Falls in older adults are a major public health concern. One in three community-dwelling older adults fall, and 22% of them fall again within a year. The healthcare costs related to fall injuries increased close to 3 times in the past 25 years and are expected to grow as the number of older adults increases. Exercise has evidence as being effective in preventing falls. Despite this established fact, after discharge from a hospital or home healthcare services, an effective and efficient home-based exercise method for older adults currently has not been established. A literature review points out that low adherence is a common drawback to solitary home-exercise due to lack of motivation, feelings of being bored, and safety concerns. In order to overcome these drawbacks, the purpose of this study is to utilize currently available internet and videoconferencing technology, and test the feasibility and pilot test the effectiveness of a group exercise at home (GEAH) program. This approach is guided by health behavior theories. It strategically places informational, instrumental, emotional, and appraisal supports delivered via Internet-based technology to motivate, encourage exercise, and promote continued exercising. Participants will exercise at home alone but will be connected with up to 11 peers and an instructor in a real time exercise group. They will view peer exercisers (with consent) and an instructor on a TV screen, while they are monitored for safety and correct procedure. This group exercise will be joyful and beneficial in increasing muscle strength and balance, attributed to an individualized safe and progressive exercise program based on NIA's four types of exercises and our past studies. The participants will gain knowledge through the website regarding other fall risk factors and receive appraisal from the research team via e-mail. In this process, sense of belongingness and positive affect will be developed, and self-efficacy to continue exercise will be increased, which will lead to high adherence to the GEAH program.
Aim 1 is to identify the relationship among variables in the process, form technology use and adherence to the program (self-efficacy to use technology, perceived benefits, affect, self-efficacy for exercise, and intention).
Aim 2 is to conduct a randomized controlled trial with a 6-month intervention with 9-month follow-up. Community-based older adults without cognitive impairment who have a history of a fall and a resulting hospital visit in the past year (N=48) will be identified by a blocked (by age and a history of fals) random sampling. Expected results are reduced fear of falling and various objective fall risk factors (strength and balance) and the number of falls. The next step following this proof of concept is to conduct a longitudinal study with a large sample size to identify fall reduction as well as cost effectiveness using this approach. This project is necessary to prevent falls in an aging society as is evidenced;we cannot afford to maintain the status-quo.

Public Health Relevance

One third of older adults fall and the healthcare costs related to falls have increased threefold in the past 25 years. Home-based exercise is strongly recommended for older adults who had a fall to prevent further falls, but low adherence is a common problem. This study addresses these public health issues by converting home-excise to group-excise at home to increase adherence, thus reduce fall risks.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Aging Systems and Geriatrics Study Section (ASG)
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Joseph, Lyndon
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State University of New York at Buffalo
Physical Medicine & Rehab
Schools of Allied Health Profes
United States
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