Adherence and Attrition in Fall Prevention Exercise Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Abstract

Fall prevention exercise programs have been reported to be effective in minimizing falls in older adults. However, adherence and attrition in exercise programs remain a challenge. This study reviewed the evidence on how levels of adherence and attrition in fall prevention exercise programs may affect magnitude of effect of fall risk reduction in community-dwelling older adults. A systematic review and meta-analysis of randomized controlled trials on fall prevention exercise programs for community-dwelling older adults aged 65+ years published between 2005 and 2016 from six databases were undertaken. Twenty articles met inclusion criteria. Results showed that program adherence >80% may result in greater fall risk reduction compared to lower levels of adherence. A possible inverse relationship exists between attrition levels and effect sizes of fall prevention exercise programs. Future studies should properly report falls/fallers and a consensus on a standardized measure for reporting adherence to fall prevention exercise programs is recommended.

Assessing the Impact of a Game-Centered Mobile App on Community-Dwelling Older Adults’ Health Activation

“…Additional investigation is needed to determine the exact mechanisms by which Bingocize ® encourages high adherence, but we speculate because the program utilizes components of Social Cognitive Theory (modelling and self-efficacy) and Self-Determination Theory (SDT), participants are intrinsically and extrinsically motivated to join and continue the program [28]. This is consistent with others who found an increase in physical activity minutes after a web-based program that combined SDT and other traditional health behaviour theories [29].…”

The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI)

“…Additionally, the switch from paper to electronic proved difficult in deriving comparable scores and metrics from a breadth of computer-captured data. The high rate of attrition is not uncommon in intensive exercise interventions [ 124 ] and it may have been exacerbated in this study given that these unpaid senior volunteers were either very busy or also dealing with other health and familial complications. Furthermore, it may have been exacerbated in that recruiting pairs was useful for safety afforded via the in-home buddy system but may have also inflated attrition since two were lost when one partner was not able to continue.…”

“…It makes sense that, if exercise interventions (both physical and mental) are to impact cognitive and brain health via cardiovascular benefits and neuroplasticity, nutritional support for building or repairing neurons could magnify the impact of an intervention. Specifically, an expanding list of nootropics, derived from plant nutraceuticals (e.g., Gingko Biloba, Bacopa Monnieri, Huperzine A, Choline, Phosphatidylserine, Vinpocetine, Rhodiola Rosea, Methylcobalamin) and other potential cognitive enhancers [ 126 ] are finding their way into mainstream use among the general population with varying degrees of scientific support on neuronal and brain health [ 124 ]. Thus, examining the combined effects of neuro-exergaming with nootropics may be supra-additive in terms of cognitive effects and warrants further study.…”

Health Literacy and Older Adults: Fall Prevention and Health Literacy in a Midwestern State

“…Although a number of viable fall prevention programs have shown promise [12][13][14][15][16][17], none of these interventions applied plain language methodology specifically addressing low health literacy. Education about falls, specifically fall prevention, should include materials developed with low health literacy in mind [5].…”