Understanding and improving adherence to exercise-based fall prevention programs in community-dwelling older people

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Embargoed until 2019-12-31
Copyright: Valenzuela Arteaga, Trinidad
With population ageing, falls in older Australians pose a significant health care burden. Considerable research has elucidated the benefits of exercise for fall prevention in older people. There is now a need to develop programs that maximise exercise adherence for effective fall prevention. The aim of this thesis was to develop a theory and evidence-based exercise program using a tablet computer to deliver tailored balance training exercises to older people in their homes. The exercise program was designed to i) provide effective exercise prescription to improve balance and reduce fall risk in older people; ii) incorporate behavioural change techniques to enhance exercise uptake and long-term adherence, and iii) use specific design criteria to optimize program usability for older people. Three exploratory studies were conducted to develop the program: (i) a systematic review investigating older peoples acceptability and adherence to exercise interventions delivered using technology. (ii) A qualitative study exploring older peoples experiences after using a technology-based exercise program unsupervised at home, as well as identifying design considerations necessary to increase usability and adherence. (iii) A feasibility study and formative evaluation of a prototype program to deliver home-based balance training exercises to older people at home. Older people were involved in all stages of the development and the findings were used to produce an evidence-based tablet computer app to deliver tailored balance training exercises to older people at home: Standing Tall . In a final evaluation study, usability, enjoyment and 6-month adherence to the program were evaluated in 101 older people as part of an ongoing randomised controlled trial. The findings provided evidence that 'Standing Tall' is feasible for older people to use over a prolonged period of time. Most participants enjoyed using the program (86%) and nearly all rated it as highly user-friendly (94%). The majority of participants (80%) reported benefiting from using Standing Tall , with 70% perceiving improvement in their physical abilities. Participants achieved on average nearly 70 minutes of exercise per week, and 29.5 hours in total. Future study results will determine whether 'Standing Tall' can prevent falls in older people, and if so, the optimal exercise dose.
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Valenzuela Arteaga, Trinidad
Razee, Husna
Lord, Stephen R
Delbaere, Kim
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PhD Doctorate
UNSW Faculty
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