Building Strong Foundations: Nonrandomized Interventional Study of a Novel, Digitally Delivered Fall Prevention Program for Older Adults

Abstract

BackgroundInjuries from falls are a major concern among older adults. Targeted exercise has been shown to improve fall risk, and recommendations for identifying and referring older adults for exercise-based interventions exist. However, even when very inexpensive or free, many do not use available fall prevention programs, citing barriers related to convenience and safety. These issues are even greater among older adults residing in rural areas where facilities are less abundant. These realities highlight the need for different approaches to reducing falls in novel ways that increase reach and are safe and effective. Web-based delivery of exercise interventions offers some exciting and enticing prospects. ObjectiveOur objective was to assess the efficacy of the Strong Foundations exercise program to change markers of physical function, posture, balance, strength, and fall risk. MethodsStrong Foundations is a once weekly (60 minutes), 12-week iterative program with 3 core components: postural alignment and control, balance and mobility, and muscular strength and power. We used a quasi-experimental design to determine changes in physical function specific to balance, postural control, and muscular strength among older adults at low or moderate risk of falling. ResultsA total of 55 low-risk and 37 moderate-risk participants were recruited. Participants significantly improved on the 30-second Chair Stand (mean change of 1, SD 3.3 repetitions; P=.006) and Timed Up and Go (mean change of 0.2, SD 0.7 seconds; P=.004), with the moderate-risk group generally improving to a greater degree than the low-risk group. Additionally, Short Physical Performance Battery performance improved significantly in the moderate-risk category (P=.02). The majority of postural measures showed statistically significant improvement for both groups (P<.05). Measures of “relaxed” posture showed improvements between 6% and 27%. When an “as tall as possible” posture was adopted, improvements were ~36%. ConclusionsIn this 12-week, iterative, web-based program, we found older adults experienced improvement not only in measures used in clinical contexts, such as the 30-second Chair Stand and Timed Up and Go, but also contextualized gains by providing deeper phenotypical measurement related to posture, strength, and balance. Further, many of the physical improvements were attenuated by baseline fall risk level, with those with the highest level of risk having the greater gains, and, thus, the most benefit from such interventions.