Adherence to supervised falls prevention exercise in community-dwelling older adults: Secondary analysis of a systematic review

Exercise reduces falls in older people, and the benefits are stronger with greater exercise adherence. This review summarized adherence and behavior change techniques in fall prevention supervised exercise interventions and investigated the association between adherence, participants’ characteristics, and intervention components. Methods: A secondary analysis of trials from the previous 2019 Cochrane Review and its associated updates, investigating fall prevention exercises in community-dwelling people aged 60+ years. We dichotomized the interventions based on adherence, using the threshold of ≥75% of the sessions provided, or ≥75% of the participants attended ≥75% of sessions. Logistic regression examined the associations between adherence and participant characteristics, and intervention components. Results: One hundred and two studies investigated 136 supervised exercise interventions, of which 116 interventions (85%) reported adherence. The median proportion of exercise sessions attended was 78% (range: 38%–100%). Adherence was associated with exercise frequency with the odds of adherence increased by 167% (95% CI, 12%–536%) for interventions conducted ≥2 times/week, compared to those <2 times/week; 72% higher (95% CI, 12%–85%) for supervised programs without home exercise component, compared to those with 4% more for 1 week less in exercise intervention conducted in trials (2%–7%), and 33% higher (95% CI, 11%–50%) for each behavior change technique not used. Conclusion: Higher adherence was observed in interventions that were shorter, did not have home exercise components, had more weekly sessions (≥2 times/wk), and used fewer behavior change techniques. Clinicians should consider these factors to optimize adherence to supervised programs.