Easy Steps to Health: The effectiveness of walking in reducing falls in older people

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A majority of the falls prevention interventions shown to effectively reduce the risk of falling in community dwelling older people, such as Tai Chi, or programs such as ‘Stepping On’ and the ‘Otago exercise program’, involve specialised training or instruction. This specialised activity places limits on the accessibility of such interventions: due to a lack of qualified instructors, the costs involved in joining programs, or the barriers inherent in attending physical activity classes. Only a small proportion of older people benefit from these interventions. In contrast, walking is a simple activity that can be done by virtually anyone, any time and anywhere without the need for specialised training or equipment. However to date only two studies have examined the effect of walking on falls; one study as a secondary outcome measure the other study combined walking with a home-based exercise program. No studies have explicitly looked at the impact of walking of falls in older people. The Easy Steps to Health study is a randomised controlled trial investigating the effectiveness of a self-managed one year (48-week) walking program in reducing the number of falls in sedentary, community-dwelling people aged 65 years and over. People will be excluded if: they are already physically active (i.e. engage in physical activity for more than 120 minutes per week or on more than three occasions per week); they cannot communicate in English, and; they have any conditions that limit their ability to participate in a physical activity program. A total of 484 participants will be randomised into either the intervention or control group. Participants randomised into the intervention group will receive instruction in the walking program via mail and telephone coaching at week 0, 12, and 24 with additional telephone support at weeks 2, 8, 18 and 36. The control group will receive the self-managed walking program at the end of the study period. During the study period the control group will receive healthy lifestyle information. Falls during the study will be recorded prospectively using a daily calendar. Baseline and end-of-study telephone interviews will be conducted using structured questionnaires assessing ‘Quality of Life’, levels of Physical Activity, confidence in avoiding a fall, confidence in ability to walk, and the ‘walkability’ of their neighbourhood. Baseline interviews will also gather basic demographic information, falls history, and a brief description of current medical conditions and medications being used. In addition, a sub-sample of 194 participants will receive physical performance assessments. These assessments will gather data on lower limb functionality (using the Short Physical Performance Battery), quadriceps strength and lower limb reaction time (using choice step reaction time). Accelerometers will also be used as a more objective measure of participants’ levels of physical activity. These measures on a sub-sample of participants will occur at weeks 0 (baseline), 12, 24, and 48.