USE OF BEHAVIOR CHANGE TECHNIQUES, ADHERENCE AND THE EFFECTIVENESS OF EXERCISE INTERVENTION TARGETING FALLS PREVENTION IN COMMUNITY-DWELLING ADULTS AGED 60+

W. Kwok^1,2, J. Oliveira^1,2, S. Nyman³, A. Tiedemann^1,2, M. Pinheiro^1,2, S. Khalatbari-Soltani^2,4, C. Sherrington^1,2

¹Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia, ²School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, ³University of Winchester, Department of Psychology, Winchester, Hampshire, United Kingdom, ⁴ARC Centre of Excellence in Population Aging Research (CEPAR), The University of Sydney, Sydney, Australia

Background: Exercise prevents falls in community-dwelling older adults.However, adherence to exercise intervention for falls prevention is sub-optimal. Participants’ characteristics or exercise intervention components including the promotion of behaviour change using behaviour change techniques (BCTs) may affect adherence to and effectiveness of exercise for falls prevention.

Purpose: 1) Summarise the use of BCTs in exercise interventions targeting falls prevention;
2) examine associations between BCTs, intervention components, participant characteristics and adherence;
3) explore the associations between BCTs, adherence, and effectiveness of supervised exercise intervention for falls prevention.

Methods: Update andsecondary analysis of the 2019 Cochrane Review investigating exercise for fall prevention in community-dwelling people aged 60+. Use of BCTs in exercise interventions published in English were coded according to the published BCT taxonomy. Regression analyses were used to explore the relationship between adherence to supervised exercise intervention with exercise intervention components (exercise type, intervention duration, session frequency and duration, delivery mode) and participants characteristics (age, sex, fall risk at enrollment). Meta-regression explored differential impacts of the exercise interventions on falls according to use of BCTs and adherence. We pooled estimates of the effect on rate of falls in exercise interventions that included commonly used BCT groupings compared with control.

Results: This study included 123 studies tested 165 exercise interventions, of which 105 studies were included in the 2019 Cochrane Review. A total of 999 BCTs were identified, with the number of BCTs used per intervention ranging between 2 and 14 (median=6). The most commonly used BCT groupings were “repetition and substitution” (292/999, 29%), “goals and planning” (205/999, 21%) and “shaping knowledge” (164/999, 16%). Adherence was associated with frequency of exercise with the odds of adherence increased by 76% (95% CI 6% to 194%, p=0.03) for an increase of one session/week, but 4% less (95% CI 2% to 7%, p<0.0001) for every one week increase of the intervention period and 72% less (95% CI 12% to 85% p=0.02) for programs that included home exercise, compared to those without. Adherence was not associated with age, sex, fall risk at enrollment, exercise type or delivery mode. Interventions with greater adherence were associated with greater effects of exercise on falls (p=0.007). No relationship was evident between the overall number of BCTs and the effect of exercise on falls (p=0.72). Exercise interventions that were coded with commonly used BCT groupings ‘repetition and substitution’, ‘goals and planning’ and ‘shaping knowledge’ reduced rate of falls by 25% (95% CI 18% to 31%), 24% (95% CI 17% to 29%), and 24% (95% CI 19% to 30%) (all p-values <0.0001), respectively, compared with control.

Conclusions: Adherence was positively associated with number of sessions per week but negatively associated with program duration and inclusion of home exercise. Greater effects of exercise on falls were seen in interventions with greater adherence. There was no association between number of BCTs used and the effectiveness of exercise interventions on falls.

Implications: Understanding the use of BCTs and components in exercise interventions associated with greater adherence and effectiveness could guide the design and implementation of exercise for fall prevention.

Funding acknowledgements: WK was supported by the National Health and Medical Research Council Center of Research Excellence Prevention of Falls injuries

Keywords:
Accidental Falls
Exercise
Older adults

Topics:
Older people
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Reason: The project is a secondary analysis of the published Cochrane review to identify the use of behaviour change techniques, intervention and participants characteristics in exercise intervention targeting falls prevention and the associations between these charactertics with adherence and the effectiveness of exercise on falls prevention.