‘It is designed for everybody to find their own level and to improve themselves’; views of older people and instructors of the Falls Management Exercise (FaME) programme

Abstract

Background Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME. Objective To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective. Methods Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor’s approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors. Results Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors’ qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants’ engagement with the programme. Instructor factors such as progression were also reported as important predictors. Conclusions Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults.

Understanding the delivery of the Falls Management Exercise Programme (FaME) across the U.K.

“…In previous exploration of the implementation of FaME in one area of the UK, home exercise, adapted Tai Chi and floorwork were also found to be the components most likely to be excluded from community-based delivery 9 . Like Orton et al 10 , the PSIs in our study indicated that confidence to deliver backward chaining, particularly related to the functional complexity of people in the class, was a barrier, and that a second instructor would increase likelihood of it being delivered 12,21 . Time restriction, because classes were often only an hour, was an additional barrier identified within our study to delivering these components, alongside participant refusal and tiredness.…”

“…Other studies exploring implementation have only explored one type of set-up model 9,10,12 and this research enables providers of FaME to consider the different advantages and disadvantages to different set-up. Individual factors emerged consistently from previous work on older adults' exercise and falls prevention/strength and balance classes 10,12,21 , and from a PSIs instructors' perspective were important factors particularly related to uptake and adherence. Interview data suggests that participant attitudes, health management and cost can be influenced by delivery model, set-up and instructor approach 12,13 .…”

How to tackle the global challenge of falls?

“…This is demonstrated by some recent large pragmatic trials which were not effective, possibly due to lack of adherence, fidelity to interventions or rigorousness in applying the protocols developed in earlier successful multifactorial falls prevention trials [ 14–16 ]. For example, adherence to exercise programmes such as the Falls Management Exercise (FaME) programme is low [ 17 ]. In a recent study, instructors’ qualities, low cost, adaptations to exercises for inclusion, home exercises that can be incorporated into daily life, social interaction, improvements in health, mobility and psychological well-being were identified as important factors promoting adherence to FaME [ 17 ].…”

“…For example, adherence to exercise programmes such as the Falls Management Exercise (FaME) programme is low [ 17 ]. In a recent study, instructors’ qualities, low cost, adaptations to exercises for inclusion, home exercises that can be incorporated into daily life, social interaction, improvements in health, mobility and psychological well-being were identified as important factors promoting adherence to FaME [ 17 ]. The main self-reported barriers to adherence by older adults were lack of discipline and motivation, poor physical health and caring responsibilities [ 17 ].…”