Post on 08-Jan-2018
description
Specialist PSI Exercise
Module
Fear of Falling and Motivation to Exercise
Fear of FallingStages of Behaviour ChangeListening and Talking about
exercise
Specialist PSI Exercise
Module
Fear of Falling• Prevalance (Tinetti 1994)
– 30-60% in people over age of 65– 50-65% in previous fallers
• Fear and lack of confidence in balance predict– Deterioration in physical functioning (Arfken 1994, Vellas
1997)
– Decreases in physical activity, indoor and outdoor (Arfken 1994, Finch 1997)
– Increase in fractures (Arfken 1994)
– Admission to Institutional Care (Cumming 2000, Vellas 1997)
Specialist PSI Exercise
Module
Adherence to exercise regimens
• Fear of activity – avoidance of activity that might lead to a fall
• High refusal to uptake exercise interventions to prevent falls– >50% common– Lord study (2002)
• Invited 11,000 responded 1,967 (18%)
• Low adherence once started– Lord study (2002)
• Randomised 1107, 74% started, 60% attended >50% of sessions
• But FaME (Skelton 2004) in frequent fallers• Randomised 50• 100% started, 10% dropped out of classes• 79% Attended >75% of sessions
Specialist PSI Exercise
Module
Increasing Motivation and Adherence – how ?
1. Assessing motivation towards physical activity
2. Helping to overcoming the barriers
3. Support strategies
Specialist PSI Exercise
Module
Pre-exercise assessment• Health• Function• Readiness to exercise(Later Life Training Manual)
How do we assess readiness to exercise among participants in PSI
classes ?
Specialist PSI Exercise
Module
Lifetime model of physical activity
Specialist PSI Exercise
Module
Key questions to ask (exploring thoughts)
• Importance question - I wonder how important being active is for you ?
• General questions - What kinds of physical activity do you do at the moment ?
• Benefits question - Imagine if you did more, what benefits would you expect to see ?
• Barriers question - What things prevent you from being more active ?
• Concerns question - What things worry you about being more active ?
Specialist PSI Exercise
Module
Change is more likely when ….
• Perceived benefits (of physical activity) outweigh the costs (decisional balance)
• Leads to social approval (significant others) not disapproval
• Consistent with highly valued, broader life goals (values and motives)
• Outcomes are within one’s personal control (self efficacy)• There are few obstacles in the way (barriers)• Opportunities and access (to physical activity) are high
(Sport England 2005)
Specialist PSI Exercise
Module
Evidence about strength and balance classes - the barriers
• Health problems (actual and perceived interference)• No observed positive effects when tried programme• Not liking social contacts in classes (peers or leader!)• Unpleasant experiences (fatigue, pain etc.) or not enjoyable• Low motivation or perceived relevance• Other priorities (caring for dependents, holidays, other
appointments, housework) (Yardley et al 2005a)
Specialist PSI Exercise
Module
Perceived positive factors and benefits
• Noticeable benefit/improvement (restoring/maintaining fitness and functioning, better health –blood pressure, dizziness, diabetes)
• Feel and look good (less stiff, less pain, more mobile, strong, energetic, better balance, mood, weight loss)
• Able to do more things (walk, do without stick, climb stairs, travel, go out alone, go shopping, ADLs)
• Maintaining and increasing independence• Social contact (bond formed through prolonged contact with
group)• Confidence/pride in achievement (general increase in self-
confidence, approval of family/friends/doctor)• Enjoy the activity (get out of house, use equipment)
Specialist PSI Exercise
Module
motives for older people to take up strength and balance training
• thinking you are the kind of person who should do these activities (self-efficacy)
• thinking other people think you should do these exercises (peers, family, partners)
• believing that these activities would be enjoyable• concern about the risk of a future fall• (NOT having recent falls, or risk factors for falls)(Yardley et al 2005a)
Specialist PSI Exercise
Module
Understanding older people’s views of falls prevention advice
(Yardley et al. 2005,2006)
Don’t mention the F-word!
Communication / Motivation important in encouraging uptake and adherence to falls
prevention interventions and the pre-exercise assessment is an ideal place to discuss their
attitudes / barriers / motivators
Specialist PSI Exercise
Module
Increasing engagement with exercise ?
60 people attending A & E as a result of a fall. When offered choice on an intervention to prevent a future fall
• 72% reluctant to take up exercise programme• 28% reluctant to take osteoporosis medication
But when asked if likely to take up an intervention to prevent a worsening health state
• 63% said they would take up exercise!• 93% would take osteoporosis medication
(Whitehead 2006)
Specialist PSI Exercise
Module
During assessment and intervention..
To encourage people to exercise:• Emphasise immediate benefits for them (rather than
reduction of risk)• Promote positive social image (rather than simply
rational advantages)• Ensure patients have positive but realistic expectations• Use psychological techniques to encourage adherence
(monitoring and reinforcement, modelling, explicit commitment etc.)
• Ensure early experiences of sessions are positive (through graded goal setting, social reinforcement etc.)
ProFaNE recommendations, Yardley 2007
Specialist PSI Exercise
Module
Engaging older people in preventative health care
• Raise awareness in the general population that undertaking specific physical activities has the potential to improve balance and prevent falls.
• When offering or publicising interventions, promote benefits which fit with a positive self-identity.
• Utilise a variety of forms of social encouragement to engage older people in interventions.
• Ensure the intervention is designed to meet the needs, preferences and capabilities of the individual
• Encourage self-management rather than dependence on professionals by giving older people an active role
• Draw on validated methods for promoting and assessing the processes that maintain adherence, especially in the longer-term.
Yardley et al (2005)
Specialist PSI Exercise
Module
Support strategies• All literature provides strong evidence that
they are effective (NICE, HDA, CDC, Campbell, FAME)
• Communication strategies - follow up using technologies, phone, diaries, email
• Social support activities (events and buddies)• Educational programmes
Which are the “best buys” and why ?