Published October 2020
Summary
Specially-designed exercise programmes have been shown to help prevent older people from falling. However, we do not know how well these exercises benefit people in the longer-term. In her PhD studentship, Dr Susanne Finnegan followed up with people after a trial of a fall-prevention exercise programme to find out if they were still exercising, and what motivated them to keep going.
The Dunhill Medical Trust was truly amazing as a funder. They were such a good fit for me – from day one they were so supportive and so approachable
Dr Susanne Finnegan
My background is as a physiotherapist, and I moved into research to work on the benefits of exercise for older people. I was most recently involved in a large trial to test whether a strength and balance exercise programme could prevent older people from having falls. My research question came about because, at the end of the six-month programme, a number of the older people involved said “Oh yes, I’ll definitely carry on.” I thought to myself: I wonder if they will? And if they do, what effect is that going to have?
Asking ‘why?’
I sent a questionnaire to over 3,000 participants who had taken part in the trial up to six years after it finished, and carried out in-depth interviews with 23 of them to explore their experiences of being involved in the trial and the exercise intervention in particular. I wasn’t only interested in whether the exercise programme had helped to reduce the number of falls, but also whether it made a difference to other things that change as people get older, including frailty, mobility, health-related quality of life and cognition.
Disappointingly, the questionnaire revealed that most people didn’t continue with the exercise programme after the end of the trial period, and we could not see any long-term benefits from having taken part in the study. But the in-depth interviews allowed me to really understand the reasons why people had not carried on as they had planned.
Challenges for health and care
Balancing exercises are important for preventing falls, but unfortunately they are often perceived as not very exciting. While some people had their own ways of exercising to maintain fitness, such as walking, this is not proven to help with falls prevention.
Our challenge now as researchers and healthcare professionals is to find our own balance between what we know is evidence-based for falls prevention and what fits into older people’s lives and is enjoyable to do – so that they are motivated to continue with their exercises long-term. This is likely something that needs to be addressed at a community level.
The in-depth interviews allowed me to really understand the reasons why people hadn’t carried on as they had planned
Dr Susanne Finnegan
All but one of my interviewees reported having fallen over since the end of the trial, but many of the falls weren’t what the participants themselves considered as ‘real falls’. Additionally, they didn’t see preventing falls as a priority for their health – even those who reported feeling more vulnerable after a fall or felt that mobility problems ‘shrank their horizons’. People do not relate to the standardised definition of a fall. They do not recognise that little accidents – such as tripping over a rug – are part of the problem, and we should not wait until they have a serious fall to help them keep safe.
If we can help people to see that these balance exercises can improve those little trips and slips, as well as preventing the more harmful ‘real falls’, it has the potential to have a big impact on people’s health and quality of life. This is our challenge for the future.
Find out more
My first literature review, exploring the facilitators and barriers to continued falls prevention exercise after completion of a structured exercise programme, is available to read here.
My second literature review investigated the long-term effect of exercise interventions in preventing falls in older people, and can be accessed at this link.
