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Icon: Exercise-based interventionsExercise-based Interventions: The Otago Exercise Programme

Campbell, et al. and Robertson, et al.

This intervention, tested in 4 randomized controlled trials and 1 controlled multi-center trial, was an individually tailored program of muscle strengthening and balance-retraining exercises of increasing difficulty, combined with a walking program. This extensively tested fall prevention program is now used worldwide.

Overall, the fall rate was reduced by 35 percent among program participants compared with those who did not take part. The program was equally effective for men and women. Participants aged 80 years and older who had fallen in the previous year showed the greatest benefit.

Population

Participants were aged 65 to 97 years and lived in the community.

Geographic Locale

Dunedin, New Zealand. 

Focus

Improve strength and balance with a simple, easy-to-implement, and affordable home-based exercise program. 

Program Setting

The program was conducted in participants’ homes and was intended for people who did not want to attend, or could not reach, a group exercise program or recreation facility. 

Content

A physical therapist (PT) or nurse visited each participant 4 times at home over the first 2 months (at weeks 1, 2, 4, and 8) and visited again for a booster session at 6 months. To maintain motivation, participants were telephoned once a month during the months when no visits were scheduled.

The first home visit lasted an hour; all subsequent visits took about half an hour. During the visits, the PT or nurse prescribed a set of in-home exercises (selected at appropriate and increasing levels of difficulty) and a walking plan.

The exercises included:

  • Strengthening exercises for lower leg muscle groups using ankle cuff weights
  • Balance and stability exercises such as standing with one foot in front of the other and walking on the toes
  • Active range of motion exercises such as neck rotation and hip and knee extensions

Participant safety was ensured by tailoring the exercise program and by giving participants instructions and an illustration for each exercise.

Duration

The exercises took about 30 minutes. Participants were encouraged to complete the exercises 3 times a week and to walk outside the home at least 2 times a week. Exercises then were continued on an ongoing basis. In 3 trials, the exercise program was prescribed for 1 year and in 1 trial was extended to 2 years.

Delivered by

The program was delivered by either a PT experienced in prescribing exercises for older adults, or a nurse who was given special training and received ongoing supervision from a PT. 

Minimum Level of Training Needed

PTs can deliver the program immediately after reading the manual. Nurses can be trained to deliver the program after a 2-day training program and with ongoing supervision by a PT. 

Key Elements

PTs should understand the research evidence on which the program is based and avoid adding or subtracting exercises from the set used in the trials, as this particular combination of exercises worked to reduce falls. 

Available Materials

The Otago Exercise Programme instruction guide, which describes the program exercises, is available to health professionals at www.acc.co.nz.

Study Citation

Primary studies

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Medical Journal. 1997 Oct 25;315(7115):1065-9.

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: A randomized controlled trial in women 80 years and older. Age and Ageing. 1999 Oct;28(6):513-8.

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: A randomized controlled trial. Journal of the American Geriatrics Society. 1999 Jul;47(7):850-3.

Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, Jacobs RJ, Sharp DM, Hale LA. Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. British Medical Journal. 2005 Oct 8;331(7520):817-20.

Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. British Medical Journal. 2001 Mar 24;322(7288):697-701.

Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres. British Medical Journal. 2001 Mar 24;322(7288):701-4.

Supplemental articles

Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise-based falls prevention programme. Age and Ageing. 2001 Jan;30(1):77-83.

Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: A meta-analysis of individual-level data. Journal of the American Geriatrics Society. 2002 May;50(5):905-11.

Contact

Practitioners interested in using this intervention may contact the principal investigator for more information:

M. Clare Robertson, PhD
Research Associate Professor
Department of Medicine, Dunedin School of Medicine
University of Otago, P.O. Box 913
Dunedin 9054, New Zealand
Tel: +64 (3) 474 7007 extension 8508
Fax: +64 (3) 474 7641
E-mail: clare.robertson@otago.ac.nz

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