A randomised feasibility study assessing an intervention to keep adults physically active after falls management exercise programmes end

Sarah Audsley, Denise Kendrick, Pip Logan, Matthew Jones, Elizabeth Orton, Sarah Audsley, Denise Kendrick, Pip Logan, Matthew Jones, Elizabeth Orton

Abstract

Background: Physical inactivity contributes to disability and falls in older adults. Falls prevention exercise (FaME) programmes improve physical activity and physical function and reduce falling rates. Improvements in physical function are reduced, and falls rates increase, if physical activity is not maintained. This research investigated the feasibility and acceptability of an intervention that aimed to maintain physical activity in older adults exiting FaME.

Methods: The Keeping Adults Physically Active (KAPA) intervention comprised of six group sessions of motivational interviewing, delivered monthly by trained and mentor-supported postural stability instructor's after the FaME programme ceased. The KAPA intervention included participant manuals, illustrated exercise books, physical activity diaries and pedometers. A feasibility study was conducted in 8 FaME classes. The study design was a two-arm, cluster randomised, multi-site feasibility study comparing the KAPA intervention with usual care. A sample of 50 community-dwelling adults aged 65 years old or older were recruited. Recruitment, retention and attendance rates, self-reported physical activity and participant interviews were used to examine the feasibility and acceptability of the KAPA intervention.

Results: Fifty of the sixty-seven (74.6%) participants invited into the study agreed to take part, 94.2% of the available KAPA sessions were attended and 92.3% of the recruited participants provided outcome data. The KAPA participants expressed positive views about the venues and postural stability instructors and reported enjoying the group interactions. Intervention participants discussed increasing their physical activity in response to the peer-support, illustrated home exercise booklet, physical activity diaries and pedometers. Most discussed the written tasks to be the least enjoyable element of the KAPA intervention. The proportion of participants reporting at least 150 minutes of moderate to vigorous physical activity per week rose from 56.3 to 62.5% in the intervention arm and from 41.4 to 52.0% in the usual care arm.

Conclusions: The participants found the KAPA intervention acceptable. Participants reported the exercise booklet, peer support and the physical activity monitoring tools encouraged them to keep active. A full-scale trial is needed to assess whether physical activity can be significantly maintained in response to the KAPA intervention.

Trial registration: Retrospectively registered on ClinicalTrials.gov (NCT03824015).

Keywords: Falls prevention; Feasibility study; Older adults; Physical activity.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Data collection time points and data collected per study arm. PhoneFITT is a self-reported PA questionnaire
Fig. 2
Fig. 2
KAPA participant flow through the KAPA feasibility study
Fig. 3
Fig. 3
The number of participants attending each of the six KAPA intervention sessions

References

    1. Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981;10(4):264–270. doi: 10.1093/ageing/10.4.264.
    1. O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137(3):342–354. doi: 10.1093/oxfordjournals.aje.a116681.
    1. Public-Health-England. Falls and fracture consensus statement: Supporting commissioning for prevention. In: England PH, editor. London; 2017.
    1. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–ii41. doi: 10.1093/ageing/afl084.
    1. NICE. Physical activity: exercise referral schemes [NICE guideline PH54]. In: Excellence NIfC, editor.; 2014.
    1. World Health Organization . WHO global report on falls prevention in older age. Geneva: World Health Organization; 2008.
    1. Lloyd BD, Williamson DA, Singh NA, et al. Recurrent and injurious falls in the year following hip fracture: a prospective study of incidence and risk factors from the Sarcopenia and Hip Fracture study. J Gerontol A Biol Sci Med Sci. 2009;64(5):599–609. doi: 10.1093/gerona/glp003.
    1. Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004;59(1):48–61. doi: 10.1093/gerona/59.1.M48.
    1. Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. 2013;16(2):105–114. doi: 10.1089/rej.2012.1397.
    1. de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int. 2009;20(12):2111–2125. doi: 10.1007/s00198-009-0938-6.
    1. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1:CD012424.
    1. A Recipe for Care – Not a Single Ingredient. In: Department-of-Health, editor. London; 2007.
    1. Iliffe S, Kendrick D, Morris R, et al. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. Health Technol Assess 2014; 18(49): vii-xxvii, 1-105.
    1. Richards D, Hallberg I. Complex Interventions in Health. An overview of research methods. London: Routledge; 2015.
    1. Elley CR, Kerse N, Chondros P, Robinson E. Intraclass correlation coefficients from three cluster randomised controlled trials in primary and residential health care. Aust N Z J Public Health. 2005;29(5):461–467. doi: 10.1111/j.1467-842X.2005.tb00227.x.
    1. Gill DP, Jones GR, Zou GY, Speechley M. The Phone-FITT: a brief physical activity interview for older adults. J Aging Phys Act. 2008;16(3):292–315. doi: 10.1123/japa.16.3.292.
    1. Ridout MS, Demetrio CG, Firth D. Estimating intraclass correlation for binary data. Biometrics. 1999;55(1):137–148. doi: 10.1111/j.0006-341X.1999.00137.x.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Harris T, Carey I, Victor C, Adams R, Cook D. Optimising recruitment into a study of physical activity in older people: a randomised controlled trial of different approaches. Age Ageing. 2008;37(6):659–665. doi: 10.1093/ageing/afn159.
    1. von Bonsdorff MB, Leinonen R, Kujala UM, et al. Effect of physical activity counseling on disability in older people: a 2-year randomized controlled trial. J Am Geriatr Soc. 2008;56(12):2188–2194. doi: 10.1111/j.1532-5415.2008.02000.x.
    1. Teri L, McCurry SM, Logsdon RG, Gibbons LE, Buchner DM, Larson EB. A randomized controlled clinical trial of the Seattle Protocol for Activity in older adults. J Am Geriatr Soc. 2011;59(7):1188–1196. doi: 10.1111/j.1532-5415.2011.03454.x.
    1. Morey MC, Peterson MJ, Pieper CF, et al. The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men. J Am Geriatr Soc. 2009;57(7):1166–1174. doi: 10.1111/j.1532-5415.2009.02301.x.
    1. Morey MC, Ekelund C, Pearson M, et al. Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses. J Aging Phys Act. 2006;14(3):324–343. doi: 10.1123/japa.14.3.324.
    1. Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ. 2003;326(7393):793. doi: 10.1136/bmj.326.7393.793.
    1. Dubbert PM, Cooper KM, Kirchner KA, Meydrech EF, Bilbrew D. Effects of nurse counseling on walking for exercise in elderly primary care patients. J Gerontol A Biol Sci Med Sci. 2002;57(11):M733–M740. doi: 10.1093/gerona/57.11.M733.
    1. Rydwik E, Lammes E, Frandin K, Akner G. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial. Aging Clin Exp Res. 2008;20(2):159–170. doi: 10.1007/BF03324763.
    1. Taylor AH, Cable NT, Faulkner G, Hillsdon M, Narici M, Van Der Bij AK. Physical activity and older adults: a review of health benefits and the effectiveness of interventions. J Sports Sci. 2004;22(8):703–725. doi: 10.1080/02640410410001712421.
    1. Bunn F, Dickinson A, Barnett-Page E, McInnes E, Horton K. A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing Soc. 2008;28:449–472. doi: 10.1017/S0144686X07006861.
    1. Stevens M, Lemmink KA, van Heuvelen MJ, de Jong J, Rispens P. Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults; validation of the behavioral change model. Prev Med. 2003;37(6 Pt 1):561–570. doi: 10.1016/j.ypmed.2003.09.012.
    1. Dye CJ, Wilcox S. Beliefs of low-income and rural older women regarding physical activity: you have to want to make your life better. Women Health. 2006;43(1):115–134. doi: 10.1300/J013v43n01_07.
    1. Hawley-Hague H, Horne M, Campbell M, Demack S, Skelton DA, Todd C. Multiple levels of influence on older adults' attendance and adherence to community exercise classes. Gerontologist. 2014;54(4):599–610. doi: 10.1093/geront/gnt075.
    1. Khan KM, Weiler R, Blair SN. Prescribing exercise in primary care. BMJ. 2011;343:d4141. doi: 10.1136/bmj.d4141.
    1. Hobbs N, Godfrey A, Lara J, et al. Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis BMC Med. 2013;11:75.
    1. Azizan A, Justine M, Kuan CS. Effects of a behavioral program on exercise adherence and exercise self-efficacy in community-dwelling older persons. Curr Gerontol Geriatr Res. 2013;2013:282315. doi: 10.1155/2013/282315.
    1. Voukelatos A, Merom D, Sherrington C, Rissel C, Cumming RG, Lord SR. The impact of a home-based walking programme on falls in older people: the Easy Steps randomised controlled trial. Age Ageing. 2015;44(3):377–383. doi: 10.1093/ageing/afu186.
    1. Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006;61(11):1157–1165. doi: 10.1093/gerona/61.11.1157.
    1. Opdenacker J, Boen F, Coorevits N, Delecluse C. Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. Prev Med. 2008;46(6):518–524. doi: 10.1016/j.ypmed.2008.02.017.
    1. Luten KA, Reijneveld SA, Dijkstra A, de Winter AF. Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community. Health Educ Res. 2016;31(1):98–106.
    1. Jancey JM, Lee AH, Howat PA, Burke L, Leong CC, Shilton T. The effectiveness of a walking booster program for seniors. American journal of health promotion : AJHP. 2011;25(6):363–367. doi: 10.4278/ajhp.090512-ARB-164.
    1. Harris T, Kerry SM, Victor CR, et al. A primary care nurse-delivered walking intervention in older adults: PACE (pedometer accelerometer consultation evaluation)-Lift cluster randomised controlled trial. PLoS Med. 2015;12(2):e1001783. doi: 10.1371/journal.pmed.1001783.
    1. Duru OK, Sarkisian CA, Leng M, Mangione CM. Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. J Am Geriatr Soc. 2010;58(10):1863–1869. doi: 10.1111/j.1532-5415.2010.03082.x.
    1. Buman MP, Giacobbi PR, Jr, Dzierzewski JM, et al. Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial. J Phys Act Health. 2011;8(Suppl 2):S257–S266. doi: 10.1123/jpah.8.s2.s257.
    1. Chase JA. Interventions to Increase Physical Activity Among Older Adults: A Meta-Analysis. Gerontologist. 2015;55(4):706–718. doi: 10.1093/geront/gnu090.
    1. Chase JA. Physical activity interventions among older adults: a literature review. Res Theory Nurs Pract. 2013;27(1):53–80. doi: 10.1891/1541-6577.27.1.53.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56. doi: 10.1186/1479-5868-5-56.
    1. Muller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: a systematic review. Prev Med. 2008;47(4):354–368. doi: 10.1016/j.ypmed.2008.07.006.
    1. NICE. Falls in older people: assessing risk and prevention (Clinical guideline [CG161]). In: Excellence NIfC, editor. London; 2013.
    1. Iliffe S, Kendrick D, Morris R, et al. Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial. Trials. 2010;11:6. doi: 10.1186/1745-6215-11-6.
    1. Breitenstein SM, Gross D, Garvey CA, Hill C, Fogg L, Resnick B. Implementation fidelity in community-based interventions. Res Nurs Health. 2010;33(2):164–173.
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40. doi: 10.1186/1748-5908-2-40.
    1. Borrelli B. The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. J Public Health Dent. 2011;71(s1):S52–S63. doi: 10.1111/j.1752-7325.2011.00233.x.
    1. Tucker JM, Welk GJ, Beyler NK. Physical activity in U.S.: adults compliance with the Physical Activity Guidelines for Americans. Am J Prev Med. 2011;40(4):454–461. doi: 10.1016/j.amepre.2010.12.016.
    1. Murphy SL. Review of physical activity measurement using accelerometers in older adults: considerations for research design and conduct. Prev Med. 2009;48(2):108–114. doi: 10.1016/j.ypmed.2008.12.001.
    1. Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot Feasibility Stud. 2015;1:37. doi: 10.1186/s40814-015-0033-z.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다