None listed
Conditions
Brief summary
Falls are a major health issue, being the largest contributor to hospitalised injuries and a leading cause of injury death in Australia (AIHW 2022). Fear of falling (Yardley and Smith 2002) and reduced quality of life (Bjerk et al 2018) are well documented consequences of falls. In Australia, more than one in four people over the age of 65 years fall each year (Milat et al 2011). The Illawarra Shoalhaven Local Health District (ISLHD) and the University of Sydney recently completed a RCT with 617 people on the effectiveness of a home-based exercise program (BEST at Home) for preventing falls in older community-dwelling people (Bates et al, 2018; Bates et al 2022). The study showed a significant reduction in fear of falling as well as a significant improvement in gait speed (Bates et al 2022). People with COPD are known to have a high risk of falls and as such, there is the need for fall prevention programs (Roig et al 2011). An Australian study reported that people with COPD had a higher rate of fear of falling compared to healthy controls and that fear of falling was associated with lower quadriceps strength, impaired balance, lower levels of physical activity and an increased fall risk (Oliveira et al 2015). A recent systematic review reported that exercise-base interventions can improve balance in people with COPD and the most benefit was found when balance training was incorporated with pulmonary rehabilitation (Delbressine et al 2020). This study aims to determine the effects of the BEST at Home Program on balance, strength and fear of falling in people with COPD who attend a virtual care program. Clients with COPD accessing the VeCC will be invited to participate in the study. Eligible participants will receive a modified version of the BEST at Home lower limb exercise program. The exercise instruction will be delivered by an experienced pulmonary rehabilitation physiotherapist in two small group sessions (approximately one hour each). Exercise instruction will occur at weeks 1 and 13, with follow-up video calls from the physiotherapist at weeks 2, 4 and 8. Participants will be encouraged to perform the set of exercises three times per week at home for a period of six months. Participants will be provided with a weight, exercise manual and booklet about preventing falls. Participants will also be provided with a calendar and asked to record their exercise and falls on a monthly basis. Assessment of strength, balance and fear of falling will be assessed at baseline, 3 months and 6 months.
Interventions
Participants will receive a modified version of the BEST at Home lower limb program which is a home-based exercise program for the lower limb which found a significant reduction in fear of falling and improvement in gait speed.(Bates e al 2018, 2022). The BEST at Home program is based on the Otago Exercise Program, which has been found to reduce rates of falls and injurious falls (Campbell et al 1997, 1999).
The lower limb exercise program includes balance and strength exercises for example sit
Participants will receive a modified version of the BEST at Home lower limb program which is a home-based exercise program for the lower limb which found a significant reduction in fear of falling and improvement in gait speed.(Bates e al 2018, 2022). The BEST at Home program is based on the Otago Exercise Program, which has been found to reduce rates of falls and injurious falls (Campbell et al 1997, 1999). The lower limb exercise program includes balance and strength exercises for example sit to stand, semi squats from a standing position, calf raises, toe raises, sideways walking, backwards walking and one leg stand. The exercise instruction will be delivered face to face by an experienced pulmonary rehabilitation physiotherapist in two small group sessions of one hour duration with approximately 3-5 participants per group. The level of exercise intensity will be low-moderate, and will be assessed using a Borg Rating of Perceived Exertion (RPE) scale. Exercise instruction will occur at weeks 1 and 13 at a local Community Health Centre, with follow-up video calls from the physiotherapist at weeks 2, 4 and 8. The video calls will cover adherence to home exercises, progress, breathing strategies and any questions a participant may have regarding the exercises. The video calls will be approximately 20 minutes in duration. Participants will be encouraged to perform the set of exercises three times per week at home for a period of six months. The set of exercises should take 30 minutes to complete. The weights to be used at the beginning of the program and progression of exercise intensity will be individualised and determined by the physiotherapist. The exercises are to be completed with good technique and control. Once exercises can be performed comfortably, they are progressed by increasing weight, increasing repetitions and/or decreasing the support. Participants will be provided with a home exercise manual (produced by the research team) which contains clear pictures and descriptions of the exercises (from the original Otago Exercise Program), a booklet about preventing falls (titled Staying active and on your feet, by NSW Health, 2010) and a calendar to record when they complete the exercises and any falls they may have. Participants will receive education on managing shortness of breath and exercise anxiety with COPD at the first exercise instruction session. Adherence will be monitored by attendance at exercise and measurement sessions, along with a paper calendar to record when they complete the exercises (which will be returned monthly using reply paid envelopes).
Sponsors
Illawarra Shoalhaven Local Health District
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All diagnosed COPD clients currently accessing Illawarra Shoalhaven Local Health District virtually enhanced community care (VeCC) will be invited to participate in the project if they are able to walk 10 metres with or without a walking aid.
Exclusion criteria
Participants will be excluded if they have dementia or other cognitive limitations, or insufficient English language skills or a progressive neurological disease or medical condition precluding exercise.
Outcome results
None listed