"Are Your Clients Having Fun?" The Implications of Respondents' Preferences for the Delivery of Group Exercise Programs for Falls Prevention.

BACKGROUND: Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults' preferences for how these programs can be delivered are unknown. OBJECTIVE: To identify older people's preferences for how group exercise programs for falls prevention can be delivered. DESIGN: A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia. METHODS: Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach. RESULTS: Ninety-seven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently. CONCLUSIONS: This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program.

What Are the Characteristics of Home Exercise Programs That Older Adults Prefer?: A Cross-Sectional Study.

OBJECTIVE: The aim of this study was to examine the preferences of older adults toward the structure and delivery of home exercise programs for the prevention of falls as well as the perceived benefits of and barriers to program adherence. METHODS: A two-wave cross-sectional telephone survey of community-dwelling older adults was conducted in Victoria, Australia. Respondents were categorized as current, previous, or nonparticipants of a home exercise program in the last 6 yrs. Thematic analysis of open-response questions examining the preferences of current and previous participants toward participation in, and delivery of, home exercise programs for falls preventions was performed. RESULTS: A total of 245 respondents completed the follow-up survey. The respondents were classified as current (n = 54), previous (n = 22), or nonparticipants (n = 169) of a home exercise program in the last 6 yrs. Program adherence was influenced by the perceived effect of programs on physical and mental health, participant autonomy, and how well the program structure complemented individual exercise and lifestyle preferences. CONCLUSIONS: Adherence to home exercise programs for falls prevention is influenced by personal preferences toward program structure and delivery as well as perceived benefits of and barriers to program participation. To optimize participant adherence, service providers need to consider personal preferences and some flexibility in the program being delivered.

Program-related factors are associated with adherence to group exercise interventions for the prevention of falls: a systematic review.

QUESTIONS: What factors are associated with adherence of older adults to group exercise interventions for the prevention of falls? What is the relationship between adherence and the falls prevention efficacy of the intervention? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: Older adults (60 years and older) undertaking a group exercise intervention for falls prevention. INTERVENTION: Group exercise not in combination with a home program and intended at least in part for falls prevention. OUTCOME MEASURES: Adherence was measured as the mean proportion of sessions attended, including participants who discontinued the intervention. Falls prevention efficacy was measured as the proportion of fallers in the intervention versus the control group at follow-up. Various program-related factors, including intervention duration, session frequency, and components of the exercise regimen were examined for each of the studies. RESULTS: Of the 210 articles identified, 18 studies met the inclusion criteria and were analysed. The pooled estimate of adherence across the studies was 0.74 (95% CI 0.67 to 0.80). Lower levels of adherence were associated with group exercise interventions that had a duration of 20 weeks or more, two or fewer sessions per week, or a flexibility component. No significant relationship was found between adherence and falls prevention efficacy. CONCLUSION: Program-related factors may influence adherence to group exercise interventions for the prevention of falls. Further research is encouraged to more precisely determine the effect of intervention level factors on adherence, and the effect of adherence on intervention efficacy.

Adherence to and efficacy of home exercise programs to prevent falls: a systematic review and meta-analysis of the impact of exercise program characteristics.

OBJECTIVE: To determine whether adherence to home exercise interventions for the prevention of falls in older adults relates to home exercise program characteristics and intervention efficacy. METHODS: In Australia (2011) a systematic literature search of four databases was conducted. Randomized controlled trials were included. Random-effects meta-analysis of participant adherence rates was performed. Meta-regression analyses were used to determine the relationship between intervention program characteristics, intervention efficacy and adherence. RESULTS: Twenty-three studies met the inclusion criteria. The pooled estimate of participants who were fully adherent was 21% (95% Confidence Interval: 15%-29%, range: 0%-68%). Higher levels of full adherence were found in interventions containing balance or walking exercise, moderate home visit support, physiotherapist led delivery and no flexibility training. Higher levels of partial adherence were found in interventions containing home visit or telephone support, a participant health service recruitment approach and no group exercise training. Neither full nor partial adherence to prescribed home exercise program dosages was associated with intervention efficacy. CONCLUSION: Adherence to home exercise for the prevention of falls in older adults is low and may be affected by home exercise program characteristics. There is an absence of evidence to link adherence to intervention efficacy.