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Dams J, Gottschalk S, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, König HH. Budget impact analysis of a Lifestyle-integrated Functional Exercise (LiFE) program for older people in Germany: a Markov model based on data from the LiFE-is-LiFE trial. BMC Geriatr 2024; 24:186. [PMID: 38395743 PMCID: PMC10893703 DOI: 10.1186/s12877-024-04802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at risk of falling. In addition, the current study aimed to analyze the budget impact of LiFE and gLiFE, compared with standard care in Germany. METHODS A Markov model was developed to reflect falls and associated care needs for community-dwelling persons over 5 years. The intervention effects of LiFE and gLiFE were shown to be equivalent in a non-inferiority trial, although the costs differed. Outpatient, inpatient, and intervention costs were assessed from a payer's perspective. The effect of parameter uncertainty was assessed in sensitivity analyses. RESULTS The budget impact due to intervention costs was €510 million for LiFE and €186 million for gLiFE. Over five years, health care expenditures were €35,008 million for those receiving standard care, €35,416 million for those receiving LiFE, and €35,091 million for persons receiving gLiFE. Thereby, LiFE and gLiFE could prevent 2700 deaths and 648,000 falls over 5 years. Parameter uncertainties in the risk of falling, uptake of an intervention offer, and in the intervention effects had a major influence; thus cost savings for LiFE and gLiFE compared with standard care could be achieved for individuals with a high risk of falling. CONCLUSIONS The results revealed that cost savings for LiFE and gLiFE compared with standard care could only be achieved for individuals at high risk of falling, with gLiFE being superior to LiFE. Future research should consider benefits and aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants). TRIAL REGISTRATION The study was preregistered under underclinicaltrials.gov (identifier: NCT03462654) on 12th March 2018; https://clinicaltrials.gov/ct2/show/NCT03462654 .
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Department of Sport Science, Human Performance Research Centre, University of Konstanz, Constance, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Center for Geriatric Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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Endress C, Schwenk M, Werner C, Becker C, Jansen CP. [Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?]. Z Gerontol Geriatr 2023; 56:464-469. [PMID: 37676321 DOI: 10.1007/s00391-023-02230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. OBJECTIVE The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6‑month follow-up and to determine which factors are associated with these changes. MATERIAL AND METHODS This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6‑month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression. RESULTS The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance. CONCLUSION The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).
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Affiliation(s)
- Christoph Endress
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Schwenk
- Human Performance Research Centre, Abteilung für Sportwissenschaft, Universität Konstanz, Konstanz, Deutschland
| | - Christian Werner
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Clemens Becker
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Unit Digitale Geriatrie, Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Carl-Philipp Jansen
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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Adams M, Carrascosa L, Jansen CP, Ritter Y, Schwenk M. "Can Do" vs. "Do Do" in Older Adults: A Cross-Sectional Analysis of Sensor-Derived Physical Activity Patterns. SENSORS (BASEL, SWITZERLAND) 2023; 23:1879. [PMID: 36850476 PMCID: PMC9959454 DOI: 10.3390/s23041879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Identifying groups with a misaligned physical capacity (PC) and physical activity (PA) is potentially relevant for health promotion. Although an important health determinant, deeper knowledge of underlying walking behavior patterns in older adults is currently missing. We aim to identify specific PA signatures of misaligned groups and determine PA variables discriminating between groups. (2) Methods: In total, 294 community-dwelling older adults (≥70 years) were divided into four quadrants based on thresholds for PA (≥ or <5000 steps/day) and PC (≤ or >12 s, Timed Up and Go test). Kruskal-Wallis and effect sizes were calculated to compare quadrants' PA variables and to determine the discriminative power of PA parameters on walking duration, frequency, and intensity. (3) Results: We identified quadrant-specific PA signatures. Compared with "can do-do do", the "cannot do-do do" group performs shorter continuous and lower-intensity walks; the "can do-do not do" group takes fewer steps and walks with less intensity. The "cannot do-do not do" group presents lower values in all PA variables. "Walking duration greater or equal 3 METs" was the strongest discriminative PA variable. (4) Conclusion: We provide distinct PA signatures for four clinically different groups of older adults. Walking intensity is most useful to distinguish community-dwelling older adults, which is relevant for developing improved customized health promotion interventions.
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Affiliation(s)
- Michael Adams
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany
| | - Lara Carrascosa
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, 78464 Konstanz, Germany
| | - Carl-Philipp Jansen
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, 70376 Stuttgart, Germany
| | - Yvonne Ritter
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, 78464 Konstanz, Germany
| | - Michael Schwenk
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, 78464 Konstanz, Germany
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Jansen CP, Gottschalk S, Nerz C, Labudek S, Kramer-Gmeiner F, Klenk J, Clemson L, Todd C, Dams J, König HH, Becker C, Schwenk M. Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program: final results from the LiFE-is-LiFE non-inferiority trial. Age Ageing 2023; 52:6998047. [PMID: 36702515 DOI: 10.1093/ageing/afac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, considering higher risk of falling due to possible PA enhancement. OBJECTIVE to investigate non-inferiority in terms of PA-adjusted fall risk and cost-effectiveness of gLiFE at 12-month follow-up. DESIGN single-blinded, randomised, multi-centre non-inferiority trial. SETTING community. SUBJECTS in total, 309 adults aged 70+ years at risk of or with history of falling; n = 153 in gLiFE, n = 156 in LiFE. METHODS LiFE was delivered one-to-one at the participants' homes, gLiFE in a group. PA-adjusted fall risk was analysed using negative binomial regression to compare incidence rate ratios (IRR). Cost-effectiveness was presented by incremental cost-effectiveness ratios and cost-effectiveness acceptability curves, considering quality-adjusted life years, PA and falls as effect measures. Secondary analyses included PA (steps/day) and fall outcomes. RESULTS non-inferiority was inconclusive (IRR 0.96; 95% confidence interval, CI 0.67; 1.37); intervention costs were lower for gLiFE, but cost-effectiveness was uncertain. gLiFE participants significantly increased PA (+1,090 steps/day; 95% CI 345 and 1.835) versus insignificant increase in LiFE (+569, 95% CI -31; 1,168). Number of falls and fallers were reduced in both formats. CONCLUSION non-inferiority of gLiFE compared with LiFE was inconclusive after 12 months. Increases in PA were clinically relevant in both groups, although nearly twice as high in gLiFE. Despite lower intervention costs of gLiFE, it was not clearly superior in terms of cost-effectiveness.
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Affiliation(s)
- Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
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Gottschalk S, König HH, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, Dams J. Willingness to pay for a group and an individual version of the Lifestyle-integrated Functional Exercise program from a participant perspective. BMC Public Health 2022; 22:1934. [PMID: 36258179 PMCID: PMC9580107 DOI: 10.1186/s12889-022-14322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perceived benefits of intervention programs from a participant perspective can be examined by assessing their willingness to pay (WTP). Aiming to support decision-makers in their decision to implement a fall prevention program, this study examined (1) the WTP for a group-based and an individually delivered fall prevention program, (2) which factors influence WTP, and (3) whether the WTP exceeds the intervention costs. METHODS WTP was elicited using Payment Cards from 237 individuals who participated in a randomized non-inferiority trial (LiFE-is-LiFE) comparing a group version of the Lifestyle-integrated Functional Exercise program (gLiFE) with the individually delivered version (LiFE). Linear regression models were used to examine factors associated with WTP. The net benefit for (g)LiFE was calculated as the difference between WTP and intervention costs, assuming different scenarios of intervention costs (varying group sizes of gLiFE) and hypothetical subsidy levels by a payer (€0, €50, or €75). RESULTS The mean WTP was €196 (95% CI [172, 221]) for gLiFE and €228 (95% CI [204, 251]) for LiFE. In the linear regression model, WTP was significantly associated with delivery format (-€32, 95% CI [- 65, - 0.2], for gLiFE) and net household income (+ 68€, 95% CI [23, 113], for ≥€3000 compared to <€2000). The net benefit for gLiFE was positive in most cases. Due to higher intervention costs of LiFE compared to gLiFE (€298 vs. €113), the net benefit for LiFE was negative for the majority of the sample, even at a subsidy of €75. CONCLUSION The results provide insight into how valuable the interventions are perceived by the participants and thereby may be used by decision-makers as complement to cost-effectiveness analyses. WTP for both programs was generally high, probably indicating that participants perceived the intervention as quite valuable. However, further research is needed on the WTP and net benefit of fall prevention programs, as results relied on the specific context of the LiFE-is-LiFE trial.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nerz C, Kramer-Gmeiner F, Jansen CP, Labudek S, Klenk J, Becker C, Schwenk M. Group-Based and Individually Delivered LiFE: Content Evaluation and Predictors of Training Response – A Dose-Response Analysis. Clin Interv Aging 2022; 17:637-652. [PMID: 35509348 PMCID: PMC9057901 DOI: 10.2147/cia.s359150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Material and Methods Results Discussion and Conclusion Trial Registration
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Affiliation(s)
- Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Correspondence: Corinna Nerz, Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, Stuttgart, 70376, Germany, Tel +49 711-81010 6070, Fax +49 711 8101 3194, Email
| | | | - Carl-Philipp Jansen
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Jochen Klenk
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Unit Digitale Geriatrie, Medical Faculty of the University Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
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Associations Between Planned Exercise, Walking, Incidental Physical Activity, and Habit Strength in Older People: A Cross-Sectional Study. J Aging Phys Act 2021; 30:813-823. [PMID: 34929661 DOI: 10.1123/japa.2021-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Habits play an important role in physical activity (PA) engagement; however, these associations in older people are not well understood. The present study aimed to investigate the relationship between engagement in types of PA and their automaticity in older people, using an observational, cross-sectional design. Current hours engaged in planned exercise (excluding walking), planned walking, and incidental activities and the automaticity of those PA behaviors were measured in 127 community-dwelling Australians aged 65 years and older via an online questionnaire. After controlling for demographic and health factors (age, gender, education level, body mass index, history of falls, and anxiety and depression symptoms), higher automaticity scores were associated with more hours undertaking planned walking and incidental activity but not planned exercise. Although preliminary, these findings indicate that the role of habit in maintaining PA in older people may, therefore, differ depending on the type of activity.
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Matthias MS, Hirsh AT, Ofner S, Daggy J. Exploring the relationships among social support, patient activation, and pain-related outcomes. PAIN MEDICINE 2021; 23:676-685. [PMID: 34718764 DOI: 10.1093/pm/pnab306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/28/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Social support has been linked to more effective pain adaptation. The relationship between social support and other relevant constructs is less well-understood. Chief among these is patient activation, which has robust links to effective self-management, yet has not been well-studied in chronic pain. We sought to better understand these relationships in an effort to inform future intervention strategies for patients with chronic pain. METHODS Using baseline data from a clinical trial with patients with chronic pain (N = 213), we analyzed the relationships among perceived social support and patient activation, depression, anxiety, general health perceptions, pain centrality, pain catastrophizing, and pain intensity and interference. Multiple linear regression was used to examine the effect of social support on outcomes. Patient activation was explored as a mediator of the effect of social support on outcomes. RESULTS Social support was significantly associated with all outcomes except pain. Social support explained the greatest variance in patient activation (squared semi-partial correlation =0.081), followed by depression (0.073) and general health perceptions (0.072). Patient activation was not found to be a significant mediator of the effect of social support on pain-related outcomes. CONCLUSIONS Findings provide insight into the roles of patient activation and social support in chronic pain management. Although patient activation did not mediate the relationship between social support and outcomes, this study is an important step toward gaining a more complete understanding of constructs thought to be related to pain self-management and points to the need to advance theory in this area to guide future research. Such work is needed to optimize interventions for patients with chronic pain.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN.,Regenstrief Institute, Indianapolis, IN.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, IN
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications: a narrative review. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-021-00770-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractLifestyle-integrated exercise is a promising approach to increase adherence levels of older adults compared to structured exercise programs as it saves time and effort and supports older adults in preventing falls and functional decline. The Lifestyle-integrated Functional Exercise (LiFE) program embodies this approach by integrating physical activity, balance, and strength activities into daily tasks of community-dwelling older adults aged 70+. A randomized controlled trial shows strong effectiveness of the original, resource-intensive one-on-one format of the LiFE program in terms of reducing falls, improving motor performance, and increasing physical activity. The positive effects of the original LiFE program have yet stimulated adaptions to group-based and information and communications technology-based formats, to younger seniors, for multicomponent interventions, and to populations with disabilities which resulted in 16 known studies about LiFE modifications. Evidence for the effectiveness of specific LiFE modifications exists for four programs, while seven adaptions are in the feasibility stage and one is still in the early development phase. A decade of existing LiFE research is summarized in this narrative review that, to the best of our knowledge, does not exist until now. The aim of this article is (1) to provide an overview of the number of LiFE modifications and their specifications, (2) to describe the current evidence regarding feasibility and effectiveness, and (3) to present challenges and potential of the different LiFE modifications. All adaptions of the LiFE program embody the benefits of the lifestyle-integrated approach and enable an enhancement of the successful LiFE concept.
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Gottschalk S, König HH, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, Dams J. Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years. J Am Med Dir Assoc 2021; 23:736-742.e6. [PMID: 34626579 DOI: 10.1016/j.jamda.2021.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program compared with an individually delivered program version. DESIGN An economic evaluation conducted alongside the LiFE-is-LiFE randomized non-inferiority trial. INTERVENTIONS Group and individually delivered version of a program consisting of strength and balance exercises integrated into everyday activities to prevent falls. SETTING AND PARTICIPANTS 309 community-dwelling older adults (aged ≥70 years) at risk of falling recruited around Heidelberg and Stuttgart (Germany). METHODS Cost-effectiveness of the group program was assessed over 6 months using different effect measures [quality-adjusted life years (QALYs, EQ-5D-5L), physical activity (mean number of steps/day), and falls] and cost perspectives (societal and payer's). Incremental cost-effectiveness ratios were determined, and cost-effectiveness acceptability curves were constructed. RESULTS From a societal perspective, mean costs, the number of falls, and the number of steps/day were somewhat higher in the group program, whereas QALYs were almost identical between the 2 interventions. From the payer's perspective, the incremental cost-effectiveness ratio for the group compared to the individual program were €56,733 per QALY and €4755 per fall prevented. Based on the cost-effectiveness acceptability curves, the cost-effectiveness of the group program had to be rated as uncertain for both effect measures and perspectives. In contrast, it demonstrated cost-effectiveness for increasing physical activity at willingness-to-pay values per additional 1000 steps/day of €1600 (societal perspective) or €600 (payer's perspective). CONCLUSIONS AND IMPLICATIONS Compared to the individual program, the group program might be cost-effective for increasing physical activity in older adults but was unlikely to be cost-effective with regard to QALY or for preventing falls. The cost-effectiveness should be evaluated long-term and compared to a regular care group.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Heidelberg, Germany; Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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11
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Jansen CP, Klenk J, Nerz C, Todd C, Labudek S, Kramer-Gmeiner F, Becker C, Schwenk M. Association between everyday walking activity, objective and perceived risk of falling in older adults. Age Ageing 2021; 50:1586-1592. [PMID: 33710267 PMCID: PMC8437067 DOI: 10.1093/ageing/afab037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into 'vigorous' (low ORF/PRF), 'anxious' (low ORF/high PRF), 'stoic' (high ORF/low PRF) and 'aware' (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet. OBJECTIVE we examined everyday walking activity in those four groups and its association with ORF and PRF. DESIGN cross-sectional. SETTING community. SUBJECTS N = 294 participants aged 70 years and older. METHODS ORF was determined based on multiple independent risk factors; PRF was determined based on the Short Falls Efficacy Scale-International. Subjects were allocated to the four groups accordingly. Linear regression was used to quantify the associations of these groups with the mean number of accelerometer-assessed steps per day over 1 week as the dependent variable. 'Vigorous' was used as the reference group. RESULTS average number of steps per day in the four groups were 6,339 ('vigorous'), 5,781 ('anxious'), 4,555 ('stoic') and 4,528 ('aware'). Compared with the 'vigorous', 'stoic' (-1,482; confidence interval (CI): -2,473; -491) and 'aware' (-1,481; CI: -2,504; -458) participants took significantly less steps, but not the 'anxious' (-580 steps; CI: -1,440; 280). CONCLUSION we have integrated a digital mobility outcome into a fall risk categorisation based on ORF and PRF. Steps per day in this sample of community-dwelling older persons were in accordance with their ORF rather than their PRF. Whether this grouping approach can be used for the specification of participants' needs when taking part in programmes to prevent falls and simultaneously promote physical activity remains to be answered in intervention studies.
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Affiliation(s)
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Chris Todd
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Jansen CP, Nerz C, Labudek S, Gottschalk S, Kramer-Gmeiner F, Klenk J, Dams J, König HH, Clemson L, Becker C, Schwenk M. Lifestyle-integrated functional exercise to prevent falls and promote physical activity: Results from the LiFE-is-LiFE randomized non-inferiority trial. Int J Behav Nutr Phys Act 2021; 18:115. [PMID: 34479573 PMCID: PMC8414469 DOI: 10.1186/s12966-021-01190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The 'Lifestyle-integrated Functional Exercise' (LiFE) program successfully reduced risk of falling via improvements in balance and strength, additionally increasing physical activity (PA) in older adults. Generally being delivered in an individual one-to-one format, downsides of LiFE are considerable human resources and costs which hamper large scale implementability. To address this, a group format (gLiFE) was developed and analyzed for its non-inferiority compared to LiFE in reducing activity-adjusted fall incidence and intervention costs. In addition, PA and further secondary outcomes were evaluated. METHODS Older adults (70 + years) at risk of falling were included in this multi-center, single-blinded, randomized non-inferiority trial. Balance and strength activities and means to enhance PA were delivered in seven intervention sessions, either in a group (gLiFE) or individually at the participant's home (LiFE), followed by two "booster" phone calls. Negative binomial regression was used to analyze non-inferiority of gLiFE compared to LiFE at 6-month follow-up; interventions costs were compared descriptively; secondary outcomes were analyzed using generalized linear models. Analyses were carried out per protocol and intention-to-treat. RESULTS Three hundred nine persons were randomized into gLiFE (n = 153) and LiFE (n = 156). Non-inferiority of the incidence rate ratio of gLiFE was inconclusive after 6 months according to per protocol (mean = 1.27; 95% CI: 0.80; 2.03) and intention-to-treat analysis (mean = 1.18; 95% CI: 0.75; 1.84). Intervention costs were lower for gLiFE compared to LiFE (-€121 under study conditions; -€212€ under "real world" assumption). Falls were reduced between baseline and follow-up in both groups (gLiFE: -37%; LiFE: -55%); increases in PA were significantly higher in gLiFE (+ 880 steps; 95% CI 252; 1,509). Differences in other secondary outcomes were insignificant. CONCLUSIONS Although non-inferiority of gLiFE was inconclusive, gLiFE constitutes a less costly alternative to LiFE and it comes with a significantly larger enhancement of daily PA. The fact that no significant differences were found in any secondary outcome underlines that gLiFE addresses functional outcomes to a comparable degree as LiFE. Advantages of both formats should be evaluated in the light of individual needs and preferences before recommending either format. TRIAL REGISTRATION The study was preregistered under clinicaltrials.gov (identifier: NCT03462654 ) on March 12th 2018.
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Affiliation(s)
- Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Sarah Labudek
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
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Applying Social Cognition Models to Explain Walking Duration in Older Adults: The Role of Intrinsic Motivation. J Aging Phys Act 2021; 29:744-752. [PMID: 33567407 DOI: 10.1123/japa.2020-0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Abstract
This study examined the applicability of the health action process approach (HAPA) to walking duration in older adults and the added value of extending the HAPA by intrinsic motivation. Self-reports from older adults (N = 309; Mage = 78.7, 70-95 years) regarding activity-related intrinsic motivation and HAPA variables were collected at the baseline of a fall prevention intervention study. Walking duration at ≥3 metabolic equivalents of task was measured for 7 days via body-worn accelerometers. Two structural equation models with walking duration as a manifest outcome were specified. In both models, the model fit was acceptable, but intention and planning were not associated with walking duration. Intrinsic motivation was significantly related to most HAPA variables and walking duration. Variance explained for walking duration was R2 = .14 in the HAPA and R2 = .17 in the extended model. For explaining older adults' walking duration, intrinsic motivation, but not HAPA-based intention and planning, seemed to be important.
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Reicherzer L, Kramer-Gmeiner F, Labudek S, Jansen CP, Nerz C, Nystrand MJ, Becker C, Clemson L, Schwenk M. Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability. BMC Geriatr 2021; 21:93. [PMID: 33522904 PMCID: PMC7852079 DOI: 10.1186/s12877-020-01991-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE. Methods Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo. Results In both formats, participants (N = 30, 22 women, ngLiFE = 15, nLiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits. Conclusion This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE. Trial registration ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01991-0.
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Affiliation(s)
- Leah Reicherzer
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | | | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Malin J Nystrand
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lindy Clemson
- Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.
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Gottschalk S, König HH, Schwenk M, Jansen CP, Nerz C, Becker C, Klenk J, Dams J. Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study. BMC Geriatr 2020; 20:401. [PMID: 33054728 PMCID: PMC7556961 DOI: 10.1186/s12877-020-01802-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Previous research has shown that not only falls, but also fear of falling (FoF) influences health-related quality of life (HrQoL) negatively. The EQ-5D (consisting of an index and a visual analogue scale [EQ-VAS]) is a frequently used instrument to determine HrQoL in clinical studies and economic evaluations, but no previous study compared the association between FoF and the EQ-5D index with the association between FoF and the EQ-VAS. Moreover, factors that influence the association between FoF and HrQoL are rarely examined. Thus, this study aimed to examine the association between FoF and HrQoL and to examine factors that mediate the association. Methods FoF (Short Falls Efficacy Scale International) and HrQoL (EQ-5D descriptive system, EQ-5D index, and EQ-VAS) were assessed in a sample of community-dwelling older persons (≥70 years) participating in the baseline assessment of a randomized controlled trial (N = 309). Linear and logistic regression analyses were performed, adjusting for sociodemographic variables, frequency of falls, number of chronic conditions, functional mobility (Timed up-and-go test), and subjective functional capacity (LLFDI function and disability scales). Multiple regression models were used to test the mediating effects. Results Moderate or high FoF was prevalent in 66% of the sample. After adjusting for covariates, FoF was negatively associated with the EQ-5D index, but not with the descriptive system or the EQ-VAS. Subjective functional capacity partly mediated the association between FoF and the EQ-5D index and completely mediated the association between FoF and the EQ-VAS. Conclusion FoF was negatively associated with the EQ-5D index. As subjective functional capacity mediated the association between FoF and HrQoL, future interventions should account for subjective functional capacity in their design.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | | | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
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Kramer F, Labudek S, Jansen CP, Nerz C, Fleig L, Clemson L, Becker C, Schwenk M. Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing. Pilot Feasibility Stud 2020; 6:6. [PMID: 31993213 PMCID: PMC6975023 DOI: 10.1186/s40814-019-0539-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
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 community-dwelling 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. TRIAL REGISTRATION ClinicalTrials.gov NCT03412123. Registered on January 26, 2018.
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Affiliation(s)
- Franziska Kramer
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | | | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Lena Fleig
- Faculty of Natural Sciences, Department of Psychology, Health Psychology, Medical School Berlin, Berlin, Germany
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
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Schwenk M, Bergquist R, Boulton E, Van Ancum JM, Nerz C, Weber M, Barz C, Jonkman NH, Taraldsen K, Helbostad J, Vereijken B, Pijnappels M, Maier A, Zhang W, Becker C, Todd C, Clemson L, Hawley-Hague H. The Adapted Lifestyle-Integrated Functional Exercise Program for Preventing Functional Decline in Young Seniors: Development and Initial Evaluation. Gerontology 2019; 65:362-374. [DOI: 10.1159/000499962] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022] Open
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Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1:CD012424. [PMID: 31789289 PMCID: PMC6360922 DOI: 10.1002/14651858.cd012424.pub2] [Citation(s) in RCA: 433] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. MAIN RESULTS We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control. AUTHORS' CONCLUSIONS Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.
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Affiliation(s)
- Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Nicola J Fairhall
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Geraldine K Wallbank
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Anne Tiedemann
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Zoe A Michaleff
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Kirsten Howard
- The University of SydneySchool of Public HealthSydneyNSWAustralia2006
| | - Lindy Clemson
- The University of SydneyFaculty of Health SciencesEast St. LidcombeLidcombeNSWAustralia1825
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Sarah E Lamb
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
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