What is the effect of a combined physical activity and fall prevention intervention enhanced with health coaching and pedometers on older adults’ physical activity levels and mobility-related goals?: Study protocol for a randomised controlled trial

Abstract

BackgroundPhysical inactivity and falls in older people are important public health problems. Health conditions that could be ameliorated with physical activity are particularly common in older people. One in three people aged 65 years and over fall at least once annually, often resulting in significant injuries and ongoing disability. These problems need to be urgently addressed as the population proportion of older people is rapidly rising. This trial aims to establish the impact of a combined physical activity and fall prevention intervention compared to an advice brochure on objectively measured physical activity participation and mobility-related goal attainment among people aged 60 +.Methods/designA randomised controlled trial involving 130 consenting community-dwelling older people will be conducted. Participants will be individually randomised to a control group (n = 65) and receive a fall prevention brochure, or to an intervention group (n = 65) and receive the brochure plus physical activity promotion and fall prevention intervention enhanced with health coaching and a pedometer.Primary outcomes will be objectively measured physical activity and mobility-related goal attainment, measured at both six and 12 months post randomisation. Secondary outcomes will include: falls, the proportion of people meeting the physical activity guidelines, quality of life, fear of falling, mood, and mobility limitation. Barriers and enablers to physical activity participation will be measured 6 months after randomisation.General linear models will be used to assess the effect of group allocation on the continuously-scored primary and secondary outcome measures, after adjusting for baseline scores. Between-group differences in goal attainment (primary outcome) will be analysed with ordinal regression. The number of falls per person-year will be analysed using negative binomial regression models to estimate the between-group difference in fall rates after one year (secondary outcome). Modified Poisson regression models will compare groups on dichotomous outcome measures. Analyses will be pre-planned, conducted while masked to group allocation and will use an intention-to-treat approach.DiscussionThis trial will address a key gap in evidence regarding physical activity and fall prevention for older people and will evaluate a program that could be directly implemented within Australian health services.Trial registrationACTRN12614000016639, 7/01/2014.

Validity of theFitbitactivity tracker for measuring steps in community-dwelling older adults

“…Yet the rapidity with which newer and cheaper pedometers are becoming available means that research validating these pedometers is unlikely to keep pace with the evolving technology, making it difficult for consumers and clinicians to determine the accuracy of each individual pedometer 5. Nevertheless, future studies are needed to confirm the effectiveness of physical activity monitors such as the Fitbit for increasing physical activity levels in older adults who do not currently meet physical activity recommendations;28 one such study is currently underway 20…”

“…Participants were community-dwelling older adults from Sydney, Australia, who were randomised to the intervention group of a trial investigating the effect of a behaviour change programme that aimed to increase physical activity participation and reduce fall risk 20. Participants were aged over 60 years, lived at home, were regular (weekly) users of the internet via a computer or tablet device and left their house regularly (at least once per week) without physical assistance from another person.…”

The Rehabilitation Treatment Specification System: Implications for Improvements in Research Design, Reporting, Replication, and Synthesis

“…To illustrate the potential benefits of the RTSS for research, we chose an article by Tiedemann et al 27 We chose this article because it provided the most comprehensive description of a multi-component rehabilitation intervention in our searches for publications that used the TIDieR checklist. Table 2 shows the TIDieR elements provided by Tiedemann et al for their intervention, as well as added treatment information that was in the main text but missing from their TIDieR table.…”

“…Specifically, instead of the researcher solely considering the outcome of primary importance and additional secondary effects, the concept of treatment components directs him or her to identify the outcomes that can be hypothetically achieved as a direct result of the ingredients provided. Tiedemann et al 27 list 3 primary outcomes of their intervention (physical activity as measured by ActiGraph over 7 days, and 2 individualized physical activity goals based on Goal Attainment Scaling), and 5 secondary outcomes (reduced falls, and patient-reported measures of quality of life, fear of falling, mood, and mobility). However, as is common in studies of rehabilitation interventions, the outcome measures do not match all of the listed targets: the 3 primary outcome measures would quantify only the row 1 target in Table 2, and all secondary outcomes appear to be aims that will require changes across multiple targets, not directly addressed by this treatment.…”

Idosos caidores e não caidores: programa de exercício multicomponente e prevalência de quedas

“…A atividade física pode prevenir quedas em idosos da comunidade em geral e idosos com alto risco de quedas, com redução de 15 a 32%, dependendo do tipo de programa e métodos usados para avaliar a eficácia 6 . Contudo, vários programas de intervenção que objetivam aumentar níveis de atividade física entre as pessoas mais velhas têm, na verdade, aumento das quedas 7 .…”