TY - JOUR
T1 - Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults
T2 - Systematic review and meta-analysis
AU - Hughes, Katie J.
AU - Salmon, Nancy
AU - Galvin, Rose
AU - Casey, Blathin
AU - Clifford, Amanda M.
N1 - Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. Objective to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. Methods eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). Results of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control Fixed effects model (FEM), SMD = 0.48 95% CI [0.26-0.70] P < 0.0001 I 2 = 0%, very low GRADE evidence). Within this limited evidence base, interventions using telecommunication and the integration of exercise into activities of daily living appear most promising when delivering exercise at home. Meta-analysis to explore the effect that these interventions to improve adherence had on balance (n = 166 experimental, n = 161 control Random-effects model (REM), SMD = 0.82, 95% CI [-1.20-2.84] P = 0.43 I 2 = 52%) and gait (n = 59 experimental, n = 56 control REM, SMD = 0.29, 95% CI [-1.62-2.20] P = 0.77 I 2 = 48%), found no statistically significant effect. Conclusions adherence to exercise can be positively influenced; however, insufficient data exists to support any single intervention that also achieves effective outcomes for balance and gait.
AB - Background exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. Objective to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. Methods eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). Results of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control Fixed effects model (FEM), SMD = 0.48 95% CI [0.26-0.70] P < 0.0001 I 2 = 0%, very low GRADE evidence). Within this limited evidence base, interventions using telecommunication and the integration of exercise into activities of daily living appear most promising when delivering exercise at home. Meta-analysis to explore the effect that these interventions to improve adherence had on balance (n = 166 experimental, n = 161 control Random-effects model (REM), SMD = 0.82, 95% CI [-1.20-2.84] P = 0.43 I 2 = 52%) and gait (n = 59 experimental, n = 56 control REM, SMD = 0.29, 95% CI [-1.62-2.20] P = 0.77 I 2 = 48%), found no statistically significant effect. Conclusions adherence to exercise can be positively influenced; however, insufficient data exists to support any single intervention that also achieves effective outcomes for balance and gait.
KW - adherence
KW - exercise therapy
KW - falls prevention
KW - older adults
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85063406679&partnerID=8YFLogxK
U2 - 10.1093/ageing/afy164
DO - 10.1093/ageing/afy164
M3 - Review article
C2 - 30358800
AN - SCOPUS:85063406679
SN - 0002-0729
VL - 48
SP - 185
EP - 195
JO - Age and Ageing
JF - Age and Ageing
IS - 2
ER -