Development and feasibility of a digital health intervention to encourage exercise maintenance after end of falls prevention exercise programmes

One third of adults aged over 65 years old, and half of adults aged over 80 years, fall each year.  Approximately, 20% of older adult falls result in hospitalisation and 5% lead to bone fractures which costs the NHS over £6.7 billion in falls and fracture related treatments per year. The human cost of falls includes reduced confidence, painful injuries, disability, loss of independence and premature mortality.

Completion of group-based, in-person, Falls Management Exercise (FaME) programmes lasting 24 weeks or more, significantly improves muscle strength and balance, functional status and reduces falls rates and injury incidence in older adults.  Physical activity engagement needs to continue after FaME programmes end to maintain the health benefits gained, but often wanes between 6 to 24-months after programmes end. The demand for in-person FaME programmes vastly outweighs clinical capacity, meaning that patients cannot attend programmes indefinitely. Therefore, this research will develop and investigate the feasibility of a digitally supported exercise maintenance programme that aims to maintain exercise participation when FaME programmes end.

The main aims and objectives of the research study.

STUDY AIM:  To design and investigate the feasibility, acceptability, and safety of a digitally supported exercise maintenance intervention to Falls Management Exercise (FaME) programme service-users.

STUDY OBJECTIVES:

1. Co-design a digitally supported exercise maintenance intervention with a Community of Practice (COP) Group and Patient and Public Involvement (PPI) group.
2. Investigate the acceptability of the digitally supported exercise maintenance intervention to FaME programme service-users.
3. Assess the feasibility of the research methods and key parameters needed to conduct future clinical trials.

How this research is going to help address MSK health.

Based on evidence within the team’s combined research portfolio, they predict the digitally supported exercise maintenance intervention developed will have good potential to encourage older adults to continue exercising when face to face FaME programmes end.  Maintaining physical activity when FaME programmes end will help to improve the long-term patient outcomes relating to functional status and falls and injury risk and incidence.  As such, this will augment the cost effectiveness of falls prevention exercise programmes and reduce the burden falls has on individual lives and NHS resources. 

The main research methods, or datasets being used.

STUDY DESIGN: The project will be conducted in two separate phases, as interdependency exists between the research objectives.

METHODS:

Phase 1: Intervention Development and acceptability testing. Intervention Development will be informed by the Normalisation Process Theory and Theoretical Framework of Acceptability.  In consultations, the research team will work with a group of diverse PPI members and key stakeholders to define a digitally supported exercise maintenance intervention and procedures. Digital intervention components may include self-monitoring physical activity via wearables, digital peer support and home exercise delivered via an evidence-based Falls Prevention App.

Phase 2: Mixed methods single arm, multi-site Feasibility Study. A mixed methods single-arm multi-site feasibility study will be conducted to investigate the feasibility, acceptability and safety of the exercise maintenance intervention (optimised in phase 1) and the feasibility of the research methods. We will recruit and deliver the exercise maintenance intervention for up to 6 months in 30 FaME class attendees. 

Feasibility data will be collected and measured over 6 months via:

• Recruitment and retention rates.
• Feasibility of collecting self-reported quality of life, falls incidence, and confidence data
• Adverse event data
• Intervention adherence

A priori progression criteria will be set on feasibility outcomes to help determine future progression to a larger-scale clinical trial.

Participant data is routinely collected by HealthWorks, a Community Health Charity, delivering FaME classes to people in deprived areas of Newcastle, for service purposes. 

SAMPLE & SETTING:  We are working in collaboration with HealthWorks. To ensure people experiencing health inequalities are represented in the study, we will recruit a sample of culturally diverse older adults from four HealthWorks hubs and deliver the intervention in these venues.

ELIGIBILITY CRITERIA: 

• Community dwelling older adults
• Independently mobile
• Enrolled on a FaME programme delivered by HealthWorks.
• Able to provide written informed consent.

EXCLUSION CRITERIA:

Has been advised by a GP or consultant not to exercise or has a medical, cognitive or physical condition that prevents safe engagement with unsupervised exercise. 

SAMPLE SIZE: During the intervention development phase, a phenomenological approach will be adopted to investigate the participants’ views on their experience of engaging with the intervention. We will recruit 10 participants to test and make recommendations to optimise the exercise maintenance intervention in phase 1.

Researcher: Dr Sarah Audsley.

Supervisor: Dr Gill Barry.

University: Northumbria University.

Award stream: Early Career Research Fellowship.

Award duration: 2 years.

Amount rewarded: £105,200.

Collaborations/ partners: Northumbria University (Dr Gill Barry, Professor Nicola Adams, Dr Sarah Moore, Dr Alasdair Odoherty), Glasgow Caledonian University (Prof Dawn Skelton), The University of Manchester (Dr Emma Stanmore).  Working in partnership with HealthWorks (Mr Paul Court) and KOKU Health.