Currently, the geriatric health field needs to respond proactively rather than reactively and provide services that reduce the impact of social distancing and isolation on older adults by utilizing alternative strategies, such as remote interventions.
A video was used as a medium to motivate older adults, increase participation rates, and increase effectiveness. This medium combined audiovisual information, such as sound, text, and pictures [ 32 ].
With the development and generalization of mobile devices, such as smartphones and tablet PCs, participants can engage in the program at any time and place they want. We aimed to bridge this gap via a remote home-based fall prevention exercise program by employing technological advancements and providing older adults with the opportunity to exercise at home.
It is necessary to cope with the current situation by devising and practically applying exercise experts in a home-based fall prevention exercise program from the conventional group fall prevention exercise program. Therefore, this study aimed to compare the effects of a remote home-based exercise program to improve the mental state, balance, and physical function and to prevent falls in adults aged 65 years and older during the COVID pandemic in Seoul, Korea.
Seventy-nine community-dwelling older adults aged 65 years and older, who were enrolled at a welfare senior center in Seoul, Korea, were recruited for the study.
The inclusion criteria were as follows: age 65 years and older; ability to walk without a walking aid; ability to communicate; and ability to provide written informed consent to take part in the study. The exclusion criteria were as follows: cardiopulmonary diseases, visual impairment, vestibular diseases, psychological disorders, unstable hypertension, and cognitive disorders. After evaluating inclusion and exclusion criteria, participants were randomly assigned to a remote home-based fall prevention exercise program group or a control group to have equal numbers in each group.
All participants provided written informed consent. Demographic data from the participants are presented in Table 1. However, 79 participants 38 in the experimental group and 41 in the control group were recruited in anticipation of dropouts. Two people in the experimental group were withdrawn from the study for personal reasons, and 1 person in the control group was excluded because of an incomplete questionnaire.
A total of 70 participants 35 in the experimental group and 35 in the control group were finally included in the study. Physical function, psychological factors, and balance were evaluated in both groups before and after the 8-week program. Prior to the start of this study, pre-tests were executed on the dependent variables, which included physical function, psychological factors, and balance. The same dependent variables were examined after the intervention.
All participants were administered a m walk test 10MW , five times sit to stand test FTSS , grip strength test, gait analysis, timed Up and Go TUG test, and static balance test for physical function. Depression was measured as a psychological factor. After the pre-test, the experimental group participated in a remote home-based fall prevention exercise program.
The post-test was performed after 8 weeks of the exercise program Figure 1 , which was conducted from June 2 to July 21, In this study, the remote home-based fall prevention exercise program enabled older adults to exercise indoors at home. The exercise program was modified and supplemented to suit the purpose of the study.
For the program to improve the physical function and prevent falls in older adults, a total of 16 sessions were conducted for 40 min twice a week for 8 weeks.
The participants in the experimental group underwent 40 min of the exercise program, including 10 min of warm-up exercise, 20 min of main exercise, and 10 min of cool-down exercises. The warm-up consisted of stretching and deep breathing exercises. After the main exercise, the cool-down exercise was performed in the same way as the warm-up exercise. The program consisted of movements using kayak paddles as a basis and consisted of stretching, vestibular rehabilitation, core and limb strengthening exercises, joint motion range exercises, and balance exercises.
To adjust the difficulty level, the program was configured in stages to perform various movements from a sitting position to a standing position. As the exercise program progressed, faster tempo and dynamic movements were added.
The detail of the exercises are shown in Table 1. When it was time to exercise, the participants used their smartphones to perform the exercise program. The videos in the remote home-based fall prevention exercise program were efficient because they provided accurate visual guidelines on how to exercise and were motivating with music and verbal instructions.
However, the physical therapist communicated with each participant by telephone twice a week to maintain their motivation. Participants in the control group were instructed to continue their usual daily activities for 8 weeks.
This test is easy to perform and can be conducted in a relatively short time. It consists of a total of 30 questions, comprising 16 negative and 14 positive questions. Converted into a score, it can range from a minimum of 0 points to a maximum of 30 points. A score of 14 to 18 is classified as depression, suspicious, and mild depression; a score of 19 to 21 is moderate; and a score of 22 or more is classified as severe depression.
The higher the score, the more severe the degree of depression. The FTSS test was used to measure lower limb muscle strength and functional mobility in older adults. The FTSS test evaluates the ability to rise from a chair. The test was used to measure functional mobility and assess fall risk in older adults.
At the start of this test, the participants were seated in a chair with a standardized seat height 46 cm with their back in a self-selected degree of comfortable knee flexion. The participants were asked to sit with their feet on the ground and take a position with their arms crossed.
The time taken to transition between the sitting and standing positions 5 times as quickly as possible was recorded. The test has excellent relative and absolute reliability and reproducibility. Hand grip strength was measured with an adjustable Jamar dynamometer in the sitting position.
While seated, the participants were instructed to grasp the dynamometer as tightly as possible. The left and right hands were evaluated alternately with a 1-min break between assessments. The mean score of the second trial was used in this study.
To evaluate gait speed, the 10MW test was performed. To rule out the acceleration and deceleration periods, a m total length included 2 m of approach, 10 m for the time measure, and 2 m beyond the measure to ensure a constant walking speed across m distance.
The walking time to 10 m was measured twice, and the average value for each participant was recorded. OptoGait is a 3-m walkway designed for optical-sensitive gait analysis. The recess period was provided between the single trials undertaken. Specific software OptoGait analysis software, version 1. The TUG test was used to measure dynamic balance, lower extremity function, mobility, and fall risk. The time required until the participant got up from the seated position with the start signal, moved to the 3-m point marked in front of the chair, and returned to the chair was measured.
The time taken to complete the entire procedure was measured using a stopwatch. It was measured twice and an average value was obtained. The TUG test shows excellent test—retest reliability in older adults [ 36 ]. The measuring system consisted of a safety bar and an equilateral triangle-shaped force plate and was connected to a laptop based on Bluetooth. The sampling frequency was 50 Hz. For the trajectory of the center of pressure, the following 3 variables were calculated: medio-lateral sway velocity, anterio-posterior sway velocity, and velocity moment [ 37 ].
After the participant was placed barefoot on a force plate, measurements were taken with both feet together. The measurements entailed standing for 20 s with the eyes closed and standing on foam Airex, Sins, Switzerland for 20 s with the eyes closed.
Data collection was performed twice, and the average values of postural sway distance and speed were obtained. The test—retest reliability measurements with eyes open and eyes closed were both 0. SPSS Data were presented as mean and standard deviation SD. Normality verification was performed using the Kolmogorov-Smirnov test. The chi-squared test was used to analyze the general characteristics of participants.
Significant main or interaction effects were followed by appropriate post hoc analyses via the Bonferroni correction method. Seventy participants participated in this study.
The main finding in this study was that the remote home-based fall prevention exercise group had enhanced physical function, psychological factors, and balance after the program. The results of this study showed that 8 weeks of a remote home-based fall prevention exercise program significantly improved physical and psychological functions and balance, as reflected in improved GDS, TUG, FTSS, grip strength, gait, and balance tests in older adults.
Stress, anxiety, fear, and depression are different factors that increase the risk and incidence of falls [ 26 ]. Physical exercise is one of the solutions to relieve these negative outcomes in older adults. Exercise was recently shown as an effective non-pharmaceutical treatment for depression [ 39 ]. A meta-analysis found that exercise was moderately effective in reducing depressive symptoms [ 39 ]. Our findings are consistent with those of other home-based exercise interventions among older adults, in which a home-based exercise group had significantly greater reductions in depression than did the control group [ 40 ].
Increased self-efficacy, mastery, and alterations in self-concept appear to be involved in the therapeutic efficacy of exercise in depression [ 41 ].
Biological pathways have also been suggested. For example, neurotrophins cause lasting changes in brain structure, such as improved vasculature, and stimulate downstream cellular processes, such as angiogenesis, that improve brain function in areas associated with depression, such as the hippocampus [ 42 ]. Hence, a reduced GDS score through a remote home-based fall prevention exercise program is a significant result.
Notably, the decrease in the time to perform the FTSS test confirmed the gains in the exercise group in muscle strength after the exercise program. A previous study showed that the FTSS test is associated with lower extremity muscle strength and balance [ 43 ]. Our fall prevention exercises consisted of lower extremity exercises, such as squats, lunges, and various step movements.
A small increase in muscle strength in older people leads to functional improvements, which are known to be one of the most crucial factors to physical functions in this population [ 44 ]. In addition, neural adaptations, such as increased activation of prime movers, improved coactivation of synergists, and reduced coactivation of antagonists, appear to be likely agents for the observed significant improvements in lower extremity strength [ 45 ]. These findings are consistent with those of Opdenacker et al [ 46 ], who reported an increase in the muscle strength of the hip flexors and extensors in home- and center-based exercises.
Thus, it can be concluded that increases in muscle strength are directly related to improvements in physical function in older adults through a fall prevention exercise program. Grip strength, a measure of body function, has been proposed as a biomarker of aging and is a useful indicator of overall health. Because of the practicality of hand grip dynamometers, grip strength measurement has been widely adopted as a single indicator of overall strength. Evidence of a predictive association between grip strength and fall incidence, all-cause and disease-specific mortality, bone density, fractures, cognition, and depression as well as problems related to hospitalization has also been provided [ 47 , 48 ].
In this study, the participants in the exercise group showed significant differences in grip strength after the program. In a previous study on an individualized home-based exercise, there was a significant difference in grip strength in the exercise group compared with the control group. It can be said that this exercise contributed to the increase in grip strength because all movements were performed with the paddle during the exercise program. Because the participants hold paddles and row consecutively and repeatedly, grip strength increases [ 50 ].
It was concluded that the increased grip strength was associated with the movement of the exercise program performed with the paddle; therefore, the remote home-based fall prevention exercise program had a significant effect on increased grip strength. Gait speed is expressed as a predictor of physical function and survival and is essentially to displacement speed. This is because older adults walking at speeds above 1. Each of these programs meets the Administration for Community Living's criteria for evidence-based programs specifically for falls prevention.
A Matter of Balance is an eight-week structured group intervention that emphasizes practical strategies to reduce fear of falling and increase activity levels for older adults. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. A mobile app version is also available.
CAPABLE Community Aging in Place — Advancing Better Living for Elders is a five-month structured program delivered at home to community dwelling older adults to decrease fall risk, improve safe mobility, and improve ability to safely accomplish daily functional tasks.
Participants work with the therapist and nurse to identify three achievable goals per discipline, examine the barriers to achieving those goals, and make action plans, supported by changes to the home and medication environment, to achieve those goals. Enhance Fitness. EnhanceFitness is low-cost, evidence-based group falls prevention and physical activity program developed specifically for older adults. Classes meet three times a week, an hour each session, providing social stimulation as well as physical benefits.
FallsTalk is an individual program for anyone who has experienced a fall or regular loss of balance; regardless of walking ability, medical condition, mobility or fitness level. The program begins with a personal FallsTalk Interview in-home or community space to discuss their unique situation. The intervention consists of initial and follow-up interviews with a trained facilitator, daily personal reflection min.
Clinical trials and community results provide evidence that FallsTalk significantly reduces falls compared to untreated fallers. FallScape is a customized program for anyone who has experienced a fall or regular loss of balance; regardless of walking ability, medical condition, mobility, cognitive or fitness level.
FallScape consists of one or two training sessions with a set of brief less than 1 min. FallScape is offered in-home or community space in conjunction with FallsTalk.
Research shows that participants achieve maximum benefit with the addition of this multimedia training. Participants are older adults who have lower extremity joint pain and stiffness related to osteoarthritis. Healthy Steps for Older Adults. Two 2-hour workshops are offered to interested individuals in the community at facilities such as senior community centers and health care organizations. Healthy Steps in Motion. The program is a one-hour session twice a week for eight weeks, and is taught by certified instructors; it starts with a warm-up, followed by strength and balance exercises and ends with a cool down-stretch.
There are three levels so participants can continue HSIM as long as they like. That means potentially surgery. Surgery in the elderly is very risky. At the very least it probably means a significant amount of time in bed. Which means the elderly person becomes weaker. That means they are more susceptible to future falls. They also become more afraid of falling. Which means they will be worried about moving around as much. Their body will become weaker and more susceptible to falls due to lack of exercise.
Many fall prevention programs focus on reducing clutter in the home, adding grab rails, and looking out ahead of time for tripping hazards. All very good ideas. We think any fall prevention program for the elderly should go further. It should also make it so the person is able to move without a high risk of falling.
Their body should be able to compensate for any sudden balance shifts. Exercise would seem like an obvious part of any fall prevention program. The stronger the person is, the less their risk of falling. Not only does exercise help prevent falls. It also reduces the chances of injury if you do fall. We have numerous blog posts on exercises here , here and here that can help the elderly prevent falls.
The best exercises for preventing falls are strength and balance exercises. Tai Chi is also a good exercise for balance and preventing falls. Another way to help reduce falls is to maintain a good level of Vitamin D.
We are big fans of Vitamin D for seniors. It helps seniors.
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