Adherence to supervised falls prevention exercise in community-dwelling older adults: Secondary analysis of a systematic review

Abstract

Background: Exercise reduces falls in older people, and the benefits are stronger with greater exercise adherence. This review summarised adherence and behaviour change techniques (BCTs) in fall prevention supervised exercise interventions and investigated the association between adherence, participants’ characteristics and intervention components.Methods: A secondary analysis of trials from the previous 2019 Cochrane Review and its associated updates, investigating fall prevention exercises in community-dwelling people aged 60+ years. We dichotomised the interventions based on adherence, using the threshold of ≥75% of the sessions provided, or ≥75% of the participants attended ≥75% of sessions. Logistic regression examined the associations between adherence and participant characteristics, and intervention components.Results: 102 studies investigated 136 supervised exercise interventions, of which 116 interventions (85%) reported adherence. The median proportion of exercise sessions attended was 78% (range:38% to 100%). Adherence was associated with exercise frequency with the odds of adherence increased by 167% (95% CI 12% to 536%) for interventions conducted ≥2 times/week, compared to those <2 times/week; 72% higher (95% CI 12% to 85%) for supervised programmes without home exercise component, compared to those with; 4% more for one week less in exercise intervention conducted in trials (2% to 7%); and 33% higher (95% CI 11% to 50%) for each BCT not used. Conclusion: Higher adherence was observed in interventions that: were shorter, did not have home exercise components, had more weekly sessions (≥2 times/week) and used fewer BCTs. Clinicians should consider these factors to optimise adherence to supervised programs