Factors influencing older adult community fall prevention exercise implementation: a scoping review.

BACKGROUND: Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. OBJECTIVE: To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. DESIGN: Scoping review. METHODS: We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). RESULTS: We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. CONCLUSION: The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

Synchronous Group-Based Online Exercise Programs for Older Adults Living in the Community: A Scoping Review.

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57-93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function.

Resistance Training on an Outdoor Exercise Structure Improves Lower-Body Relative Strength in Older Adults.

Improving relative strength is important for maintaining functionality with age, and outdoor exercise structures could be useful to facilitate this. A total of 29 adults aged 65+ participated in a non-randomized crossover study with a 6-week control followed by a 6-week resistance training intervention on an outdoor exercise structure (3x/week). Relative strength (predicted maximal leg press/lower body lean mass [Dual-energy X-ray Absorptiometry]) and physical function variables were measured at baseline, post-control, and post-intervention. Represented as median (25th-75th), lower body relative strength improved from 7.91 (7.01-9.35) post-control to 8.50 (7.99-9.72) post-intervention (p = .002) in study completers (n = 17). Maximum leg press (p = .002), 30-second chair stand (p < .001), one-leg stance (p = .011), and maximum chest press (p = .009) also improved significantly during the intervention. There were no significant changes in aerobic activity, grip strength, lean mass, or muscle power. This study demonstrates that there could be potential relative strength benefits associated with the use of outdoor exercise structures in older adults.

Convergent validity and inter-rater reliability of a lower-limb multimodal physical function assessment in community-dwelling older adults.

Introduction: Lower-limb physical function declines with age and contributes to a greater difficulty in performing activities of daily living. Existing assessments of lower-limb function assess one dimension of movement in isolation or are not time-efficient, which discourages their use in community and clinical settings. We aimed to address these limitations by assessing the inter-rater reliability and convergent validity of a new multimodal functional lower-limb assessment (FLA). Methods: FLA consists of five major functional movement tasks (rising from a chair, walking gait, stair ascending/descending, obstacle avoidance, and descending to a chair) performed consecutively. A total of 48 community-dwelling older adults (32 female participants; age: 71 ± 6 years) completed the FLA as well as timed up-and-go, 30-s sit-to-stand, and 6-min walk tests. Results: Slower FLA time was correlated with a slower timed up-and-go test (ρ = 0.70), less sit-to-stand repetitions (ρ = -0.65), and a shorter distance in the 6-min walk test (ρ = -0.69; all, p < 0.001). Assessments by two raters were not different (12.28 ± 3.86 s versus 12.29 ± 3.83 s, p = 0.98; inter-rater reliability ρ = 0.993, p < 0.001) and were statistically equivalent (via equivalence testing). Multiple regression and relative weights analyses demonstrated that FLA times were most predicted by the timed up-and-go performance [adjusted R 2 = 0.75; p < 0.001; raw weight 0.42 (95% CI: 0.27, 0.53)]. Discussion: Our findings document the high inter-rater reliability and moderate-strong convergent validity of the FLA. These findings warrant further investigation into the predictive validity of the FLA for its use as an assessment of lower-limb physical function among community-dwelling older adults.

Fear of Falls Following an Online Exercise Program for Aging Adults.

Individuals who participate in regular exercise tend to report a lower fear of falling; however, it is unknown if this fear can be reduced following an online fall prevention exercise program. The main purpose of this study was to test if offering a peer-led fall prevention exercise program online reduced the fear of falling and if this potential improvement was greater than when the program was offered in person. The secondary objectives were to describe participants' characteristics when participating online, the rate of falls and the context in which falls occur. A total of 85 adults aged 69.0 ± 7.8 years participated in the program offered online (n = 44) and in-person (n = 41). No significant differences in fear of falling before and after participation in the program were reported for either group: online (20.7 ± 5.1-21.8 ± 5.5) and in-person (20.6 ± 5.1-21.2 ± 5.3). Online participants reported a greater proportion of falls (n = 9; 20.5% vs. n = 4; 9.8%; p = .14), mostly occurring outdoors (n = 7) (77.8). A properly designed study is needed to test if the rate of falls is greater when an exercise program is offered online.