iStoppFalls 7.FRP

Falls are very common, especially in adults aged 65 years and older. Systematic review evidence has suggested that exercise programs can reduce falls in older people. Fast emerging developments of technology have inspired researchers to explore the concept of combining exercise with digital gaming to make exercise programs more engaging. Within the current project (iStoppFalls) an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance and muscle strength in older people.The objectives of the iStoppFalls project were
1) to reduce risk of falls, and thus improve quality of life
2) to offer improved fall prediction & prevention measures
3) to fit very well inside basic daily behavioral settings
4) to provide self-learning solutions with advanced reasoning
5) to provide advanced HCI technologies (usability & accessibility).

This international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. After the baseline assessments and computer-based randomization, participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology (e.g., full-body controller-free motion tracking). Educational material about a healthy lifestyle (i.e., recommendations about exercise, nutrition, and fall prevention) will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical (i.e., Physiological Profile Assessment, Short Physical Performance Battery, Timed Up and Go) and cognitive (i.e., Victoria Stroop Test, Attention Network Test, Trail Making Test) tests. Additionally, questionnaires assessing health (e.g., World Health Organization Disability Assessment Schedule), fear of falling (e.g., Iconographical – Falls Efficacy Scale), quality of life (e.g., European Quality of Life – 5 Dimensions (EQ-5D-5L), and psychosocial (e.g., Patient Health Questionnaire) determinants will be applied. Falls will be followed up for 6 months by monthly falls calendars.

The 16-week iStoppFalls exercise program reduced physiological fall risk as hypothesized and additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway, stepping reaction and executive function. Our study findings suggest that iStoppFalls is feasible for use in the homes of older community-dwelling people with initial instructor support. The relatively low adherence to the recommended dose, which can be largely explained by the pioneering use of new technology, indicates that further research and development is required to improve the adherence and thus the effectiveness of exergame systems for fall prevention.