Tailored Exercise For Fall And Fracture Prevention In Older Adults: A Family Health Team Approach

Abstract

Background: Exercise interventions reduce falls in older adults. Methods for enhancing uptake and adherence to exercise programs in at-risk individuals are needed. Objectives: This pilot study evaluated feasibility of recruitment, short-term retention and adherence to PEPTEAM (Prescribe Exercise for Prevention of Falls and Fractures), an exercise plus behaviour change intervention.

Methods: Patients > 65 years old plus ≥ 1 additional risk factor for falls/fractures (≥2 falls in 6 months, age 75+, high CAROC fracture risk, difficulty walking/balance, acute fall, fragility fracture) were identified by nursing staff at the Center for Family Medicine. The intervention was delivered in two visits, with two follow-up calls, and included: a) physician telling the patient they are at risk; b) exercise prescription provided by a physical therapist; c) motivational interviewing, action and coping planning delivered by a kinesiologist. The primary outcome was change in minutes per day of moderate to vigorous physical activity (MVPA) from baseline to six-week follow-up, measured using X2 mini accelerometers. Secondary outcomes included: feasibility of recruitment and retention, an action planning questionnaire, EQ-5D-5L, Short Physical Performance Battery, and the Timed Up and Go. Adherence to exercise was determined using activity logs.

Results: 92 patients were screened, 22 were eligible and 11 were recruited (mean [SD] age 72.64 [6.47] years). All participants returned at 6 weeks. Adherence to exercise was 52%. Mean [SD] minutes of MVPA were 24.7 [22.8] at baseline and 21.6 [15.8] at six weeks (p=0.722). Participant action planning and coping planning abilities were significantly improved (P=0.008), (P=0.012) respectively. Patient-rated health at 6 weeks also significantly improved (P=0.010).

Conclusion: Many but not all patients demonstrated positive changes in intensity-specific MVPA. The feasibility information collected from this study in addition to practical recommendations identified for future work could be used to inform a future multicenter randomized controlled trial.