Exercise-Based Fall Prevention Programs

The U.S. Preventive Services Task Force (USPSTF) recommends exercise-based programs as a fall prevention strategy for adults over the age of 65. Regular exercise can reduce the risk of falling by helping individuals improve their balance, strength, coordination, and confidence. For example, exercises can help older adults practice the transition from sitting to standing and feel steadier when getting up from chairs or using the toilet.

Exercise-based fall prevention programs can be conducted in community group classes or individual in-home sessions. Programs may include a range of exercises such as strength training, low-impact aerobics, or tai chi. Programs are often conducted in structured formats at least once a week for multiple weeks, but program frequency may be tailored to community or individual needs. Many of these programs have been shown to have a positive return on investment by reducing falls and avoiding injury-related medical costs.

Examples of Exercise-Based Fall Prevention Programs

Fit & Strong is an evidenced-based eight-week exercise program specifically geared toward older adults with osteoarthritis. The program includes exercises, self-management, and group discussions designed to address specific needs related to osteoarthritis and promote long-term behavior change. The program has been easily adapted to rural communities across the country, such as by South Dakota State University Extension and North Dakota State University Extension. More information about the Fit & Strong program can be found in the Rural Health Models and Innovations section.
A Matter of Balance is a community program that promotes physical activity among older adults to reduce falls. Designed by the Roybal Center at Boston University, the program offers in-person and virtual sessions that teach participants how to control falls, remove hazards in their homes, set exercise goals, and exercise. The A Matter of Balance program has been implemented in several rural communities, such as Brazos Valley, Texas where the program successfully reduced the number of falls among older adults.
The Otago Exercise Program is an in-home exercise program for older adults that improves strength and balance. Trained physical therapists help participants through a series of 17 Otago exercises over a period of six months to one year. The Community Health and Mobility Partnership (CHAMP) program in Western North Carolina successfully implemented an Otago Exercise Program that reduced fall risks among older adults. This program is supported in 16 states by the Centers for Disease Control and Prevention, the Patient Centered Outcomes Research Project, and the Administration for Community Living.
Tai Ji Quan: Moving for Better Balance is an evidence-based instructor-led program designed to improve strength, coordination, and range of motion among older adults through tai ji quan exercises. Classes are conducted as 60-minute group sessions at least twice per week in a community setting. A 2016 Preventing Chronic Disease article describes successes and lessons learned related to adopting the Tai Ji Quan: Moving for Better Balance program in rural faith-based organizations in West Virginia.

Implementation Considerations

Rural communities may need to consider the availability of instructors and the level of required training when deciding which program to implement. Some programs require instruction from health professionals, such as occupational or physical therapists, whereas other programs train lay people to serve as program leaders. In areas where certain health providers are limited, rural communities may consider implementing a program that employs local personnel and includes a curriculum for the required instructor training. As the training of instructors requires some upfront investment, programs may also need to consider who will be able to consistently dedicate time to instruction to maximize return on investment.

Some at-home exercise-based programs may be able to deliver instruction virtually and more programs are beginning to adapt to this format. For example, the Otago Exercise Program can include virtual telehealth visits with a physical therapist to assess progress with learning the exercises. Several best practices should be followed when implementing these types of programs virtually, such as verifying reimbursement, licensing, insurance coverage, and that the technology is adapted to meet the needs of both the patient and program.

Group exercise-based prevention programs also require appropriate space to host classes. These spaces should be large, well-lit, and have non-slip, even floors. Rural communities may also consider holding classes in areas that are already familiar to or frequently visited by older adults, such as faith-based centers or community centers. While some of these programs have been led virtually, rural communities may consider how technology limitations and lack of broadband access may impact their target populations.

Organizations looking to start exercise-based fall prevention programs may consider funding from the Older Americans Act Title III-D and Prevention and Public Health Fund discretionary grants.

Program Clearinghouse Examples

Resources to Learn More

CGEC Physical Therapist Registration, and Listing
Website
Provides a searchable list of physical therapists (PTs) by state and country that have completed the Otago Exercise Program.
Organization(s): University of North Carolina School of Medicine, Carolina Geriatrics Education Center

Evidence-Based Falls Prevention Programs
Website
Includes an annotated list of evidence-based fall prevention programs that meet criteria set by the Administration for Community Living.
Organization(s): National Council on Aging

Older Adult Fall Prevention: Interventions
Website
Provides a collection of evidence-based home modifications and clinical interventions to prevent falls by older adults and includes a how-to guide for implementing community-based fall prevention programs.
Organization(s): Centers for Disease Control and Prevention