Fear of Falling and Motivation to Exercise

Specialist PSI Exercise

Module

Fear of Falling and Motivation to Exercise

Fear of FallingStages of Behaviour ChangeListening and Talking about

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)


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


Module

Increasing Motivation and Adherence – how ?

1. Assessing motivation towards physical activity

2. Helping to overcoming the barriers

3. Support strategies


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Pre-exercise assessment• Health• Function• Readiness to exercise(Later Life Training Manual)

How do we assess readiness to exercise among participants in PSI

classes ?


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Lifetime model of physical activity


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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 ?


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)


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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)


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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)


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)


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


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)


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


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)


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 ?

Fear of Falling and Motivation to Exercise

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