Home-Based Exercise and Fall Prevention in Older Adults: Development, Validation and Usability of the Mais Equilíbrio Mobile App

Editorial introductions.

To the Editor: Ganz and Latham (Feb. 20 issue)1 review strategies and evidence regarding fall prevention in older adults and make recommendations for practice. The case vignette describes a woman who has fallen after tripping on uneven pavement, an event that reflects a common cause of fall-related injuries.2 Prevention of a fall after a trip requires either the perception and avoidance of the obstacle (gait adaptability) or a rapid balance-recovery response (reactive balance control). Neither ability is addressed directly in the assessment of or training for the measures suggested by Ganz and Latham — walking speed, standing balance, performance on .

Resistance exercise is an efficacious stimulus for improving cognitive function in older adults, which may be mediated by the upregulation of blood-borne neurotrophic growth factors (NTFs) like brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1). However, the NTF response to resistance exercise and training in older adults is poorly understood. Therefore, the purpose of this study was to characterize the timing and magnitude of the NTF response following an acute bout of resistance exercise before and after 8 weeks of resistance training. Ten cognitively normal, older adults (ages 60-77 years, five men) were examined. The acute NTF response to resistance exercise was assessed via serum samples drawn at designated time points following exercise. This procedure was then repeated following 8 weeks of resistance training. BDNF increased immediately post-exercise (Δ9% pre-training, Δ11% post-training) then returned to resting levels while IGF-1 remained stable following resistance exercise before and after 8 weeks of resistance training. Basal levels of both NTFs were unaffected by the 8 week training period. We report a transient increase in serum BDNF following a bout of resistance exercise in older adults, which could have implications for the design of interventions seeking to maximize cognitive function in older adults.

Introduction: Self-efficacy is defined as a person’s own judgment of their capabilities to perform a specific activity to attain a particular outcome. The concept of self-efficacy of exercise in older adults with diabetes may still be unclear, so it is essential to elucidate its meaning for better understanding in this concept. This paper aims to explore the meaning of self-efficacy with regard to exercise in older adults with diabetes.Methods: Using the Walker and Avant concept analysis, it discusses cases showing diabetic Thai people and how they manage their health behavior changes, such as with exercise.Results: Analysis of the concept of self-efficacy in terms of its defining attributes, antecedents, consequences, and empirical referents provides information related to clinical usefulness. It helps healthcare professionals communicate the same notion when discussing self-efficacy and can distinguish this concept from other related concepts.Conclusion: Analysis of the concept of self-efficacy provides information related to exercise in older adults and can assist healthcare professionals in communicating the same notion when discussing the concept.

Decreased fitness of the lower extremities is a potentially modifiable fall risk factor. This study aimed to compare two exercise programs--square-stepping exercise (SSE), which is a low-cost indoor program, and walking--for improving the fitness of the lower extremities. We randomly allocated 68 community-dwelling older adults (age 65-74 years) to either the SSE or walking group (W group). During the 12-week regimen, the SSE group participated in 70-minute exercise sessions conducted twice a week at a local health center, and the W group participated in outdoor supervised walking sessions conducted weekly. The W group was instructed to increase the number of daily steps. Prior to and after the program, we obtained information on 11 physical performance tests for known fall risk factors and 3 self-reported scales. The fall incidence was followed-up for 8 months. At 12 weeks postregimen, significant differences were observed between the two exercise groups with respect to leg power (1 item), balance (2 items), agility (2 items), reaction time (2 items), and a self-reported scale (1 item); the SSE group demonstrated a marked improvement in the above-mentioned items with Group x Time interactions. Significant time effects were observed in the tests involving chair stands, functional reach, and standing up from a lying-down position without Group x Time interactions. During the follow-up period, the fall rates per person-year in the SSE and W groups were 23.4% and 33.3%, respectively (p =.31). Although further studies are required, SSE is apparently more effective than walking in reducing fall risk factors, and it appears that it may be recommended as a health promotion exercise in older adults.

THU0457 Long Term Barriers and Facilitators to Exercise and Physical Activity in Older Adults with Knee Pain: The Beep Longitudinal Qualitative Study

BackgroundAlzheimer disease (AD) and related dementias (ADRD) are a global concern, with major personal and socio‐economic impacts. Physical inactivity and poor sleep are important modifiable risk factors for ADRD and addressing these factors could reduce the prevalence of dementia by up to 40%. For example, poor sleepers have a 1.6‐fold higher risk of developing AD but how do we define poor sleep, what components of sleep are relevant, by how much can sleep quality be improved and what effect does improving sleep have on brain health? Equally, what types of physical activity improve brain health and sleep quality, and what are the relative magnitudes of effect? We will present data demonstrating the association between poor sleep and impaired cognition, and the beneficial effects of aerobic exercise on sleep and cognition in older adults at increased risk of ADRD.MethodsSleep (in‐home polysomnography), cardiorespiratory fitness (VO2peak) and cognition (overall composite, domains) data from two cohorts: BIM‐I is a prospective cohort study of older sedentary adults with longitudinal assessments over a long term (5‐7 years) follow‐up. The second cohort is from the BIM‐II randomized controlled trial involving aerobic exercise in older adults at increased risk of ADRD. Data from BIM‐II examines the inter‐relationship between exercise, sleep and cognition.ResultsData from BIM‐I and II demonstrate: 1) compared to younger adults, older adults have a significant reduction in deep (i.e., slow wave) sleep, an increase in transitional sleep and more wakefulness during sleep; 2) evidence of sex differences in sleep and in exercise effects on sleep; and 3) aerobic exercise is more effective than stretch and tone exercise to improve sleep quality, cognition, and cerebrovascular health.ConclusionsThe novel cross‐sectional, interventional and longitudinal data emerging from BIM‐I and BIM‐II in community dwelling & non‐clinical populations provide evidence supporting age‐related declines in sleep architecture and improvements in sleep with aerobic exercise, as well as a complex interplay between sleep, exercise and cognition in older adults at increased risk of ADRD. These findings help advance knowledge of how lifestyle modifications maintain brain and cognitive health with aging, with relevance to prevention of ADRD.

Exergames have emerged as a strategy to promote physical activity and cognitive tasks through entertainment, being a promising solution for multicomponent training and fall prevention in older adults. Even though seniors may enjoy playing, game design is often not suited to this age group, which hinders interaction and user experience. Therefore, we developed a motion-based interactive game for motor-cognitive training in older adults, based on typical exergames, dance and Tai Chi. New forms of interaction based on inertial sensors and movement were included and tested with eight older adults in multiple sessions, during which usability and user experience were evaluated. People found the exergame fun, even though some challenges related to interaction were reported. Despite the challenges, people learned how to use the system and interaction has gradually became easier. In-game strategies to support interaction are required to encourage autonomous use devoid of supervision.

One of the strategies to mitigate the deleterious effects of the aging process is body weight exercise. However, gaps remain regarding the appropriate progression and intensity, particularly in older adults with cardiometabolic risk factors. The aim of this study was to analyze the rate of perceived exertion (RPE) and affectivity associated with body weight exercise in older adults with cardiometabolic risk factors, considering different levels of complexity. This is a descriptive cross-sectional study. The RPE was assessed using the OMNI-Res scale, and affectivity was measured using the Hardy and Rejeski scale. Multi-joint exercises (squat, push up, pull up) were performed using only body weight and categorized into hypothetical intensities (easy, medium, and difficult) based on complexity adjustments. No significant difference in RPE was found for squat (p=0.261) and push up (p=0.063). However, a significant increase in RPE was observed for the pull up exercise (p=0.001) between the easy and difficult, as well as the medium and difficult complexities. No difference in affectivity was observed for the squat exercise (p=0.008). In the push up exercise, a significant difference in affectivity was found between the easy and difficult complexities (p=0.004), while in the pull up exercise, differences were observed between the easy and difficult, as well as the medium and difficult complexities (p=0.003). Modifying the complexity of squat and push up exercises in trained older adults with cardiometabolic risk factors did not result in differences in perceived intensity. However, performing pull up exercises using the TRX may be an interesting alternative for intensity progression.

IntroductionFew clinical trials have examined the effects of home-based exercise programmes on health-related quality of life (HR-QoL) in older adults with frailty. Radio-Taiso is the most famous exercise programme in...

Humans have never questioned the unique normal walking (NW) pattern they rely on for survival. Even if instability or falls occur during walking, people do not attribute the problem to their walking pattern, but rather to their physiological (including psychological) factors. A significant body of literature primarily emphasizes individual physiological (including psychological) aspects when addressing fall prevention in older adults. It seems that the NW pattern is perfect. However, this is not entirely the case. Aiming to address the phenomenon of human instability or falls during walking, after years of observation and exploration, the authors discovered that the primary cause of instability or falls during walking mainly originates from issues within the problems existing in the NW itself. In response, the authors propose a sitting-walking (SW) mode derived from the Tai Chi gait. The long-term practice has confirmed the uniqueness of SW in maintaining gait balance. In this paper, by comparing NW with SW, the problems associated with NW and the uniqueness of SW will be discussed. The main problems of NW and its negative effects on walking stability and the body are discussed, focusing on gait, balance, and posture. At the same time, according to the characteristics of SW (described in the first part), the paper introduces the advantages of SW in terms of walking stability while effectively avoiding the related problems of NW.

This bibliometric analysis investigates technological solutions for fall prevention in older adults by examining 105 articles from 1996-2024 in the Web of Science database. Utilizing advanced techniques, it maps publication trends, contributors, research hotspots, themes, influential works and emerging topics. Findings reveal increasing research output after 2012, led by the U.S., U.K. and Australia. Prominent hotspots include virtual reality, digital health tools and multidisciplinary interventions. Highly cited works highlight virtual reality, wearable devices and fall prevention education. Emerging areas focus on virtual reality, wearable technologies, mHealth solutions and gait biomarkers. These findings inform geriatric fall prevention research and clinical translation.

Ageing is associated with an upregulation of mitochondrial dynamics proteins mitofusin 2 (Mfn2) and mitochondrial dynamics protein 49 (MiD49) in human skeletal muscle with the increased abundance of Mfn2 being exclusive to type II muscle fibres. These changes occur despite a similar content of mitochondria, as measured by COXIV, NDUFA9 and complexes in their native states (Blue Native PAGE). Following 12weeks of high-intensity training (HIT), older adults exhibit a robust increase in mitochondria content, while there is a decline in Mfn2 in type II fibres. We propose that the upregulation of Mfn2 and MiD49 with age may be a protective mechanism to protect against mitochondrial dysfunction, in particularly in type II skeletal muscle fibres, and that exercise may have a unique protective effect negating the need for an increased turnover of mitochondria. Mitochondrial dynamics proteins are critical for mitochondrial turnover and maintenance of mitochondrial health. High-intensity interval training (HIT) is a potent training modality shown to upregulate mitochondrial content in young adults but little is known about the effects of HIT on mitochondrial dynamics proteins in older adults. This study investigated the abundance of protein markers for mitochondrial dynamics and mitochondrial content in older adults compared to young adults. It also investigated the adaptability of mitochondria to 12weeks of HIT in older adults. Both older and younger adults showed a higher abundance of mitochondrial respiratory chain subunits COXIV and NDUFA9 in type I compared with type II fibres, with no difference between the older adults and young groups. In whole muscle homogenates, older adults had higher mitofusin-2 (Mfn2) and mitochondrial dynamics protein 49 (MiD49) contents compared to the young group. Also, older adults had higher levels of Mfn2 in type II fibres compared with young adults. Following HIT in older adults, MiD49 and Mfn2 levels were not different in whole muscle and Mfn2 content decreased in type II fibres. Increases in citrate synthase activity (55%) and mitochondrial respiratory chain subunits COXIV (37%) and NDUFA9 (48%) and mitochondrial respiratory chain complexes (∼70-100%) were observed in homogenates and/or single fibres. These findings reveal (i) a similar amount of mitochondria in muscle from young and healthy older adults and (ii) a robust increase of mitochondrial content following 12weeks of HIT exercise in older adults.

Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance.

IntroductionResistance exercise has been shown to improve muscle health in older adults and is recommended as a front-line treatment for many health conditions, including sarcopenia and frailty. However, despite considerable...