Australian Health Promotion Association

Amanda Bates, Philippa Eccleston, Michelle Kershaw

Introduction: Falls are a major health problem for older people. Approximately one in three people aged 65 years and over falls every year.1 There is strong evidence that exercise programs can reduce falls in older people.2,3 It has been recommended that exercise interventions for preventing falls should include balance training.4 The minimum exercise dose effective in reducing falls is a twice weekly program for 25 weeks.2

Exercise programs for improving balance and strength can be either group or home-based. A survey of people aged 55 years and over found that strength and balance training at home had greater appeal than exercise classes.5 Providing strength and balance training at home may address barriers to participation in group programs.6,7

Home-based exercise has been shown to be safe and effective in improving balance and strength.7-10 The Otago Exercise Program (OEP) is a home-based program of strength and balance exercises designed to prevent falls, provided by physiotherapists or trained community nurses via five home visits over six months. The OEP showed a reduction in the number of falls and injuries from falls10-13 but was resource intensive.10-12 This pilot study aimed to determine whether a less-resource-intensive home-based exercise program improved strength and balance and reduced falls in adults aged 60 years and over living in the community.

Issue addressed: Home-based exercise with home visits has been shown to improve strength and balance and reduce falls in older people. This pilot study aimed to determine whether a home-based exercise program (delivered via workshops instead of home visits) improved strength and balance and reduced falls in adults aged 60 years and over.
Methods: Participants attended two workshops over a six-month period and were instructed in the exercises by physiotherapists. Participants recorded their exercise and falls on a calendar and strength and balance measures were assessed at baseline and 12 weeks. Data was analysed using Wilcoxon signed rank tests, McNemar’s test and regression.
Results: A total of 167 participants commenced the BEST at home program. The mean age was 69 years and 67% were female. Participants significantly improved in all measures of strength and balance. The number of falls was reduced during the six-month period but statistical significance was not achieved.
Conclusions: The BEST at home program improved strength and balance in people aged 60 years and over. More research is required to determine long term adherence to BEST at home and whether this program can reduce falls.
So what? Home-based exercise has the potential to reduce falls and improve strength and balance in older people living in the community. It may provide an alternative to, or complement, group-based exercise to assist people in reaching the recommended exercise dose of twice a week for preventing falls.

Health Promotion Journal of Australia 2011; 22: 234-7