Trial Protocol: Home-based exercise programs to prevent falls and upper limb dysfunction among community-dwelling older people: study protocol for the BEST (Balance Exercise Strength Training) at Home randomised, controlled trial

Bates, Amanda; Furber, Susan; Tiedemann, Anne; Ginn, Karen A.; Dolder, Paul van den; Howard, Kirsten; Bauman, Adrian; Chittenden, Catherine; Franco, Lisa; Kershaw, Michelle; Sherrington, Catherine

doi:10.1016/j.jphys.2017.10.001

Cited by 6 publications

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“…It had a pragmatic RCT design, with broad inclusion criteria. It followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines [ 20 ] and the protocol was registered prospectively and published [ 19 ]. It also attempted to minimise the risk of bias through concealed random allocation to groups, and assessor-blinded outcome assessment.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial

et al. 2022

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Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits by health professionals can prevent falls however this strategy would be costly to deliver at scale. We developed a new approach to teach home exercise through group-based workshops delivered by physiotherapists. The primary aim was to determine the effect of this approach on the rate of falls among older community-dwelling people over 12 months. Secondary outcomes included the proportion of people falling, fear of falling, physical activity, lower limb strength, balance and quality of life. Methods A randomised controlled trial was conducted among community-dwelling people aged ≥65 in New South Wales, Australia. Participants were randomised to either the intervention group (exercise targeting balance and lower limb strength) or control group (exercise targeting upper limb strength). Results A total of 617 participants (mean age 73 years, +SD 6, 64% female) were randomly assigned to the intervention group (n = 307) or control group (n = 310). There was no significant between-group difference in the rate of falls (IRR 0.91, 95% CI 0.64 to 1.29, n = 579, p = 0.604) or the number of participants reporting one or more falls (IRR 0.99, 95% CI 0.76 to 1.29, n = 579, p = 0.946) during 12 month follow-up. A significant improvement in the intervention group compared to control group was found for fear of falling at 3, 6 and 12 months (mean difference 0.50, 95% CI 0.2 to 0.8, p = 0.004; 0.39, 95% CI 0.001 to 0.8, p = 0.049; 0.46, 95% CI 0.006 to 0.9, p = 0.047, respectively), and gait speed at 3 months (mean difference 0.09 s, 95% CI 0.003 to 0.19, p = 0.043). No statistically significant between-group differences were detected for the other secondary outcomes. Conclusions There was no significant intervention impact on the rate of falls, but the program significantly reduced fear of falling and improved gait speed. Other exercise delivery approaches are needed to ensure an adequate intensity of balance and strength challenge and dose of exercise to prevent falls.

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Section: Discussionmentioning

confidence: 99%

“…All methods were performed in accordance with the relevant guidelines and regulations. A detailed protocol describing the design and methods of the study has been published [ 19 ]. The study reporting is in accordance with the Consolidated Standards of Reporting (CONSORT) [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial

et al. 2022

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“…In particular, preparticipation screening for those with known chronic conditions or risk factors, as well as individualizing training plans to include optimal combinations of resistance and aerobic training, are important 93 . Improved risk stratification methods will enable aging athletes to perform at high levels into later age and current treatment methods may help to prolong exercise capacities into later years of life 27 . Further research is needed to better understand the effects of exercise in aging athletes, injuries specific in this population, and optimization of treatments.…”

Section: Discussionmentioning

confidence: 99%

“…93 Improved risk stratification methods will enable aging athletes to perform at high levels into later age and current treatment methods may help to prolong exercise capacities into later years of life. 27 Further research is needed to better understand the effects of exercise in aging athletes, injuries specific in this population, and optimization of treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Although the risk and severity of injuries are higher in the aging population, there are also significant benefits of exercising in aging athletes. Aging athletes experience an improved quality of life while maintaining function, 27 better mental health (including lower rates of anxiety and mild depression 28 ), reduced risk of cardiovascular diseases such as coronary artery and peripheral vascular disease, 29 and reduced risk of metabolic syndrome and diabetes 30 compared to age‐matched adults who do not routinely exercise. Aging adults who regularly participate in moderate exercise have a reduced risk of osteoarthritis compared to those who do not exercise 31 .…”

Section: Epidemiology Of Injuries In Aging Athletesmentioning

confidence: 99%

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The aging athlete

Catapano

Ahmed

Breslow³

et al. 2022

PM&R

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Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.

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Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

Welch

Mathew

Babelmorad

et al. 2021

Campbell Systematic Reviews

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Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and http://ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on‐going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de‐duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality. The most common interventions were home‐based rehabilitation for older adults (n = 276) and home‐based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental functio...

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Trial Protocol: Home-based exercise programs to prevent falls and upper limb dysfunction among community-dwelling older people: study protocol for the BEST (Balance Exercise Strength Training) at Home randomised, controlled trial

Abstract: If effective, the trial will provide a model for both upper limb and lower limb exercise programs that can be performed at home and implemented at scale to community-dwelling older adults.

Cited by 6 publications

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Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial

Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial

The aging athlete

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

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