Aquatic exercise for falls prevention: The AQUA STEPS study

Introduction: About one in three adults over the age of 65 fall at least once annually. Land-based exercise can cut overall falls by up to 34% and the number of people who fall by more than 15%. However, exercising on land may be difficult for some, such as very frail individuals, those with a high risk or fear of falling, or people with painful joints and limited mobility. Aquatic exercise may also help reduce falls, but the available evidence is limited. This study aimed to develop and deliver an aquatic exercise therapy programme for fall prevention and to assess its feasibility and acceptability for older adults at high fall risk.

Methods: Fifty-one eligible participants volunteered for the aquatic arm of the intervention (Aqua Steps). For the land exercise arm, 50 people who had already been referred to an established land-based falls prevention service in Edinburgh (Steady Steps) agreed to take part. Both programmes ran for 16 weeks and included one hour of supervised weekly exercise, falls education, and optional home exercises. The main outcomes were based on the feasibility of Aqua Steps: recruitment, retention, adverse events, and indications of improvement in secondary measures (falls and fallers; functional, strength and balance assessments; and self-reported measures of falls efficacy, balance confidence, quality of life and health).

Results: Aqua Steps was safe and had excellent recruitment, retention, adherence and acceptability. There was clear evidence of reduced falls and fallers, along with gains in function, strength, balance, and decreased fear of falling. These benefits were largely maintained over six months of follow-up and exceeded those of the land-based programme.

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.