Skelton, et al.
This study examined the effectiveness of an individualized, tailored group and home-based exercise intervention designed to improve participants’ dynamic balance and core and leg strength, and to recover their ability to get down to and up from the floor.
After 36 weeks, the fall rate in the exercise group was reduced by one-third. Over the entire study, which included a 50-week follow-up period, the fall rate was reduced by 54 percent.
Participants were women aged 65 or older, living independently, who had fallen 3 or more times in the previous year.
London, United Kingdom
Improve balance and strength.
Group classes were conducted at 4 locations in London in Community Leisure Centers (gym facilities that have rooms for exercise classes). Home exercises were performed in participants’ homes.
Group classes were conducted at 4 locations in London in Community Leisure Centers (gym facilities that have rooms for exercise classes). Home exercises were performed in participants’ homes. Content: Before starting the program, participants were assessed for asymmetry in strength or balance and specific problems with strength, balance, and flexibility. Five basic functional tests were used:
- Shoulder flexibility
- Hamstring flexibility
- Timed up and go
- 180 degree turn
- Functional reach
Participants also received a health screening and were evaluated for fear of falling (FES-I), fracture risk (Black score), quality of life (SF12), and confidence in maintaining balance (ConfBal).
Falls Management Exercise (FaME) group classes are based on the Otago Exercise Programme, which includes exercises for endurance and flexibility as well as floor exercises. The exercises meet the American College of Sports Medicine guidelines for adults over age 65.
Class exercises were tailored to the abilities of the group and home exercises were tailored to each participant’s needs and abilities. All exercises became more challenging (that is, increased in intensity or difficulty) as the program progressed. For example, classes used individualized resistance bands and progressively reduced levels of support (seated and supported options moving to unsupported options). Home exercises addressed asymmetry in strength or balance by prescribing additional repetitions or sets for the weaker side.
Class exercises focused on:
- Improving first static then dynamic balance
- Muscle and bone strength (e.g., Thera-Bands, free weights, low-impact side stepping and standing squats, etc.)
- Endurance (e.g., marching, side stepping)
- Flexibility of 5 major muscle groups
- Gait (e.g., side and backward walking)
- Functional skills (e.g., sit to stand)
- How to avoid falling (e.g., compensatory stepping)
- Functional floor exercises (e.g., crawling, rolling, back extensions, and side leg lifts)
Note: These exercises were introduced after at least 8 weeks of preparatory physical therapy to restore the skills needed to get down to and up off the floor.
The home exercise program consisted of:
- 10-minute endurance session
- Otago exercises along with additional resistance-band strengthening exercises
- Developmental flexibility exercises
Participants wore hip protectors during the exercise sessions in group classes and at home to reduce the risk of hip fractures. They were not encouraged to wear them at other times.
- The pre-exercise assessment lasted about 40 minutes.
- One-hour group classes were held once a week for 36 weeks.
- 30 minutes of home exercises were done twice a week.
Postural Stability Instructors. These are qualified “exercise for the older person” instructors, physical therapists, and occupational therapists who have taken the 5-day training course, “Exercise for the Prevention of Falls and Injuries in Frailer Older People.” See standards and requirements in Appendix D-2, Form D514.
The United Kingdom has national education standards governing the training content for exercise instructors working with special populations, including older people. Further information can be found at www.skillsactive.com/training/standards.
Standards for adapting an exercise program for older adults can be found in Appendix D-2, Form D467.
After instructors are trained to work with older people, they can train as Postural Stability Instructors, focusing on older people at high risk of falling. Physical therapists and occupational therapists do not have to become an exercise instructor in order to take this training.
The 5-day training course to become a Postural Stability Instructor is considered postgraduate-level training. It involves 54 contact hours of theory and practical delivery and 100 noncontact hours. The qualification is based on successfully completing a 40-minute practical exam, a case study on a faller, and a theoretical paper.
Additional information about the course content can be found at www.laterlifetraining.co.uk/page5.html.
The United Kingdom Chartered Society of Physiotherapists endorses the Postural Stability Instructor training course. Additional information can be found at www.csp.org.uk/director/members/ careersandprofessionaldevelopment/courses/otherendorsedprogrammes/ laterlifetraining.cfm.
- To be successful, the exercise program should last at least 36 weeks.
- It should include a minimum of 2 hours per week of combined group and home exercises.
- Exercise must be progressive, continually increasing in intensity, resistance, weight, and challenging balance.
- Exercises must be tailored to each individual’s needs and abilities, both in group classes and at home.
It is desirable but not essential to include floor work to reduce fear of falling and improve falls self efficacy.
The participants’ home exercise booklet is available at www.ageuk.org.uk/Documents/EN-GB/ID8950%20 Strength%20And%20Balance%20Book.pdf?dtrk=true.
Information about the accredited Postural Stability Instructor course in the United Kingdom is available at www.laterlifetraining.co.uk.
The training manual for the Postural Stability Instructor course can be purchased from www.laterlifetraining.co.uk.
Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise—FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age and Ageing. 2005 Nov;34(6):636-9.
Skelton DA, Dinan SM. Exercise for falls management: Rationale for an exercise program aimed at reducing postural instability. Physiotherapy Theory and Practice. 1999 Jan;15(2):105-20. Available at: www.laterlifetraining.co.uk/documents/ ExerciseFallsManage.PDF.
Iliffe A, Kendrick D, Morris R, Skelton D, Gage H, Dinan S, Stevens Z, Pearl M, Masud T. 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 Jan;11(1):6-10.
Skelton DA, Stranzinger K, Dinan SM, Rutherford O. BMD improvements following FaME (falls management exercise) in frequently falling women age 65 and over: An RCT. Journal of Aging and Physical Activity. 2008 Jul;16(Suppl):S89-90.
Skelton DA. The Postural Stability Instructor: Qualification in the United Kingdom for effective falls prevention exercise. Journal of Aging and Physical Activity. 2004 Jul;12(3):375-6.
Skelton DA. Effects of physical activity on postural stability. Age and Ageing. 2001 Nov;30(Suppl 4):33-9.
Practitioners interested in using this intervention may contact the principal investigator for more information:
Dr. Dawn Skelton Reader in Ageing and Health School of Health, HealthQWest A236 Govan Mbeki Building Glasgow Caledonian University Cowcaddens Road, Glasgow G4 0BA, United Kingdom Tel: +44 (0) 141 331 8792 E-mail: firstname.lastname@example.org
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