E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial

Delbaere, Kim, Valenzuela, Trinidad, Lord, Stephen R., Clemson, Lindy, Zijlstra, G.A. Rixt, Close, Jacqueline C.T., Lung, Thomas, Woodbury, Ashley, Chow, Jessica, McInerney, Garth, Miles, Lillian, Toson, Barbara, Brigs, Nancy, and van Schooten, Kimberley S. (2021) E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. British Medical Journal, 373. n740.

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Abstract

Objective: To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people.

Design: Assessor blinded, randomised controlled trial.

Setting: Older people living independently in the community in Sydney, Australia.

Participants: 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise.

Interventions: Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years.

Main outcome measures: The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number of injurious falls (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months.

Results: The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.82, 95% confidence interval 0.66 to 1.02, P=0.070). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.72 to 1.12, P=0.348). However, the intervention group had a 16% lower rate of falls over 24 months (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027) and a 20% lower rate of injurious falls over 24 months compared with the control group (incidence rate ratio 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.74 to 1.02, P=0.077). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred.

Conclusions: The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies.

Item ID: 72788
Item Type: Article (Research - C1)
ISSN: 1756-1833
Keywords: falls, balance, older people, exercise, randomised controlled trial
Copyright Information: Copyright © Author(s) (or their employer(s)) 2019. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC grant APP1084739, NHMRC grant APP1105106, NHMRC grant APP1117171, NHMRC Early Career Fellowship APP1141392
Date Deposited: 11 May 2022 00:17
FoR Codes: 42 HEALTH SCIENCES > 4207 Sports science and exercise > 420799 Sports science and exercise not elsewhere classified @ 100%
SEO Codes: 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200502 Health related to ageing @ 100%
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