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

Comprehensive Assessment of Lower Limb Function and Muscle Strength in Sarcopenia: Insights from the Sit-to-Stand Test

The sit-to-stand test is an essential tool used to assess lower limb function and muscle strength in older adults and various patient populations, and also plays a role in sarcopenia screening. Among its forms, the five-time sit-to-stand test (FTSST) is widely used, with previous studies suggesting cutoff values of >10 seconds and >11 seconds for the sitting-to-standing and standing-to-sitting transitions, respectively. The 30-second and 1-minute sit-to-stand tests (30STS and 1MSTS, respectively) also provide comprehensive assessments. While much of the current research on sarcopenia focuses on the FTSST, there is a burgeoning need for an in-depth exploration of the 30STS and 1MSTS. Studies on these tests are vital to refine the criteria for sarcopenia, establish accurate cutoff values, and enhance diagnostic precision and treatment effectiveness. This need highlights the importance of further research into the 30STS and 1MSTS for refining the diagnostic criteria for sarcopenia.

Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall

BACKGROUND

Continuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored.

METHODS

The primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people's experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training.

DISCUSSION

Tele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ( https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1 ), registration number: ChiCTR2200063370. Registered on 5 September 2022.

The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis

BACKGROUND

Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults.

OBJECTIVE

To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty.

METHODS

We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors.

RESULTS

10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people.

CONCLUSIONS

The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.

Knowledge and Use of Evidence-Based Programs for Older Adults in the Community: A Survey of Physical Therapy Professionals

BACKGROUND AND PURPOSE

The Agency for Healthcare Research and Quality highlights the need for sustainable linkages between clinical and community settings to enhance prevention and improve care of people with chronic conditions. The first step in promoting linkages is understanding the knowledge and use of evidence-based programs by physical therapy (PT) professionals. Therefore, the objective of this study was to describe the knowledge of and referral to evidence-based programs in the community by a convenience sample of PT professionals and to examine the characteristics of those who refer to evidence-based programs.

METHODS

A cross-sectional web-based survey containing 36 questions regarding respondents' demographics and evidence-based program knowledge and referral practices was disseminated to a convenience sample of PT professionals via email, news-blasts, social media, and word of mouth.

RESULTS AND DISCUSSION

A total of 459 PT professionals completed the survey. Approximately half reported practicing for more than 20 years and 75% are members of the American Physical Therapy Association (APTA). The majority (74%) are aware of evidence-based programs; however, fewer (56%) refer to these programs. Compared with individuals who do not refer to evidence-based programs, individuals who refer are more likely to be involved in PT organizations and be an APTA Geriatrics member. Of the individuals who do not refer to evidence-based programs, 21.5% reported not knowing they existed and 33% reported not knowing where the programs are located.

CONCLUSIONS

Most survey respondents reported knowing about evidence-based programs and more than half reported being aware of the evidence-based programs available in their communities. These results indicate many PT professionals already have a knowledge of evidence-based programs to support clinic-community linkages. As survey respondents were a sample of convenience and likely do not represent all PT professionals in the United States, the results should be interpreted with caution. Additional research on a more representative sample is needed to fully understand the current utilization of evidence-based programs, which will enable us to design efforts to improve the clinic to community transition. Improving linkages between PT professionals and community resources has the potential to benefit both patients and clinicians and lessen the burden on the health care system.

Using an academic-community partnership model to deliver evidence-based falls prevention programs in a metropolitan setting: A community case study

Background

Prevention is an effective approach for mitigating the negative health outcomes associated with falls in older adults. The Administration for Community Living (ACL) has sponsored the implementation of evidence-based falls prevention programs (EBFPPs) across the United States through cooperative agreement grants to decrease the health and economic burden of falls. Marymount University received two of these grants to deliver three EBFPPs into the northern Virginia region. This community case study describes the development of a collaboration between a university and community-based organizations to adopt and implement multiple evidence-based programming in an area where none previously existed.

Methods

Through an academic-community partnership, EBFPPs were introduced to and implemented by senior-focused organizations. Target adopters were senior and community centers, multi-purpose senior services organizations, recreational organizations, and residential facilities serving older adults. The three EBFPPs were (1) Stay Active and Independent for Life (SAIL), (2) a Matter of Balance (MOB) and (3) Otago Exercise Program (OEP). Key interdependent project elements included: (1) fostering ongoing community organization collaboration, (2) introducing programs in the community, (3) growing and sustaining delivery sites, (4) preparing trained program leaders, and (5) building community demand for the programs.

Results

From August 2016–June 2022, 5,857 older adults participated in one of the three EBFPPs. SAIL classes were offered at 33 sites and MOB workshops at 31 with over 70% of them occurring at community or senior centers. OEP was offered at 4 sites. Factors that influenced the implementation of these programs included having: key advocates at host organizations, programs embedded into site workflows, sufficient capacity and workforce, engaged invested partners, and flexibility in working with a complex set of agencies and systems with different administrative structures.

Conclusion

By connecting academic faculty with various community members from multiple sectors, new initiatives can be successfully implemented. Results from this ACL-funded project indicate that using an academic-community partnership model to build relationships and capacity for ongoing delivery of health promotion programming for older adults is feasible and effective in delivering EBFPPs. In addition, academic-community partnerships can develop a strong network of invested partners to foster continued support of fall prevention activities.

Experience and Perceptions among Older Outpatients after Myocardial Infarction following an Exercise Intervention: A Qualitative Analysis from the PIpELINe Trial

Traditional cardiac rehabilitation (CR) programs effectively improve physical performance and outcomes after myocardial infarction (MI). However, older patients are less likely to participate in such programs. The aim of this qualitative analysis was to investigate experiences and perceptions of cardiac outpatients enrolled in an innovative and exercise-based CR program and to identify possible barriers to improving adherence and quality of life. Semi-structured interviews were conducted on a sample of 31 patients (84% male; age 76 ± 6 years) from the Physical Activity Intervention in Elderly after Myocardial Infarction (PIpELINe) trial, after about six months of the event. Three main themes were identified: Personal feelings after the event; lifestyle change and perception of barriers; and relationships with familiars. Participants perceived sensations of fear at the time of their diagnosis and showed awareness of the importance of following specific health suggestions. They reported a significative change in previous habits and highlighted the need for periodic controls. Few of them felt insecure in carrying out daily activities or practicing exercise and reported an unnecessary protection from the family members. These findings will provide valuable insights for the development of a more feasible patient-centered CR model of intervention.

Effect of Zingiber Cassumunar Roxb. Phonophoresis Versus Aqua Sonic Gel on Pain, Range of Motion, and Functional Disability in Patients With Osteoarthritis of Knee: A Randomized Controlled Trial

The aim of this trial was to collate, analyze, and compare the effectiveness of phonophoresis and ultrasound adjunct to Otago exercise program for pain, knee range of motion, and functional disability in patients with grades I and II of knee osteoarthritis. This is a single-blind randomized control study. A total of 52 patients with pre-diagnosed osteoarthritis on radiological investigation were included in the study. They were then randomly assigned into two groups: group A (n=26) received the experimental treatment, which included phonophoresis, and group B (n=26) subjects were treated with conventional physiotherapy. The interventions were given for six days/week for two weeks. Pain via the visual analog scale, knee range of motion via a goniometer, level of functional disability through the Western Ontario and McMaster Universities Osteoarthritis Index, and balance through the star excursion balance test were evaluated. Measurements of the outcome were taken prior to initiation of intervention and on the day of the last session, succeeding the treatment. Statistically, both the groups showed significant improvement in pain, range, dynamic balance, and functioning. Between the two groups, no clinically significant difference was present for balance, but the intergroup comparison for pain and functions was statistically and therefore clinically significant. Phonophoresis treatment was observed to be effective in treating pain in osteoarthritis. Combined Otago exercises and phonophoresis with modified gel can be used to achieve superior clinical results.

Effect of Otago exercise programme on limb function recovery in elderly patients with hip arthroplasty for femoral neck fracture

OBJECTIVES

Hip arthroplasty is the most important surgical method for the treatment of hip fractures and necrosis in the femoral head. Limb function recovery is an important criterion to reflect the efficacy of surgery and the quality for life of patients. Postoperative rehabilitation exercises are crucial for limb function recovery. Otago exercise programme (OEP) is a safe, effective, practical, and economical rehabilitation exercise, which has been proven to prevent falls, improve limb function and walking ability, and lower limb strength. This study aims to explore the effect of OEP on limb function rehabilitation in elderly patients with hip arthroplasty for femoral neck fractures.

METHODS

A total of 77 elderly patients with hip arthroplasty for femoral neck fractures who met the criteria for inclusion and exclusion were enrolled for this study. They were randomly divided into a control group ( n =39) and an intervention group ( n =38). The control group was given routine rehabilitation training, and the intervention group performed OEP on the basis of the control group. Time get up and go test (TGUT), five times sit to stand test (FTSST), 10-meter walking test (10MWT), Harris Hip Score (HHS), Daily Activity Scale (Barthel index), and the Mos 36-Item Short Form Health Survey (SF-36) were used before the intervention, at discharge, and the 12th week after discharge.

RESULTS

Before the intervention, there were no differences in TGUT, FTSST, 10MWT, HHS score, Barthel index, and SF-36 score between the 2 groups (all P >0.05). At the discharge after the intervention, there was no difference in TGUT between the 2 groups ( P >0.05), but the FTSST and 10MWT in the control group were longer than those in the intervention group (both P <0.05), and the HHS score, Barthel index, and SF-36 score in the control group were lower than those in the intervention group ( P <0.05). At the 12th week after discharge, TGUT, FTSST, 10MWT, HHS score, Barthel index, and SF-36 score in the intervention group were better than those in the control group ( P <0.05).

CONCLUSIONS

OEP can effectively promote limb stability and hip function recovery in elderly patients with hip arthroplasty for femoral neck fractures, improve daily mobility and quality of life, and it is suitable for clinical application.

Normative Reference Values and Validity for the 30-Second Chair-Stand Test in Healthy Young Adults

Background

Clinicians often use physical performance tests (PPT) to measure performance measures in sports since they are easy to administer, portable, and cost-efficient. However, PPT often lack good or known psychometric properties. Perhaps, the 30-second chair-stand test (30CST) would be a good functional test in athletic populations as it has been shown to demonstrate good psychometric properties in older adults.

Hypothesis/Purpose

The purpose of this study was to determine normative values for and concurrent, convergent and discriminative validity of 30CST for healthy young adults aged 19-35 years.

Study Design

Cross-sectional.

Methods

Eighty-one participants completed this study. All participants performed two trials of 30CST, 5-times sit-to-stand (5xSTS), and lateral step-up test (LSUT). Investigators used the International Physical Activity Questionnaire Leisure Domain (LD-IPAQ) to divide participants into insufficiently or sufficiently active groups based on the weekly metabolic equivalent of task per the Physical Activity Guidelines for Americans.

Results

Participants (Mean + SD age, 25.1 ± 3.4 years; body height, 1.71 ± 0.09 m; body mass, 72.6 ± 16.1 kg; females 47) performed an average of 33.0±5.4 30CST repetitions. The 30CST performance was negatively associated with 5xSTS (r=-0.79 p=0.01) and positively associated with LSUT performances (r=0.51, p=0.01) when using Pearson correlations. In addition, the sufficiently active group performed significantly greater 30CST repetitions than the insufficiently active group (mean difference = 2.5; p=0.04).

Conclusions

In addition to finding a reference value for 30CST performance in young adults, investigators found that the 30CST displayed concurrent and convergent validity in assessing functional lower extremity (LE) muscle strength and discriminated between those with sufficient and insufficient physical activity levels. Training and rehabilitation professionals could use the 30CST for testing functional LE muscle strength for athletes in pre-season or during rehabilitation. Future investigators should perform studies to determine if 30CST predicts sport performance.

Level of Evidence

Level 2.

Promotion and maintenance of physically active lifestyle in older outpatients 2 years after acute coronary syndrome

AIMS

To examine long-term changes in lifestyle and exercise capacity of older patients hospitalized for acute coronary syndrome (ACS) involved in an innovative centre- and home-based exercise-based secondary prevention program.

METHODS

A sample of 118 patients with ACS (age 76 [72-80] years) was analysed. Long-term changes in self-reported weekly leisure-time physical activity (wLTPA), walking speed (WS), and estimated cardiorespiratory fitness (eCRF, VO₂peak, mL/kg/min) were the outcome variables. The program consisted of seven individual on-site sessions including motivational interviewing to reach exercise goals. Exercise prescription was based on the results of a standardized moderate and perceptually regulated treadmill walk to estimate VO₂peak. wLTPA, WS, and eCRF were assessed at 1 (baseline), 2, 3, 4, 6, 12, and 24 months after discharge.

RESULTS

87, 76, and 70 patients completed follow-up at 6, 12, and 24 months, respectively. wLTPA significantly increased during the follow-up period (median METs/H/week 2.5, 11.2, 12.0, and 13.4 at baseline, 6, 12, and 24 months, respectively; P < 0.0001). At baseline, 18% of the sample met the current international guidelines for physical activity, while 75%, 70%, and 76% of them met the recommended values at 6-, 12-, and 24-month follow-up sessions, respectively. These results were associated with increasing median WS (2.9 ± 1.0, 4.3 ± 1.2, 4.5 ± 1.1, 4.5 ± 1.2 km/h, respectively, P < 0.0001), and VO₂peak (16.5, 21.4, 21.1, 21.3 mL/kg/min, respectively, P < 0.0001).

CONCLUSIONS

This early, individualized exercise intervention improved long-term adherence to a physically active lifestyle, walking capacity, and eCRF in older patients after ACS. Larger studies are needed to confirm short- and long-term clinical benefits of this intervention.

Effects of the Otago exercise program on falls, balance, and physical performance in older nursing home residents with high fall risk: a randomized controlled trial

PURPOSE

The aim of this study was to evaluate the effects of Otago exercises on falls, balance, and physical performance in old-aged adults with high fall risk living in a nursing home.

METHODS

This randomized controlled trial included 72 individuals over 65 years of age residing in a single nursing home in Izmir, Turkey. The participants were randomized into the Otago exercise group and walking (control) group. The Otago group performed 45 min of Otago exercises 3 days/week for 12 weeks plus a walking program on 3 other days of the week. The control group did only the walking program (minimum of 30 min 3 days/week). Number of falls, Berg Balance Scale (BBS), 30-s Chair Stand Test (30 s-CST), and 6-min Walk Test (6MWT) were assessed before the intervention and at the end of the 3-month intervention. The primary outcome was number of falls.

RESULTS

The groups were well matched in terms of age (74.6 ± 5.9 vs. 75.8 ± 4.5) and sex (p > 0.05). The Otago group showed a significantly greater reduction in number of falls at the end of the intervention (p < 0.05). Of the secondary outcomes, the Otago group had greater median increases in BBS score (p < 0.05) and 30 s-CST score (p < 0.05) post-intervention compared to the walking group. There was no significant difference between the groups in terms of post-intervention change in 6MWT distance (p > 0.05).

CONCLUSION

The Otago exercise program improved balance and physical performance and reduced falls in our sample and may be effective in falls prevention interventions for old-aged nursing home residents.

Mobility in Older Community-Dwelling Persons: A Narrative Review

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.

Effects of a personalized physical exercise program in peripheral and central blood pressure in community dwelling old hypertensive adults: the AGA@4life intervention model

We aimed at testing the effect of a tailored physical exercise intervention program on brachial and central blood pressure (bBP and cBP, respectively) in a group of hypertensive old adults. Thirty-three participants (mean age: 82 ± 9 years) were divided into two groups (intervention group and control group) according to their adherence to the physical training program. The exercise program included aerobic and strength components, prescribed in a personalized approach, and implemented under a strict control of two experienced professionals. An oscillometric-based device was used to measure bBP and cBP, both at baseline ant 3 months after the intervention period. The groups had similar clinical and demographic characteristics at baseline. No significant changes were observed in any of the considered endpoints in the control group. Conversely, a significant reduction was depicted in the intervention group, for both bBP and cBP. The results demonstrate that physical exercise prescribed in a tailored approach is an effective nonpharmacological tool to reduce pBP and cBP in older adults.

A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Clinical trial testing in-home multidisciplinary care management for older adults with cognitive vulnerability: Rationale and study design

Care management approaches are being widely tested in the Medicare-eligible population to manage chronic conditions, but few have focused on cognitive vulnerability as the pathway to optimizing independence in the community-dwelling older population. Cognitive vulnerability refers to living with dementia, depression, and/or a history of delirium. Many studies have shown that cognitive vulnerability is associated with poor health-related outcomes in community-dwelling older adults, raising the health policy importance of finding evidence-based approaches to improve outcomes for this target population. Moreover, very little is known about effects of care management approaches in the rapidly growing Medicare Advantage population. In response to these knowledge gaps, we are testing the efficacy of an in-home, nurse practitioner-led care management team for adults age ≥ 65 with cognitive vulnerability in a Medicare Advantage population. Older adults and family caregivers randomized either to this multidisciplinary care management team, or to a telephonic care management program routinely offered by our Medicare Advantage partner. The intervention period is 12 months and the primary outcome is any emergency department visit or hospitalization over the 12-month period. In this paper, we report on the rationale for testing a multidisciplinary care management intervention for this target population, and explain how a university-based research team collaborated with a Medicare Advantage insurer to conceptualize and implement the clinical trial. We also provide details on study design, and on components of the in-home and telephonic care management interventions. We conclude with a synopsis of recruitment progress along with selected baseline characteristics of the study cohort.

Characteristics Associated with Improved Physical Performance among Community-Dwelling Older Adults in a Community-Based Falls Prevention Program

This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation of the Otago Exercise Program (OEP). Participants with increased falls risk (n = 353) were provided with individualized exercises from OEP and were invited to return for monthly follow-up. One hundred twenty-eight participants returned for at least two follow-up visits within 6 months of their initial visit (mean time to second follow-up = 93 days with standard deviation = 43 days). Outcome measures assessed at initial and all follow-up visits included Four Stage Balance Test (4SBT), Timed Up and Go test (TUG), and Chair Rise Test (CRT). Distributions were examined, and results were categorized to depict improvement from initial visit (IVT) to second follow-up visit (F2). Key predictor variables were included in multivariable linear or logistic regression models. Improved 4SBT performance was predicted by greater balance confidence. Better TUG performance at F2 was predicted by no use of assistive device for walking, higher scores on cognitive screening, and better IVT TUG performance. Improvement on CRT was predicted by younger age and lower scores on cognitive screening. While improvements on each of the three measures were predicted by a unique combination of variables, these variables tended to be associated with less frailty.

Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial

OBJECTIVE

To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS).

METHODS

The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4-9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded.

RESULTS

Overall, 235 patients with ACS (median age 76 (73-81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70-90) vs 70 (50-80) points, p<0.001 and at 1 year 75 (70-87) vs 65 (50-80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04).

CONCLUSIONS

The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit.

TRIAL REGISTRATION NUMBER

NCT03021044.

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

The aim of this randomized controlled trial was to examine the 12-month effects of the home-based Otago Exercise Program (OEP) with or without the support of motivational interviewing (MI) on community-dwelling people 75 years and older who needed walking aids and/or home help service. In total, 175 participants were randomized into three groups: OEP (n = 61), OEP with MI (n = 58), and a control group (n = 56) (M age = 83 years). Measures were physical performance, physical activity level, balance, grip strength, fall-related self-efficacy, fall rate, and fall injury rate. The OEP with and the OEP without MI, with the support of a physical therapist (six home visits and three phone calls), demonstrated no benefits in any of the measures compared with a control group. In this subgroup of pre-frail older adults, more frequent support by personnel may be required to secure efficient intensity and progression in the exercises performed on your own at home.

Effectiveness of robotics fall prevention program among elderly in senior housings, Bangkok, Thailand: a quasi-experimental study

OBJECTIVE

This study aimed at investigating the effectiveness of a robotic fall prevention program on knowledge, exercises, balance, and incidence of falls among elderly in senior housings.

PATIENTS AND METHODS

This is a quasi-experimental study. Sixty-four elderly in two senior housings in Bangkok with Barthel Index scale ≥12, who had either at least one fall experience in the past 12 months and/or had Timed Up and Go (TUG) test ≥20 seconds were recruited and purposively assigned to the intervention group (received a small robot-installed fall prevention software, personal coaching, and handbook, n=32) and control group (received only handbook, n=32). Outcomes were knowledge score evaluated by structured questionnaire through face-to-face interviews, number of exercises measured by self-recorded diary, and balance score assessed by TUG and Berg Balance Scale (BBS). The incidence of falls was assessed by face-to-face interviews. Both groups were assessed at baseline, 3rd, and 6th month after the intervention.

RESULTS

There was a statistically significant improvement in knowledge mean score at 6th month in both the groups. However, the intervention group showed faster increase in knowledge mean score than the control group at 3rd month (P<0.01). The intervention group showed a statistically significant higher number of exercises than the control group at 3rd and 6th month (P<0.05). There was no statistically significant difference on TUG and BBS mean scores between the two groups at baseline, 3rd, and 6th month. However, the intervention group showed a statistically significant improvement in TUG and BBS at 6th month post-intervention (P<0.01). There was one fall reported in the control group.

CONCLUSION

The robotic fall prevention program increased knowledge on fall prevention and promoted exercises and balance among elderly in senior housings.

Exercise, ageing and cognitive function - Effects of a personalized physical exercise program in the cognitive function of older adults

Ageing is associated with a progressive decline in cognitive function, which occurs according to heterogeneous trajectories, dependent on multiple physiological and environmental components. To tackle this major challenge, we designed a project to test the effect of a tailored physical exercise intervention program in the cognitive function of a Portuguese elderly cohort, included in the AGA@4life project. The exercise program included aerobic and strength components, prescribed in a personalized approach according to the AGA@4life model, and implemented under direct control of two experienced professionals. The 33 included elderly participants were divided into two groups (intervention group -IG - and control group - CG) according to their willingness to participate in the physical training program. Cognitive function was evaluated with the Cambridge Neuropsychological Test Automated Battery (CANTAB) platform at baseline ant three-months after the intervention period in all the participants. The groups had similar clinical and demographic characteristics at baseline. After the intervention program, significant improvements in cognitive function were observed in the IG, but not in the CG. Particularly, a significant improvement in motor control, spatial working memory and visuospatial associate learning were depicted in the IG, which revealed an overall better cognitive performance as compared with the CG after the follow-up period. The results clearly identify physical exercise as an effective non-pharmacological tool to positively modulate age-related decline in cognitive function in older adults, particularly when prescribed in a personalized approach with a multicomponent structure as foreseen in the innovative AGA@4life model.

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination

Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults.

Does modified Otago Exercise Program improves balance in older people? A systematic review

Exercise interventions focused on strength and balance are effective for falls prevention in older people, however compliance to exercise is often a problem. Tailored intervention programs are recommended to meet the person preferences and increase compliance. Otago Exercise Program (OEP) is the most disseminated fall prevention program and is individually prescribed at home. The purpose of this study was to identify OEP modified formats and investigate their effects on balance when compared to its original form of delivering.

Four electronic databases were searched, PubMed, PEDro, Science Direct and Scopus, between January and February 2017. Eligibility criteria included experimental or qualitative design studies conducted among older adults (≥50 years) at risk of falling, ongoing exercise interventions with modified formats of OEP. The primary outcome was balance. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used.

Eight studies met the inclusion criteria, five were randomized controlled trials (RCTs), two were quasi-experimental and one was a qualitative study. Therefore, a qualitative analysis was performed. Modified formats of OEP included additional vestibular or multisensory balance exercises, augmented reality, exercise in group and a DVD delivering format (in group or individual). In general, all studies using OEP modified formats reported improvements on balance and functional ability. However, it remains unclear if it is as effective as the original OEP and which modified format is more effective.

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Otago Exercise Program (OEP) is worldwide recommended for falls prevention.

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Our systematic review examined effectiveness of modified OEP on balance.

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Interventions with modified OEP improve balance and reduce falls in older adults.

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Evidence suggests that tailored interventions are effective and needed.

Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults

Background

Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk.

Objective

The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate.

Methods

A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features.

Results

Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00).

Conclusions

The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.