Sawa R.1, Doi T.2, Murata S.3, Nakamura R.4, Isa T.3, Ebina A.3, Kondo Y.3, Tsuboi Y.3, Asai T.5, Ono R.3
1International University of Health and Welfare, Physical Therapy, Narita, Japan, 2National Center for Geriatrics and Gerontology, Obu, Japan, 3Kobe University Graduate School of Health Sciences, Kobe, Japan, 4Home Visit Nursing Care Station Sakura, Nishinomiya, Japan, 5Kobegakuin University, Kobe, Japan
Background: Fear of falling (FoF) refers to a lack of self-confidence that normal activities can be performed without falling, and the prevalence ranges up to 60% in the community-dwelling older adults. Restrictions of activity of daily living and/or life-space may be caused by FoF. However, studies investigating the association between FoF and objectively measured physical activity were scarce, and little is known about the influence of FoF on the intensity of physical activity.
Purpose: The aim of this study was to describe the associations between fear of falling (FoF) and objectively measured physical activity in community-dwelling older adults.
Methods: Two hundred and fifty-seven subjects were analyzed in this cross-sectional study. FoF was assessed by using the Fall Efficacy Scale International (FES-I), and we categorized subjects into three groups based on the score of FES-I; low FoF (16-19), moderate FoF (20-27), and high FoF (28-64). Our subjects were asked to attach a uniaxial accelerometer (Kenz Lifecorder EX, SUZUKEN CO., LTD, Aichi, Japan) for 7 consecutive days while awake except for sleeping, bathing and swimming. We calculated steps per day, duration of light intensity physical activity (LPA) and duration of moderate/vigorous intensity physical activity (MVPA). To clarify the association of FoF with each measure of physical activity, linear regression analysis were performed in multivariate model. Objective variables were each measure of physical activity, whereas explanatory variable was FoF. Confounding variables were age, sex, years of education, body mass index, current smoking, living alone, the number of medications use, the number of comorbidities, gait speed, depressive symptom assessed by Geriatric Depression Scale, the number of chronic pain sites and the number of falls in the past year. Beta coefficient (Beta) and 95% confidence intervals (CI) were calculated in all models. All participants were informed adequately about this study and signed written consent forms, according to the Declaration of Helsinki, before their participation.
Results: After the adjustment for confounding variables, moderate FoF was significantly associated with LPA (Beta -10.2, CI -20.2 to -0.3). By contrast, high FoF showed the significant association with all domains of physical activity. (step counting: Beta -2194.1, CI -3574.6 to -813.6; LPA: Beta -14.1, CI -26.9 to -1.3; MVPA: Beta -11.1, CI -20.2 to -2.0).
Conclusion(s): FoF is serious barrier against all domains of physical activity in older adults. In particular, LPA restriction associated with FoF should be considered when aiming to increase physical activity levels in community setting.
Implications: LPA is main activity of older adults in the community. Therefore, our results demonstrate the importance, for community-dwelling older adults, of reducing FoF to maintain physical activity in daily life.
Funding acknowledgements: none
Topic: Older people
Ethics approval: Ethical approval for this study was given by the Ethics Committee of Kobe University Graduate School of Health Sciences.
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