The effect of walking on falls in older people: the 'Easy Steps to Health' randomized controlled trial study protocol

Abstract

BackgroundFalls in older people continue to be a major public health issue in industrialized countries. Extensive research into falls prevention has identified exercise as a proven fall prevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in falls prevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time.Methods/DesignThis study uses a randomised controlled trial design.A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme.Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status.DiscussionCertain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting falls prevention need to be invested elsewhere.Trial RegistrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000380099

Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults

“…However, the utility of walking as a fall prevention strategy is unclear (Voukelatos et al, 2011). The systematic review by Sherrington and colleagues found that the inclusion of a walking regimen in fall prevention exercise programs actually attenuated program effectiveness (Sherrington et al, 2008).…”

Neighborhood walkability, fear and risk of falling and response to walking promotion: The Easy Steps to Health 12-month randomized controlled trial

“…Participants were community dwelling older adults (≥ 65 years) who enrolled in the “Easy Steps to Health” RCT that evaluated the effect of a home-based self-paced walking program on falls (primary outcome), walking and physical activity (secondary outcomes). The study protocol ( Voukelatos et al, 2011 ) and main outcomes ( Voukelatos et al, 2015 ) have been published elsewhere. The walking program did not significantly reduce falls (IRR = 0.88, 95% CI: 0.60–1.29) in the intervention group compared to the control group, but significantly increased walking and physical activity (median change 1.69 vs. 0.75 h/week, Cohen ' s D = 0.52) ( Voukelatos et al, 2015 ).…”

Measuring Physical Activity Using Accelerometry in a Community Sample with Dementia

“…PA monitoring devices have been validated in samples across the lifespan 7 and are used to assess risk of falls, 8 quality of life, 9 and sleep 10 in elderly adults. The current study demonstrated the feasibility of objectively assessing PA in a community sample of individuals with dementia.…”