The results of a new trial to test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people, have been published. The introduction to the results is below, with links to the full report.
Falls and fall related injuries have persisted over the past three decades as a leading cause of morbidity and mortality in older people.1 With a rapidly ageing population globally, sustainable access to evidence based, cost effective fall prevention programmes is a priority. Evidence from high quality systematic reviews and meta-regressions has confirmed that well designed exercise programmes are among the most effective fall prevention strategies for community dwelling older people, with fall reduction rates averaging 23%.2 However, to achieve similar effectiveness at a population level, we need a programme that people can access easily and adhere to in the long term. Previous studies have found that older people prefer home based exercises and that the inclusion of balance exercises is associated with higher adherence.3 Nevertheless, sustained adherence to prescribed home exercise programmes is low, with pooled estimates of 21% (range 0-68%).4 Studies providing a physiotherapist led programme or a moderate level of home visits (that is, less than one home visit per month and more than two home visits in total) achieve higher levels of adherence4; however, such measures substantially increase the cost and reduce the feasibility as a population approach.
Digital technology can provide engaging and widely accessible methods for delivery of exercise programmes to enhance long term motivation and adherence at relatively low cost.5 However, the provision of a well designed, unsupervised exercise programme that is tailored and progressive in nature, yet safe, could be a challenge. StandingTall is a home based, e-health balance exercise programme provided through an app that was developed by using principles of consumer design to ensure an appropriate and user friendly interface for older people. Behavioural change strategies are incorporated to enhance exercise uptake and long term adherence.6
This randomised controlled trial aimed to determine the effect of StandingTall on the recommended set of core outcomes for fall prevention trials in older people (fall rate, number of people who fall and those who have an injurious fall; and known fall risk factors, including balance, gait, concern about falling, health related quality of life, and physical activity levels).7 The trial had a 24 month follow-up period and compared the outcomes of the intervention with a health promotion education control programme. We hypothesised that StandingTall would lead to a reduced fall rate compared with a control group with minimal intervention.