Accidental Falls Clinical Trial
Official title:
Improving Balance and Mobility in Older Veterans
Falls are dangerous leading to injuries and even death. The VA has made fall prevention a priority, but effective programs only reduce falls by 30%. Tai Chi, a standing exercise program, has been effective at improving balance but may not prevent falls. Most falls occur during walking when an individual experiences a slip or a trip. Programs that focus on walking, stepping, and recovery from a slip may be more effective at fall reduction. This study will compare Tai Chi to a novel multimodal balance intervention (MMBI). MMBI focuses on standing balance, walking, stepping, strength training, and recovery from a slip. The Investigators believe that the MMBI program will be more effective than Tai Chi at improving balance and preventing falls in older Veterans and the Investigators will use the results of this study to develop a larger study on fall prevention in older Veterans.
Background: Falls are currently the leading cause of injurious death and non-fatal injuries
for adults over the age of 65. Older Veterans may be at greater risk for falls due to their
high burden of medical co-morbidity. The VA has made research into fall prevention a high
priority. Falls are complex with numerous deficits including impaired balance, decreased
postural control, muscle weakness, and an inability to successfully negotiate environmental
hazards. Tai Chi is currently considered to be one of the most effective fall prevention
exercise interventions, with an endorsement from the Centers for Disease Control and
Prevention (CDC) which widely influences health care policy. However, there are few studies
comparing Tai Chi with another active intervention. Tai Chi may generally improve balance,
decrease fall risk, and provides a general lower body strengthening. However, Tai Chi may not
sufficiently improve gait and dynamic mobility and does little to target obstacle
negotiation, one of the largest contributors to a fall. The majority of falls occur during
walking, with slips and trips being the most common causes and targeted interventions focused
on improving stepping and walking ability may be even more effective at improving balance and
reducing falls.
The Investigators plan to enroll 56 older (age > 65 years) community dwelling Veterans with a
history of a fall in the last year who are at high risk for a recurrent fall. After baseline
testing participants will be randomized to either MMBI or a Tai Chi intervention modeled
after the Tai Chi Moving for Better Balance Program. All participants will participate in a
group exercise class in their assigned intervention for 1 hour, 3 times per week for 24
weeks. After the completion of 24 weeks of exercise group changes will be compared for 1)
balance (4-square step test); 2) mobility and fall risk (functional gait assessment); 3) rate
of falls; 4) lower extremity isometric strength testing (biodex); and 5) body composition.
The investigators also plan for follow all participants for 6 months after completion of the
intervention to examine differences in fall rates after the cessation of the program between
the groups.
Impact: This research directly benefits Veterans as it may lead to new and effective
interventions that could reduce fall risk, injury-related hospitalization and death in older
Veterans. MMBI is also readily exportable to the community and with minimal resources could
be widely implemented at other VAs as part of standard of care, similar to Managing
Overweight and/or Obesity for Veterans Everywhere! (MOVE!). Results from this SPIRE grant
will be used to power a larger randomized clinical trial that will examine the effectiveness
of the two interventions to reduce rate of falls and risk of falling in older Veterans at
high risk for falls.
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