer falls during the 6-month intervention.ConclusionInnovative models in which the OEP exercise sessions are delivered by non-physical therapists appear to be effective in improving physical performance measures and decreasing fall risk over a 6-month period. Because these models do not require a physical therapist, they may require fewer resources to implement. These findings have implications to inform implementation and dissemination strategies to bring the OEP to scale.

The Otago Exercise Program With or Without Motivational Interviewing for Community-Dwelling Older Adults: A 12-Month Follow-Up of a Randomized, Controlled Trial

“…To support home exercises, over a period of 12 months, we suggest more frequently and regularly performed home visits and phone calls, especially for relatively frail older adults. This is supported in the literature where an alternative delivery model for the OEP recently has been explored (Shubert et al, 2017). The Shubert et al delivery model included eight home visits and weekly phone calls over a 6-month period, M age = 79.8 (11.8) years.…”

Effects of a Personalized Physical Exercise Program in the Arterial Stiffness in Older Adults

“…The aerobic exercise sessions followed the recommendations of the World Health Organization [28], consisting of two sessions per week with the following structure: walk at least 10 min on a flat or slightly sloping ground, joint mobilization exercises with respiratory coordination and balancing and coordination exercises (total duration per session: 1 h). The laboratory sessions were held three times a week (1-h session), including strength and balance/coordination exercises based on the Otago program [29] embedded in a technological platform using inertial and pressure sensors, feedback and exergames. The sessions were structured in an alternating pattern from Monday to Friday: laboratory session; aerobic session; laboratory session; aerobic session; laboratory session.…”

Effects of a Personalized Physical Exercise Program in the Ventricular-arterial Coupling of Older Adults. A Pilot Study

“…The aerobic exercise sessions followed the recommendations of the WHO [23] consisting of two sessions per week with the following structure: a 10-min walk on flat or slightly sloping ground, joint mobilization exercises with respiratory coordination and balance and coordination exercises (total duration per session: 1 h). The laboratory sessions took place three times a week (1-h sessions), including strength and balance/coordination exercises based on the Otago program [24] embedded in a technological platform using inertial and pressure sensors, feedback and exergames. The intervention was implemented for three months after the baseline assessment and was readjusted individually according to individual needs.…”