Staying UpRight in Residential Care: An exercise program for older people living in residential care designed to reduce rates of falls

"Staying UpRight" is a strength, power and balance program, delivered in 1 hour sessions, twice weekly over 1 year. It is a group program (approximately 8 residents per group), delivered by one physiotherapist and one assistant. Strength training uses low repetitions, moderate-high resistance (2 x 10 repetitions at 5-7/10 effort) in weight-bearing positions (e.g. lunges, squats, sit to stand, heel raises) progressed by increasing the speed and/or depth of the movement (e.g. deeper lunges). Balance training comprises static and dynamic activities (e.g. tandem and one legged stand, reaching, stepping, walking, and turning) and is progressed by reducing hand support, reducing the base of support, reducing visual input; and adding a cognitive task. For example, walking on the spot on toes and heels is progressed to walking on toes and heels forwards, backwards and sideways; and stepping over obstacles. The program is manualised and includes instruction on exercise delivery and exercise progression. Exercises completed in each session, and exercise progressions for the group are recorded on a spreadsheet, in addition to a participant attendance record. The active control program, led by an activities coordinator, uses only seated activities (no standing component), ‘light’ work (<5/10) with no resistance exercises and no progressions. Activities focus on seated movement and variety e.g. seated upper and lower limb activities; seated boxing, seated marching, heel and toe tapping; seated upper and lower limb stretches using non elastic bands and games e.g. seated scarf catch and throw, pass the parcel. Fidelity of program delivery will be checked during the first 6 months (of physiotherapist delivery) and the second 6 months (of facility staff member delivery) through: a. A site visit from the project manager within the first 2 months of each 6-month block, which entails observation of a class taking place. Feedback is given as necessary to the physiotherapist or facility staff member to ensure fidelity of intervention delivery. Any actions expected in response to the feedback will be monitored via telephone calls and visits as required. b. A monthly audit of the spreadsheets used to record each participant’s exercises by the physiotherapist research team member (who initially trained the research physiotherapists to check the class content). If violations in the exercise program are noted, the physiotherapist research team member will contact the delivering physiotherapist or facility staff member and discuss the issues to a satisfactory resolution. c. All observed or noted episodes of program fidelity violations will be recorded and reviewed monthly by the research physiotherapy team members.