Abstract
Background:
Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling-up the interventions remains a challenge. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.
Objective:
To assess the effectiveness of the Safe Step application, a self-managed unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control group, study attrition, and adherence to the Safe Step exercise program.
Methods:
Community-dwelling individuals, aged 70 or older, who had experienced falls or a decline in balance in the past year were randomized to an exercise group using the Safe Step application combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted one year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio (IRR) of fall rate and the relative risk (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively.
Results:
In total, 1628 people were enrolled in the study, 79% were women, the mean age was 75.9 years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person year in the exercise group and 2.41 in the control group, IRR 0.92, 95%, CI 0.76 to 1.11, P=0.37). The risk, of experiencing at least one fall was 11% lower in the exercise group compared to the control group (53.0% vs. 59.6%, RR 0.89, 95% CI 0.80 to 0.99, P=0.033). No differences were observed regarding the risk of two or more falls (34.1% in the exercise group, 37.1% in control group; RR 0.92, 95% CI 0.79 to 1.06, P=0.226). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9 and 12 months.
Conclusion:
Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.
Trial registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570
Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling-up the interventions remains a challenge. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.
Objective:
To assess the effectiveness of the Safe Step application, a self-managed unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control group, study attrition, and adherence to the Safe Step exercise program.
Methods:
Community-dwelling individuals, aged 70 or older, who had experienced falls or a decline in balance in the past year were randomized to an exercise group using the Safe Step application combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted one year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio (IRR) of fall rate and the relative risk (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively.
Results:
In total, 1628 people were enrolled in the study, 79% were women, the mean age was 75.9 years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person year in the exercise group and 2.41 in the control group, IRR 0.92, 95%, CI 0.76 to 1.11, P=0.37). The risk, of experiencing at least one fall was 11% lower in the exercise group compared to the control group (53.0% vs. 59.6%, RR 0.89, 95% CI 0.80 to 0.99, P=0.033). No differences were observed regarding the risk of two or more falls (34.1% in the exercise group, 37.1% in control group; RR 0.92, 95% CI 0.79 to 1.06, P=0.226). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9 and 12 months.
Conclusion:
Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.
Trial registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570
| Original language | English |
|---|---|
| Number of pages | 13 |
| Volume | 27 |
| Specialist publication | Journal of Medical Internet Research (JMIR) |
| DOIs | |
| Publication status | Published - 31 Mar 2025 |
Keywords
- Geriatric Medicine
- accidental falls
- aged
- independent living
- eHealth
- mHealth
- digital health
- exercise
- exercise therapy
- fall prevention
- preventative medicine
- self management
