Prescribe Exercise for Prevention of Falls and Fractures: A Family Health Team Approach

NCT01698463 | Completed Results

• 1 other identifier: 17664
• Study Type: interventional
• Target: 11
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Fall and Fractures Prevention

Keywords

Falls, Fractures, Osteoporosis, Frailty, Older Adults.

Outcome Measures

Primary Outcomes (2)

• Physical Activity (Reporting Change in Physical Activity From Baseline to Six-week Follow-up)

  The X2-Mini accelerometer (Gulf Coast Data Concepts.,USA) is a three-dimensional sensor that is used to capture the activity levels of an individual. The accelerometer is worn on the hip of the participant for four days. The number of minutes that the individual spends in each exercise intensity category is acquired. Accelerometer thresholds make up four categories of activity: (1) sedentary; (2) low-light; (3) high-light; (4) moderate-vigorous. Activity monitors have been indicated as the most accurate means of measuring physical activity levels.

  Baseline, 6 week follow-up

• Physical Activity (Self-report) (Reporting Change in Physical Activity From Baseline to Six-week Follow-up)

  Participants complete a physical activity log book daily in order to document their completion of the prescribed exercises and list any additional activities that they may have been engaged in. The percentage of prescribed exercises completed are reported (for e.g. if participants completed 2 of 3 prescribed exercise then the reported percentage would be 67%). Mean (SD) are reported.

  Baseline, 6 week follow-up

Secondary Outcomes (5)

• Behavior Change Outcome: Action Planning

  Baseline, 6 week follow-up

• Behavior Change Outcome: Coping Planning

  Baseline, 6 week follow-up

• Behavior Change Outcome: Coping Self-Efficacy

  Baseline, 6 week follow-up

• Behavior Change Outcome: Intentions

  Baseline, 6 week follow-up

• Health Related Quality of Life (HRQOL)

  Baseline, 6 week follow-up

Study Arms (1)

Identify Patients at Risk/Exercise Prescription

OTHER

The intervention was delivered in two visits and two follow-up phone calls. Physician identifies that the patient is at risk of falls or fractures Visit one: individualized exercise prescription by a physiotherapist. Visit two: motivational interviewing (behavioural counselling) by kinesiologist Phone call 1 and 2: Kinesiologist reviews behavioural components (action planning, coping planning, coping self-efficacy, intentions.

Other: Identification of patients at risk, tailored exercise prescription, motivational interviewing, review of behavioural outcomes

Interventions

Identification of patients at risk, tailored exercise prescription, motivational interviewing, review of behavioural outcomes OTHER

The intervention was delivered in two visits and two follow-up phone calls. * Physician identifies that the patient is at risk of falls or fractures * Visit one: individualized exercise prescription by a physiotherapist. * Visit two: motivational interviewing (behavioural counselling) by kinesiologist * Phone call 1 and 2: Kinesiologist reviews behavioural components (action planning, coping planning, coping self-efficacy, intentions.

Identify Patients at Risk/Exercise Prescription

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• \> age 65
• Patient of the Centre for Family Medicine Family Health Team (CFFM FHT)
• Have at least one of the following:
• or more falls in the past 12 months
• age 75 +
• high risk of fracture based on the CAROC
• difficulty with walking or balance as determined by attending physician
• acute fall
• history of a fragility fracture after the age of 50

You may not qualify if:

• moderate to severe cognitive impairment
• moderate to severe neurologic impairment
• not able to communicate in English
• contraindications to exercise as determined by physician
• uncontrolled hypertension
• palliative care, current cancer, on dialysis
• participation in a similar exercise program including resistance training at least 3 times a week

Sponsors & Collaborators

• University of Waterloo: lead
• The Centre for Family Medicine, Ontario: collaborator

Study Sites (1)

Centre for Family Medicine (CFFM)

Kitchener, Ontario, N2G 1C5, Canada

Location

Related Publications (36)

• Boonen S, Dejaeger E, Vanderschueren D, Venken K, Bogaerts A, Verschueren S, Milisen K. Osteoporosis and osteoporotic fracture occurrence and prevention in the elderly: a geriatric perspective. Best Pract Res Clin Endocrinol Metab. 2008 Oct;22(5):765-85. doi: 10.1016/j.beem.2008.07.002.

  PMID: 19028356 BACKGROUND

• Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001 May;49(5):664-72. No abstract available.

  PMID: 11380764 BACKGROUND

• Leslie WD, O'Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A; Osteoporosis Surveillance Expert Working Group. Trends in hip fracture rates in Canada. JAMA. 2009 Aug 26;302(8):883-9. doi: 10.1001/jama.2009.1231.

  PMID: 19706862 BACKGROUND

• Brown AP. Reducing falls in elderly people: A review of exercise interventions. Physiother Theory Pract 1999;15:59-68.

  BACKGROUND

• Statistics Canada. Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (CANSIM Table 051-0001). Ottawa: Statistics Canada 2010.

  BACKGROUND

• World Health Organization. WHO Global Report on Falls Prevention in Older Age. Geneva, Switzerland: World Health Organization. 2007; Available at: http://www.who.int/ageing/publications/Falls_ prevention7March.pdf. Accessed Retrieved Aug, 2011.

  BACKGROUND

• Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993 Jun;94(6):646-50. doi: 10.1016/0002-9343(93)90218-e. No abstract available.

  PMID: 8506892 BACKGROUND

• National Osteoporosis Foundation. America's bone health: the state of osteoporosis and low bone mass in our nation. Washington DC: National Osteoporosis Foundation. 2002.

  BACKGROUND

• Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. 2009 Sep 1;181(5):265-71. doi: 10.1503/cmaj.081720. Epub 2009 Aug 4.

  PMID: 19654194 BACKGROUND

• Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, Brown JP, Josse RG, Kaiser S, Anastassiades T, Goltzman D, Papadimitropoulos M, Tenenhouse A, Prior JC, Olszynski WP, Adachi JD; CaMos Study Group. The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int. 2009 May;20(5):703-14. doi: 10.1007/s00198-008-0743-7. Epub 2008 Sep 19.

  PMID: 18802659 BACKGROUND

• Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int. 2001;12(4):271-8. doi: 10.1007/s001980170116.

  PMID: 11420776 BACKGROUND

• Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD; Scientific Advisory Council of Osteoporosis Canada. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010 Nov 23;182(17):1864-73. doi: 10.1503/cmaj.100771. Epub 2010 Oct 12. No abstract available.

  PMID: 20940232 BACKGROUND

• Martyn-St James M, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone. 2008 Sep;43(3):521-31. doi: 10.1016/j.bone.2008.05.012. Epub 2008 May 26.

  PMID: 18602880 BACKGROUND

• Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007146. doi: 10.1002/14651858.CD007146.pub2.

  PMID: 19370674 BACKGROUND

• Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research. J Fam Pract. 2000 Feb;49(2):158-68.

  PMID: 10718694 BACKGROUND

• Health Council of Canada 2010. Family Physicians as Gatekeepers.

  BACKGROUND

• Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J Sport Med. 2000 Jan;10(1):40-8. doi: 10.1097/00042752-200001000-00008.

  PMID: 10695849 BACKGROUND

• Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003 Apr;93(4):635-41. doi: 10.2105/ajph.93.4.635.

  PMID: 12660210 BACKGROUND

• Petrella RJ, Wight D. An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Arch Fam Med. 2000 Apr;9(4):339-44. doi: 10.1001/archfami.9.4.339.

  PMID: 10776362 BACKGROUND

• Nupponen R. What is counseling all about--basics in the counseling of health-related physical activity. Patient Educ Couns. 1998 Apr;33(1 Suppl):S61-7. doi: 10.1016/s0738-3991(98)00010-x.

  PMID: 10889747 BACKGROUND

• Ritchie CS, Stetson BA, Bass PF 3rd, Adams KJ. Talking to patients about aerobic exercise for disease prevention: an educational exercise for medical students. Nutr Clin Care. 2002 May-Jun;5(3):103-14. doi: 10.1046/j.1523-5408.2002.00041.x.

  PMID: 12134565 BACKGROUND

• Walsh JM, Swangard DM, Davis T, McPhee SJ. Exercise counseling by primary care physicians in the era of managed care. Am J Prev Med. 1999 May;16(4):307-13. doi: 10.1016/s0749-3797(99)00021-5.

  PMID: 10493287 BACKGROUND

• Health Canada. Database on the Internet 2011; Available at: http://www.hc-sc.gc.ca/hl-vs/physactiv/index-eng.php. Accessed June 8 2011.

  BACKGROUND

• Barling NR, Lehmann M. Young men's awareness, attitudes and practice of testicular self-examination: a Health Action Process Approach. Psychol Health Med 1999; 4(3):255-263.

  BACKGROUND

• Cao D, Xie G. From intention to health behavior: An overview on Health Action Process Approach. Chinese Journal of Clinical Psychology 2010; 18(6):809-812.

  BACKGROUND

• Chiu C. Testing schwarzer's health action process approach (HAPA) model of health promotion for people with multiple sclerosis: A path analytic approach. University of Wisconsin - Madison; 2009. 217 pp. Available from: UMI Order AAI3384139.:M1: Ph.D.

  BACKGROUND

• Luszczynska A, Goc G, Scholz U, Kowalska M, Knoll N. Enhancing intentions to attend cervical cancer screening with a stage-matched intervention. Br J Health Psychol. 2011 Feb;16(Pt 1):33-46. doi: 10.1348/135910710X499416.

  PMID: 21226782 BACKGROUND

• Schwarzer R, Luszczynska A. How to overcome health-compromising behaviors: The health action process approach. European Psychologist 2008; 13(2):141-151.

  BACKGROUND

• Williams RJ, Herzog TA, Simmons VN. Risk perception and motivation to quit smoking: a partial test of the Health Action Process Approach. Addict Behav. 2011 Jul;36(7):789-91. doi: 10.1016/j.addbeh.2011.03.003. Epub 2011 Mar 21.

  PMID: 21463920 BACKGROUND

• Schwarzer R. Self-efficacy: Thought control of action. Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. Washington: Hemisphere; 1992. p. 217-243.

  BACKGROUND

• Luszczynska A, Schwarzer R. Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychology and Health 2003; 18:93-108.

  BACKGROUND

• Renner B, Spivak Y, Kwon S, Schwarzer R. Does age make a difference? Predicting physical activity of South Koreans. Psychol Aging. 2007 Sep;22(3):482-93. doi: 10.1037/0882-7974.22.3.482.

  PMID: 17874949 BACKGROUND

• Buman MP, Hekler EB, Haskell WL, Pruitt L, Conway TL, Cain KL, Sallis JF, Saelens BE, Frank LD, King AC. Objective light-intensity physical activity associations with rated health in older adults. Am J Epidemiol. 2010 Nov 15;172(10):1155-65. doi: 10.1093/aje/kwq249. Epub 2010 Sep 15.

  PMID: 20843864 BACKGROUND

• Gerdhem P, Dencker M, Ringsberg K, Akesson K. Accelerometer-measured daily physical activity among octogenerians: results and associations to other indices of physical performance and bone density. Eur J Appl Physiol. 2008 Jan;102(2):173-80. doi: 10.1007/s00421-007-0571-z. Epub 2007 Sep 29.

  PMID: 17906874 BACKGROUND

• Matthews CE, Ainsworth BE, Thompson RW, Bassett DR Jr. Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc. 2002 Aug;34(8):1376-81. doi: 10.1097/00005768-200208000-00021.

  PMID: 12165695 BACKGROUND

• Hughes DA. Feasibility, validity and reliability of the Welsh version of the EQ-5D health status questionnaire. Qual Life Res. 2007 Oct;16(8):1419-23. doi: 10.1007/s11136-007-9238-9. Epub 2007 Jul 25.

  PMID: 17653613 BACKGROUND

MeSH Terms

Conditions

Fractures, Bone; Osteoporosis; Frailty

Interventions

Motivational Interviewing

Condition Hierarchy (Ancestors)

Wounds and Injuries; Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases; Nutritional and Metabolic Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Directive Counseling; Counseling; Mental Health Services; Behavioral Disciplines and Activities; Health Services; Health Care Facilities Workforce and Services

Limitations and Caveats

Small sample size and short study duration. Use of accelerometers to objectively capture physical activity (not all activity is captured by the accelerometers) and use of self-report physical activity logs. Possible self motivated participants.

Results Point of Contact

• Title: Dr. Lora Giangregorio
• Organization: University of Waterloo

lmgiangr@uwaterloo.ca

(519) 888-4567

Study Officials

• Lora M Giangregorio, PhD

  University of Waterloo

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 30, 2012
• First Posted: October 3, 2012
• Study Start: January 1, 2012
• Primary Completion: June 1, 2012
• Study Completion: July 1, 2012
• Last Updated: February 18, 2019
• Results First Posted: February 18, 2019

Record last verified: 2017-11

Locations

CA (1)