Falls are the second leading cause of unintentional injury and death around the globe. About one in every three older adults falls each year worldwide. With the aging population, the cost of treating fall-related injuries is increasing exponentially. There is a pressing need for a cost-effective fall prevention program. Ample evidence has shown the substantial standalone effectiveness of well-designed physical exercises in preventing falls. However, continuous exercise adherence is required for a long-lasting fall prevention effect. Unfortunately, adherence to an exercise program was generally only 21%. Building up the habit of doing regular exercise is thus crucial in preventing falls. Lifestyle integrated Functional Exercise program (LiFE) has been shown to be able to reduce the fall rate by 31% and maintain 64% of the participants exercising at 12 months follow-up. This proposed randomized controlled trial aims at comparing the effectiveness of an internet-based LiFE in reducing subsequent falls and promoting exercise adherence in community-dwelling older adults.
All subjects will then be randomly assigned to receive either an internet-based therapist-led LiFE program with a home environment safety assessment (iLiFE) or attention control intervention. Randomization into block groups of four in a 1:1 ratio (the iLiFE group or the attention control group) will be generated in a password-protected excel file by independent research personnel not involved in data collection or intervention after the baseline assessment. The randomization will be concealed by the independent personnel. Research assistants who are blinded to the group allocation will conduct all the subsequent monthly surveillance and assessments at baseline and follow-up sessions. All data will also be entered and checked by the blinded research assistants. All procedures concur with the Declaration of Helsinki (2013).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
322
receiving internet-based LiFE training and home safety assessment
upper limb exercise training
The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control
Hong Kong, Hong Kong
fall incidence as assessed by monthly telephone or internet follow-up
Time frame: 12 months
physiological fall risk as assessed by the Physiological Profile Assessment (PPA)
will be done at the baseline- and re-assessments
Time frame: 4 months
balance as assessed by the 4-stage stance
will be done at the baseline- and re-assessments
Time frame: 4 months
balance as assessed by functional reach tests
will be done at the baseline- and re-assessments
Time frame: 4 months
mobility as assessed by the Short Physical Performance Battery Test
will be done at the baseline- and re-assessments
Time frame: 4 months
mobility as assessed by the Timed Up and Go Test
will be done at the baseline- and re-assessments
Time frame: 4 months
mobility as assessed by the Ten Metre Walk Test
will be done at the baseline- and re-assessments
Time frame: 4 months
muscle mass as assessed by the Bioimpedance Analysis (BIA)
will be done at the baseline- and re-assessments
Time frame: 4 months
postural hypotension as assessed by the blood pressure in sitting and standing
will be done at the baseline- and re-assessments
Time frame: 4 months
physical activity level as assessed by thigh-worn accelerometer (ActivPAL4 physical activity monitor, PAL Technologies Ltd., Glasgow, UK)
The participants will be required to wear the device for 7 consecutive days right after the baseline assessment and the re-assessment. Data about the duration of time spent in different activity types such as walking and sitting will be extracted and calculated on a daily basis.
Time frame: 4 months
Cognitive flexibility as assessed by Trail Making Test
will be done at the baseline- and re-assessments
Time frame: 4 months
balance confidence as assessed by the Short version of the Chinese version of the Activities-specific Balance Confidence Scale
will be done at the baseline assessment, re-assessment, and the last monthly telephone or internet follow-up. The participants will be asked to indicate their level of confidence in performing each activity on a 0-100 scale. A higher score indicates better balance confidence.
Time frame: 12 months
exercise adherence as assessed by Section B of the Exercise Adherence Rating Scale
This will be done at the re-assessment and the last monthly telephone or internet follow-up. The total score ranges from 0 to 24. Higher total scores indicate better exercise adherence.
Time frame: 12 months
health-related quality of life as assessed by EQ-5D-5L
will be done at the baseline and re-assessment and the last monthly telephone or internet follow-up
Time frame: 12 months
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