Abstract
Introduction: One-third of people aged ≥65 years fall at least once a year. Exercise on land reduces falls by up to 34% and fallers by >15%. Exercise on land may sometimes be challenging, e.g., for very frail people with high risk or fear of falling, people with painful joints, obesity and other comorbidities. Aquatic exercise may have positive effects on falls reduction, but research on it is sparce. The aim of this study was to design and deliver an aquatic exercise therapy intervention for falls prevention, and investigate its feasibility and acceptability for older adults with high fall risk.
Methods: Fifty-one people who met the eligibility criteria were allocated to the aquatic group (Aqua Steps). For the land group, 50 people who had been referred to an established falls prevention programme that is being delivered in Edinburgh (Steady Steps) volunteered to also join the study. Both interventions lasted 16 weeks and had 60 min of supervised exercise per week, as well as falls’ education and optional home exercises. The primary outcomes were based on the feasibility of Aqua Steps: recruitment, retention, adverse events, and evidence of improvements in some secondary outcomes (falls and fallers; functional, strength and balance tests; self-reported outcomes on falls efficacy, balance confidence, quality of life and health).
Results: Aqua Steps was safe and had high recruitment, retention, adherence and acceptability. There was strong evidence of reduction in falls and fallers, and of improvements in function, strength, balance and fear of falling. The improvements were generally sustained during a six-month follow up period, and were greater than those of the land exercise group.
Conclusion: Aqua Steps met comfortably the feasibility targets that had been set. This evidence can now be used to inform a follow-up, definitive, randomised controlled trial.
Comments
Water great idea
Hello. Thank you for presenting your study on benefits of water-based exercise. Why do you think water-based exercise resulted in greater improvement in the three recorded falls categories compared to land-based exercise?
Hello Alasdair and many…
Hello Alasdair and many thanks for your comments!
This was designed as a feasibility study, so the main aims were to create a high-quality intervention for falls prevention, assess its feasibility and acceptability for older adults at high risk of falls, and answer the question ‘should we proceed to the next stage?’. The study had excellent outcomes on all the above, but a direct comparison was not within its design (this will be done in a follow-up larger scale trial).
Nevertheless, we also tested a second group of people who were undertaking an established land exercise programme at the same time, which has been delivered for a long time locally (by referal) and has well documented positive effects. We did that for the purpose of providing some context to any improvements observed in the aquatic group. When improvements are better in an aquatic group, some advantages of the aquatic environment could be contributing to those. For example, buoyancy reduces spine and joint loads and allows one to work out without having to support most of their weight. There is increased mobility and range of motion in the water, which allows the execution of exercises that would not be possible on land. Water resistance acts throughout the movement, which could help with some strength gains. The hydrostatic pressure from the water assists with balance, while the pain is usually lower and more rare than when exercising on land, which can help people do more and improve retention and attendance.
Hope this helps,
Stelios
This project has gone swimmingly!
A really good project - with good data, and presented in an excellent manner, including video - well done!
What barriers do you think there are for patients being able to access Aqua steps, and what are your next steps for the project?
Thanks
Hello Megan and many thanks…
Hello Megan and many thanks for your comments!
We had conversations with our participants and are still in the process of analysing the data, so do not have the complete picture just yet, but there are a few things that have come up. Hearing in a pool environment can be difficult sometimes, especially at busy times when it's more noisy. Having the instructors speaking loud, using microphones, and be very 'animated' when demonstrating an exercise certainly helps. Proximity of pool to one's home can be a barrier, as well as session timings (lunch time sessions seemed less popular). Pool accessibility features are important, e.g. lift (if pool not on the ground floor of building), easy access into the pool (pools hand rails for support and gradual steps, rather than ladders, were commented upon favourably, while a hoist is also very useful for some of the more frail participants). Occasionally people would mention things like not being in a pool for a long time, water temperature being cold (in public pools); these did not seem to be important barriers for those in our study, but it would be interesting to know if these would be important barriers for people who did not volunteer to participate.
Hope this helps