Friday, February 15, 2013

Exercise and education are important to address fear of falling

...from Don't Fall.ca by: William Gage, Ph.D. Associate Dean, Research and Innovation, Faculty of Health, York University

A person who has fallen in the past is more likely to report having a fear of falling, compared with someone who has never fallen. However, a person does not have to have fallen previously to now suffer with a fear of falling. It’s been shown that just knowing someone who has suffered as a result of a fall is enough to spark a fear of falling. Just knowing that you are a person who is at a greater risk of injury if you fall, related to, for example, having been diagnosed with osteoporosis, is enough to engender a fear of falling. As we discussed last time, a fear of falling can actually increase your risk of experiencing a fall. Fear of falling is a risk factor for falling! So, what do you need to know to help yourself or your friend? What can you do?

Knowing that fear of falling is a risk factor for falling, many researchers and clinicians have been very interested to develop a deeper understanding of this relationship, and to develop treatments or interventions to address the fear, improve overall health, and reduce the risk of falling. Every year or two I attend a scientific meeting, called the “International Society for Posture and Gait Research” – last year this was held in Norway, this year it is in Japan; and yes, I love my job – and many of the 500 or so researchers from around the world discuss their work in the area of fear of falling and fall risk reduction. Fear of falling is a serious concern affecting the lives of millions of people, and people around the world are interested in solving this problem.

The outcome of fear of falling, as we’ve discussed, can be reduced participation in daily activities and social isolation. Physically, muscle strength and fitness are affected by reduced activity. In 2004, an experiment that looked at two different types of exercise programs to treat fear of falling – a muscle strengthening program and an agility, or balance, program – showed that fear of falling and balance confidence both improved with the exercise programs. However, the 98 older women in the study did not actually improve in their physical abilities. Balance and objective measures of fall risk did not improve. Physical activity level also did not improve. The researchers suggested that education about fear of falling is important to complement the exercise programs (click here for more information).

The exercise programs described above improved balance confidence, but they did not actually result in better balance. However, a recent study has shown that people with better balance also had better balance confidence. This study involved 131 community dwelling Roman Catholic priests between the ages of 60 and 97 (split into 60-74, and 75+). The younger men had better balance confidence than the older priests, and better balance confidence was related to better balance scores, better functional ability (TUG), and less depression. Across all of the men, better balance confidence was related to greater participation in daily activities (click here for more information). Better balance ability was related to better balance confidence and greater participation in daily activities.

Better balance ability leads to better balance confidence, and greater participation in daily activities. This was supported by a very recent study (click here for more information), published only just this past month in The Journal of Geriatric Physical Therapy that has shown that participation in daily activities is more related to balance and mobility than it is to fear of falling. Over 80 men and women with an average age of 74 years answered a questionnaire called the Survey of Activities and Fear of Falling in the Elderly, or SAFE, for short. And they had their balance and mobility tested. Both fear of falling and participation restriction were related to balance and mobility test results, but only participation restriction predicted balance and mobility. These results really suggest that it is participation restriction, or reduced physical activity that leads to reduced balance and mobility, not fear of falling.

What is very important to understand is that these results highlight that fear of falling is a critical mediating factor between participation in activity and a person’s balance and mobility. If you can reduce a person’s fear of falling, they can be more active. They can participate more. This in turn results in improved balance ability and mobility, and decreased risk of falling. What all of this really means is that treatment programs to deal with fear of falling should include a component of participation or activity encouragement. Essentially, while working on the fear, the cognitive or mental aspect, attention needs to be paid to actually increasing the person’s engagement in real physical activity. This approach is likely to be beneficial in at least two ways. First, the physical activity will result in improved muscle strength, cardiovascular fitness, and bone health, all of which will reduce the risk of falling. Second, the engagement in real physical activity will improve the person’s social engagement – this social activity makes the activity more enjoyable (improving the ability to stick with it) and reduces social isolation, improving mood and perhaps symptoms of depression, which again reduces the risk of falling.

Taken together, all of this research points to the following: a combination of exercises and education is important for many people who have a fear of falling. Exercises, including a combination of those targeting muscle strength, cardiovascular fitness, and, importantly, balance ability, result in improved physical ability. Education about factors associated with fear of falling and reduced balance confidence is important to helping people understand how they are restricting their own participation. Improved physical ability creates the foundation for greater activity and social engagement, and improved understanding and knowledge of the effects of fear of falling and why they happen provides the wherewithal for the person to build on that foundation and become active again. Critically, both the body and the mind need to be addressed in order to overcome fear of falling and get back to healthy living.

Want to meet William Gage in person?

Join Us on Wednesday, March 27, 2013 when he presents:

"Why We Fall, and What You Can Do To Reduce Your Risk"

As we age, our risk of falling increases, One in three people over the age of 65 fall each year. What can we do to reduce your risk of falling? We'll discuss why falls increase as we get older and practical tips for reducing your risk of falling.

FREE and All Welcome!

All events start at 1:00 pm at the Evergreen Seniors Community Centre, 683 Woolwich Street Guelph, Ontario

To Register - please contact: Pat Gage 519-837-5696