None listed
Conditions
Brief summary
Falls are an important public health issue for older people, health providers and policy makers, as up to 35% of all older people fall every year and 68% of fallers sustain an injury. It has been shown that an effective method of reducing falls risk among older people is the provision of targeted and validated exercise programmes. Older people with depressive symptoms are at an even higher risk of significant impairment in support balance reactions and a concomitant two times increased risk of falling and the development of associated disability than those without depressive symptoms. Consequently there is a need to also explore the effect on falls rates of exercise programmes that specifically target older people with depression. However, depression is associated with poor participation in physical activity programmes and so attention to choice and acceptability of activity is important to short-term and long-term sustainability for participants with depression. This study will develop and test the effectiveness of an evidence based multi-sensory exercise programme among older people with depression. Using a randomised controlled trial design the combined home and group based programme will be compared to a frequency matched sham programme to explore the impact of the programme on physiological measures related to falls risk. In addition the safety and adherence to the programme will be determined.
Interventions
Participants in the activity intervention group will be given home-based individual instruction in a physical activity programme and attend a group programme twice weekly for 4 weeks, both components of the intervention will focus on factors identified as being specific to falls risk among older people with depression. The home-based programme will be based on the Otago Exercise Programme, which comprises progressive moderate-intensity balance retraining, lower limb-strengthening exercises and w
Participants in the activity intervention group will be given home-based individual instruction in a physical activity programme and attend a group programme twice weekly for 4 weeks, both components of the intervention will focus on factors identified as being specific to falls risk among older people with depression. The home-based programme will be based on the Otago Exercise Programme, which comprises progressive moderate-intensity balance retraining, lower limb-strengthening exercises and walking. The participants will be encouraged to undertake the home based programme twice per week with visits from the research team twice in the first week to supervise the programme. Participants will attend the group based programme twice per week for four weeks. There will be eight participants in each group. The programme will last for up to 90 minutes and will utilise different types of equipment balls, as tools to target sitting and standing balance control through the use of perturbation exercises that focus on the skill to recover balance and stepping reactions. The programme will constantly challenge the postural control system with exercises that incorporate elements related to the demands of normal activities of daily living. Such elements include single leg standing, weight transfer between feet, and change of support area as well as different reaching and bending movements of the trunk while standing and sitting. It will be based on principles shown to improve balance and stepping among older people at risk of falling. An experienced physiotherapist will be used to supervise all intervention group classes.
Sponsors
John Parsons
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
82 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
Participants from a previous trial (Depression and Exercise in Later Life [DeLITTE], n=193) (ANZCTR -ACTRN12605000667617) to determine the effect of physical activity among older people with depression living in the Auckland region undertaken by members of the research team will be contacted to ascertain their willingness to participate. The inclusion criteria for DeLITTE were: aged 77 years or older, community dwelling, able to communicate in English to complete assessments and that they had no severe dementia or unstable medical conditions precluding participation in a physical activity programme. All participants also showed a level of depressive symptoms on initial screening using a validated depression screening tool. DeLITTE citations: Kerse, N., Peri, K., Robinson, E., Wilkinson, T., Randow, M., Kiata, L., Parsons, J., Latham, N., Parsons, M., and Willingale, J., Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. British Medical Journal, 2008. 337(oct09 3): p. a1445. Kerse, N., Hayman, K.J., Moyes, S.A., Peri, K., Robinson, E., Dowell, A., Kolt, G.S., Elley, C.R., Hatcher, S., Kiata, L., and Parsons, J., Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE-A Randomized Controlled Trial. The Annals of Family Medicine, 2010. 8(3): p. 214.
Exclusion criteria
Severe dementia (<7/10 on AMTS) Severe or unstable cardiovascular disease (i.e. unstable angina, pacemaker fitted, dysrhythmia other than controlled atrial fibrillation) Near-terminal disease (including advanced heart, lung, kidney, liver failure resistant to medical management)
Outcome results
None listed