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Tuvemo Johnson S1, Anens E1, Johansson A-C2, Hellström K1
1Uppsala University, Department of Neuroscience, Uppsala, Sweden, 2Mälardalen University, School of Health, Care and Social Welfare, Västerås, Sweden
Background: Exercise programs designed to enhance physical function to support fall prevention in older adults have been investigated in a substantial number of studies. Still, the challenge of determining the best exercise program for the sub-group of older community-dwelling adults with limits in daily activities remains.
Purpose: The purpose of this study was to examine the long-term effect of the Otago exercise program (OEP) with or without the support of motivational interviewing (MI) on community-dwelling people 75 years and older who need walking aids and/or home help service.
Methods: A 3-armed, randomized, controlled trial was conducted with 175 participants with a mean age of 83 years. The participants were allocated into 2 intervention groups: OEP (n=61), OEP with MI (n=58) or a control group (n=56). The home exercises were instructed to be performed 3 times per week and walks were suggested on the days without exercises. A physical therapist made 6 home visits and 3 phone calls to support the participants in the two intervention groups over a 12-month period. Measures at baseline and after 12 months included: physical activity level (the Frändin/Grimby Activity Scale), physical performance (the Short Physical Performance Battery), balance (the Mini-BESTest), grip strength (the Jamar hand dynamometer), fall related self-efficacy (the Falls Efficacy Scale, Swedish version), fall rate (monthly fall calendar) and fall injury rate (telephone call). For parametric analyses the one-way analyses of variance (ANOVA) and the paired t test were used, and for non-parametric analyses the Kruskal Wallis independent samples test and Wilcoxon's signed-rank were used.
Results: Physical function and the activity level were maintained in all groups over 12 months. The results did not demonstrate a long-term benefit of the home-based OEP or home-based OEP+MI compared to a control group regarding physical performance, walking speed, grip strength, balance, physical activity, fall self-efficacy, fall rate and fall injury rate. These results are in contrast to previous studies on the outcomes of the OEP in older community-dwelling adults.
Conclusion(s): Home exercise interventions with physical therapist support 9 times over a 12-month period demonstrated no benefits for community-dwelling older Swedes who needed walking aids or home help service. In this sub-group of older adults, alternative delivery arrangements and/or more frequent support by physical therapist or other personnel may be required to secure efficient intensity and challenges in the exercises performed at home.
Implications: If home-exercises are performed to enhance physical functioning, the individual and the physical therapist should reflect on the specific exercise to determine whether it can be accomplished with enough challenge when the physical therapist is not present. Regular follow-ups and adjustments in exercise levels to secure safety and enough degree of difficulty in the exercises are recommended.
Keywords: Fall prevention, older adults, exercise
Funding acknowledgements: The municipality of Uppsala, The regional research council in Uppsala and Örebro, and the Medical faculty of Uppsala University
Purpose: The purpose of this study was to examine the long-term effect of the Otago exercise program (OEP) with or without the support of motivational interviewing (MI) on community-dwelling people 75 years and older who need walking aids and/or home help service.
Methods: A 3-armed, randomized, controlled trial was conducted with 175 participants with a mean age of 83 years. The participants were allocated into 2 intervention groups: OEP (n=61), OEP with MI (n=58) or a control group (n=56). The home exercises were instructed to be performed 3 times per week and walks were suggested on the days without exercises. A physical therapist made 6 home visits and 3 phone calls to support the participants in the two intervention groups over a 12-month period. Measures at baseline and after 12 months included: physical activity level (the Frändin/Grimby Activity Scale), physical performance (the Short Physical Performance Battery), balance (the Mini-BESTest), grip strength (the Jamar hand dynamometer), fall related self-efficacy (the Falls Efficacy Scale, Swedish version), fall rate (monthly fall calendar) and fall injury rate (telephone call). For parametric analyses the one-way analyses of variance (ANOVA) and the paired t test were used, and for non-parametric analyses the Kruskal Wallis independent samples test and Wilcoxon's signed-rank were used.
Results: Physical function and the activity level were maintained in all groups over 12 months. The results did not demonstrate a long-term benefit of the home-based OEP or home-based OEP+MI compared to a control group regarding physical performance, walking speed, grip strength, balance, physical activity, fall self-efficacy, fall rate and fall injury rate. These results are in contrast to previous studies on the outcomes of the OEP in older community-dwelling adults.
Conclusion(s): Home exercise interventions with physical therapist support 9 times over a 12-month period demonstrated no benefits for community-dwelling older Swedes who needed walking aids or home help service. In this sub-group of older adults, alternative delivery arrangements and/or more frequent support by physical therapist or other personnel may be required to secure efficient intensity and challenges in the exercises performed at home.
Implications: If home-exercises are performed to enhance physical functioning, the individual and the physical therapist should reflect on the specific exercise to determine whether it can be accomplished with enough challenge when the physical therapist is not present. Regular follow-ups and adjustments in exercise levels to secure safety and enough degree of difficulty in the exercises are recommended.
Keywords: Fall prevention, older adults, exercise
Funding acknowledgements: The municipality of Uppsala, The regional research council in Uppsala and Örebro, and the Medical faculty of Uppsala University
Topic: Older people; Health promotion & wellbeing/healthy ageing
Ethics approval required: Yes
Institution: Uppsala University
Ethics committee: The Regional Ethics Review Board of Uppsala, Sweden
Ethics number: Dnr. 2012/147
All authors, affiliations and abstracts have been published as submitted.
