1. Dr Dawn Skelton
Workshop on Strength and Balance Training in Older People to Prevent Falls

3. New Zealand RCTs - OTAGO
Individually tailored programme: Campbell, BMJ 1997
-80+ years, n=233, home-based, physiotherapist ankle, leg and hip strength, balance, gait, transfers
-1 year, falls  32%, injuries  39%
Nurse delivered programme at home: Robertson, BMJ 2001
-75+ years, n= 240, home, district nurse
-1 year, falls  46%,  serious injuries and hospital costs
Physiological studies: Exercise shown to increase muscle strength and improve balance thus provide rational for using it to attempt tp reduce falls.
FICSIT metan.(5comm, 2 Nh)-Province 1999,2-4 yrs, dif progs,subjects assigned to an x gp less likely to fall. No x component sig for injurious falls
Cochrane review incons. Data. x alone did not protect against falls
Tai Chi: (Atlanta FICSIT): 48% reduction (adjusted for fall risk factors) cf computerised balance training programme(interestingly only controlgp improved balanced showing importance of fall as primary measure (Mcmurdo)
Campbell 1997: -cognitively intact, able to move around house hr visits over 2 months- individ 30 min progrm of strengthening exercises using ankle weights and balance training exercises included standing with one foot directlt in front of the other, walking tandem, heel walking, toe walking, knee squats. 3+ times a week and also walk outside home at least 3 times a week.
-also relative hazard for injurious falls reduced and balance scores improved
Campbell 1999 Age Ageing: rate of falls remained sig lower in the ex group than control gp at 2 years in those who continued the programme.
Robertson; Nurse home: serious injuries and hosp admissions reduced.
-cost /fall (1988 prices) Pv = NZ$1803 (£523) IRR = Inc rate ratio
-cost / fall averted considering hospital costs NZ$155 (£45)
Robertson: nurse. GP centres: no diff in serious injuries or hosp. Costs
-cost/ fall averted : NZ$1519 (£441)
Ebrahims 97, AgeAgeing brisk walking gp: falls up, therefore x is not x is not x. Qualified x practitioners-graded strengthening+ walking program
Nurse programme at GP centres: Robertson, BMJ 2001
-80+ years, n=450, general practice nurse
-1 year, falls  30%, injuries  28%
Visually Impaired Older People: Campbell, BMJ 2005
-1 year, Only effective with full compliance, falls 28%

4. OTAGO Exercise Programme
Summary
Designed to ↓ falls by ↑ strength and balance
Effective in ↓ falls in community dwelling OP
Effective when delivered by physiotherapist and trained, supervised nurses
Most effective for 80+ years with previous falls history
Only effective with good compliance in OP with visual impairment

5. Programme Essentials
Delivered at home or in groups by a trained OEP leader
Lower limb muscle strength and balance exercises individually tailored from a set programme
Frequency - 3 x p/w
Intensity - Moderate
Duration mins
Progressive
+ Walking (30 mins x 2 p/w)

6. OEP Schedule X 4 home visits in first 2 months
Booster visit at 6 months
1 hour first visit, 30 mins subsequent visits
Telephone call x 1 p/m between visits
Exercises (warm up, strength, balance, flexibility, cool down)
Walking

7. OEP Schedule 1 2 3 4 5 6 …… 12 8   Month Week Home Exercise Visits
Telephone follow up 

8. OEP Exercise Components
Warm Up – 5 exercises
Strength training – 5 exercises
Balance training (dynamic & static) – 12 exercises
(Cool down)
Walking programme

9. Daily walking
Plus 3 x per week home exercise programme
Exercises do not have to be done in any set order or all at the same time

10. Head Movements (Repeat 5 times)

11. Neck Movements (Repeat 5 times)

12. Back Extension (Repeat 5 times)

13. Trunk Movements (Repeat 5 times)

14. Ankle Movements (Sit or stand Repeat 10 times)

15. Front Knee Strengthening Exercise (Repeat 10 times) Ankle cuffs increase in weight from 0.5 to 5kg over the year

16. Back Knee Strengthening Exercise (Repeat 10 times)
Ankle cuffs increase in weight from 0.5 to 5kg over the year

17. Side Hip Strengthening Exercise (Repeat 10 times)
Ankle cuffs increase in weight from 0.5 to 5kg over the year

18. Calf (Heel) Raises (with support) (Lift x 20)

19. Calf Raises (no support) (Lift x 20)
PROGRESSION
Calf Raises (no support) (Lift x 20)

20. Toe Raises (with support) (Lift x 20)

21. Toe Raises (no support) (Lift x 20)
PROGRESSION
Toe Raises (no support) (Lift x 20)

22. Knee Bends (with support) (Repeat 10 times)

23. Knee Bends (no support) (Repeat 10 times)
PROGRESSION
Knee Bends (no support) (Repeat 10 times)

24. Backwards Walking (with support) (10 steps x 2)
Preparation – Forwards walking with and without support

25. Backwards Walking (no support) (10 steps x 2)
PROGRESSION
Backwards Walking (no support) (10 steps x 2)

26. Walking and Turning Around (figure of 8 x 2)
Preparation – with chair support

27. Sideways walking (10 steps x 2)
Preparation – with chair support

28. Heel Toe Standing (with support) (10 secs)

29. Heel Toe Standing (no support) (10 secs)
PROGRESSION
Heel Toe Standing (no support) (10 secs)

30. Heel Toe Walking (with support) (10 steps x 2)

31. Heel Toe Walking (no support) (10 steps x 2)
PROGRESSION
Heel Toe Walking (no support) (10 steps x 2)

32. One Legged Stand (with support) (10 secs)

33. One Legged Stand (no support) (10 secs)
PROGRESSION
One Legged Stand (no support) (10 secs)

34. Heel walking (with support) (10 steps x 2) Preparation – toe walking

35. Heel walking (no support) (10 steps x 2)
PROGRESSION
Heel walking (no support) (10 steps x 2)

36. Toe walking (with support) (10 steps x 2)

37. Toe walking (no support) (10 steps x 2)
PROGRESSION
Toe walking (no support) (10 steps x 2)

38. Heel Toe Backward Walking (no support) (10 steps x 2) Preparation – heel toe forward walking with and without support and heel toe backward walking with support

39. Sit to stand (two hands) (Repeat 10 times)
PROGRESSION
Sit to stand (two hands) (Repeat 10 times)

40. Sit to stand (one hand) (Repeat 10 times)
PROGRESSION
Sit to stand (one hand) (Repeat 10 times)

41. Sit to stand (no hands) (Repeat 10 times) Preparation – hands on knees
PROGRESSION
Sit to stand (no hands) (Repeat 10 times) Preparation – hands on knees

42. Stair walking (Up and down steps)