Older adults’ preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: a comparison between a digital programme and a paper booklet

Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet. Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start. Results: Sixty-seven participants, with mean age 77 ± 4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p = .078). In both groups 50–59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p = .001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p = .026) degree of being content, and feeling supported by the programme (p = .044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p = .036). Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise

Promotion of physical activity for older people with musculoskeletal conditions

Many older adults have musculoskeletal conditions that can act as a substantial barrier to physical activity. Older people, and some health professionals, may be concerned that participating in exercise programmes or completing other physical activities may cause or exacerbate symptoms associated with existing musculoskeletal conditions. However, in most cases, there are safe exercise-based interventions that have potential to improve function and general health without undue risk. This chapter discusses several groups of musculoskeletal conditions that are prevalent among older adults and provides a practical case study as well as some points for broader consideration

Drawing the Line at Neglected Marine Ecosystems: Ecology of Vermetid Reefs in a Changing Ocean

Vermetid mollusks form reefs that protect coasts from erosion, regulate sediment transport, serve as carbon sinks, and provide habitat for many fish and invertebrates. This biogenic habitat is found in tropical, sub-tropical, and warmtemperate coastal areas, such as Bermuda, oceanic islands in Brazil, and Hawaii, several locations within the Caribbean and the Mediterranean. These reefs are functionally similar to tropical coral fringing reefs but are built by gregarious vermetid gastropods cemented by a crustose coralline algal species, which probably triggers their settlement. Some descriptive studies in different regions worldwide and comparisons among tropical and Mediterranean reefs contributed to show their important role as engineered habitat and biodiversity hotspots. In recent years, a dramatic decrease in the vermetid live cover was recorded in the Eastern basin of the Mediterranean, with some documented local extinctions within a few decades. Pollution and the spread of invasive species are potential threats to this animal forest and to the biodiversity it supports. Yet, the response of the vermetid reef to climate change is almost unknown, although recent experiments demonstrated high sensitivity of this snail species to ocean acidification. Hence, the ongoing rapid environmental change and increasing anthropogenic use along the coast may have detrimental effects on the remaining reefs and therefore significant ramifications for coastal systems in the Mediterranean and subtropical and warm-temperate regions. This chapter aims at filling these knowledge gaps by presenting both a short literature-based study and a set of new research paths to explore and improve conservation and research activities given the range of ecosystem services pristine vermetid reefs may provide