Fall and Fractures Prevention Clinical Trial
Official title:
Tailored Exercise for Fall and Fracture Prevention in Older Adults: A Family Health Team Approach
Falls and fractures are a leading cause of death and disability in the older adult population. The consequences of falls and fractures contribute substantially to health care costs and can have a significant negative impact on the quality of life of the individual. Exercise has been studied as an option to reduce fracture risk and prevent falls though improving balance and muscle strength. The prevention of falls is important, as a history of falls is strongly predictive of suffering another. Those who are at a high risk of fracture or falling require a patient specific assessment and individualized exercise prescription that is tailored to their needs. This kind of program may not be typically available within the community and at a low cost. These individuals may experience difficulty when trying to engage in exercise due to barriers such as a lack of transportation, and a lack of knowledge. As the first point of contact with the health care system for many family doctors are in the ideal position to deliver exercise advice to their patients. However, a lack of time and specialized skills in prescribing exercise make this difficult for many of them. As a result, family health teams who provide interdisciplinary patient centered care are becoming popular. In this model the care is shared and provided by the most appropriate team member (e.g. doctor, nurse, exercise specialist). Additionally, many exercise interventions do not include a behavior change aspect, which may be an important component when trying to get individuals to engage in a new health behavior like exercise. Therefore the purpose of this project is to assess the feasibility of implementing a tailored exercise program to those at high risk of falls or fractures over the age of 65 in a primary care setting using an interdisciplinary model of care that is based on a health behaviour change model.
Falls and fractures together represent one of the leading causes of morbidity and mortality
within the older adult population. Additionally, the consequences of falls and fractures
contribute substantial costs to the health care system and negatively impact the quality of
life of the individual. Given that Canada's aging population in increasing at an
unprecedented rate, it is imperative that the prevention and management of falls and
fractures is made a priority. One such population particularly vulnerable to falls and
fractures are those diagnosed with osteoporosis or low bone mass.
It has been estimated that approximately 10 billion individuals have been diagnosed with
osteoporosis and another 34 million are at risk with low bone mass. Osteoporosis-related
fragility fractures are a common consequence of osteoporosis and result in increased
morbidity and mortality. Approximately 50% of those who suffer a hip fracture do not regain
their previous level of mobility and functional independence thus resulting in many of these
individuals relying on the use of assistive devices.
Currently the emphasis of osteoporosis treatment and management is to prevent the occurrence
of fragility fractures and the subsequent side effects that accompany them. A recent
meta-analysis has shown that exercise can assist in the prevention and maintenance of bone
loss in postmenopausal women. Other benefits of exercise such as increases in muscle strength
and balance have been strongly established to indirectly prevent fractures through a
reduction in falls risk. Those who are at a high risk of falls or fracture require patient
specific assessment and individualized prescription that is not typically available within
the community or at a low cost. Further, it may be difficult to engage these individuals if
they have spent most of their life in a sedentary state and experience barriers such as a
lack of transportation, and a lack of knowledge on appropriate types of exercise or how to
initiate exercise into their daily living. Furthermore, many exercises may not be appropriate
for all individuals depending on location of fracture and level of physical function. It has
been emphasized that the focus should be on an individualized exercise program, which would
encompass individual needs while recognizing individual limitations.
Family physicians may be in an ideal position to deliver an exercise prescription to a
patient, as they are often the first point of contact with the health care system. However,
there have been a number of problems cited with using family physicians to implement the
delivery of an exercise prescription. Among those barriers, a lack of time and a lack of
knowledge have been identified as the most problematic. An interdisciplinary family health
team model of care is becoming increasingly important in regards to the treatment of chronic
conditions such as osteoporosis. Family health teams provide an ideal form of care where team
members work together to deliver the program and enhance adherence.
A limitation of many exercise interventions is that they fail to include a behavior change
component which may be an important factor to consider when attempting to facilitate
adherence to an exercise program. The Health Action Process Approach is a model of behavior
change that has been widely used in a variety of health contexts including but not limited to
physical activity. The rationale for the selection of this model is that it incorporates key
principles of other behavior change models. Furthermore, the model has been cited as being a
valid and reliable tool for predicting physical activity levels in older adults.
This project outlines an exercise intervention that is multidisciplinary in nature and
tailored to the individual to be employed within an interdisciplinary family health team.
Additionally, a behavior change component is built into this intervention with key principles
such as action planning and coping planning that are based on the HAPA model to facilitate
the uptake of physical activity in this vulnerable population.
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