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Abstract Background Effective recruitment and retention of participants are prerequisites for high quality physical activity intervention programs and evaluation trials, but this is underreported in the literature making it difficult to identify the most promising strategies. Incorporating stakeholder feedback in the design of program components and recruitment materials can optimise recruitment reach and the engagement of participants throughout programs and trials. Methods The Active Women over 50 randomised controlled trial is testing a program designed to support women aged 50 + to be more physically active. To optimise program design and recruitment flyers, we conducted one focus group and 17 interviews with diverse purposively sampled women aged 50 + living in New South Wales, Australia. Women were asked to review recruitment flyers and the four proposed program components: (1) health coaching, (2) dedicated website with resources, (3) private Facebook group and (4) motivational email and SMS messages. Data analysis incorporated framework methods, deductive analysis using the Adapted Mobile App Rating Scale for evaluating websites and abductive analysis to critique the underlying program theory. Results Five themes were identified in relation to recruitment: I want to see (women like) myself, Keep it real, Readability is for everyone, Why should I do it? and Find us where we live. The four program components were strongly supported as a package, but were valued differently for their relative importance. Results were used to refine the health coaching scheduling; website appearance and content; promotion and moderation of the Facebook group; and the structure, appearance and content of messages. Not all suggestions were actionable due to technological and time constraints, and the desire to keep program costs low enough for delivery at scale during the study and beyond. The program theory was expanded to encompass two emergent concepts. Conclusions This consultation resulted in substantial refinements to recruitment flyers and strategies, and all four program components. We anticipate that these refinements will increase the reach and appeal of the trial and optimise future scale-up. Consultation feedback, while specific to this program, may have wider transferability for recruitment and the design of programs with similar components targeting women aged 50+.

BackgroundVolunteering positively affects overall health of both volunteers and recipients through social interaction, support and physical activity. Health professionals’ volunteering has considerable potential to improve health outcomes in communities.ObjectivesThis study aimed to summarize published scientific literature regarding volunteering by health professionals.MethodMedine, Embase, Scopus, PsycINFO and CINAHLdatabases were searched to identify eligible studies published between 2010 and 2023. Data on study methods and findings were extracted and synthesized.ResultsOf the 144 eligible studies, 80 (56%) used quantitative methods, 46 (32%) used qualitative, 18 (12%) used mixed methods and 8 (6%) were interventional. Doctors (74 studies, 51%) and nurses (n = 40, 28%) were the professions with most reports of volunteering. Half the studies were from USA (n = 77, 53%), followed by UK (n = 19, 13%), Canada (n = 12, 8%), and Australia/New Zealand (n = 11, 8%). International volunteering in low-to-middle-income countries was reported in 64 studies (44%). Providing service and training were the dominant types of activities (n = 90, 62.5%), with health promotion reported in only 4 studies (3%). Studies reported positive impact from volunteering, both professionally and personally. Time and family commitments were the main barriers. Enablers, barriers and impact were summarized in a socio-ecological map.ConclusionHealth professionals volunteer in diverse activities and report multifaceted benefits. Studies of volunteering interventions could enable new, sustainable approaches to health promotion.

IntroductionDance can positively impact older people’s health and wellbeing across cultures and socioeconomic groups, countering age-related physical, sensorimotor and cognitive decline.Background/objectivesThe RIPE (Really Is Possible for Everyone) Dance program aims to improve older people’s physical, mental, cognitive and social wellbeing by integrating engaging dance sequences with evidence-based fall prevention exercises. We sought to identify what mechanisms support observed long-term participation in this program, including by people living with challenging health conditions.MethodsFollowing a realist evaluation approach, we co-developed and tested program theories iteratively with participant interviewees (n = 20), dance teachers (n = 2) and via observation of a dance class. Initial data were dual-coded and emergent findings were interrogated by the research team. Findings were organised to express Program activities + Context + Mechanism = Process outcomes configurations.ResultsWe identified four program theories comprising 14 mechanisms which explained long-term attendance: 1. RIPE Dance benefits my body and mind (trust in the program, belief in health benefits), 2. RIPE Dance helps me feel good about myself (self-efficacy, pride in achievement, psychological safety, defying expectations, feeling valued), 3. RIPE Dance creates camaraderie (social connection, mutual support, rapport with the teacher), and 4. RIPE Dance is uplifting (raised spirits, fun, synchrony, musical reactivity).ConclusionThe RIPE Dance program provides effective and enjoyable ‘exercise in disguise’ for older people with diverse mobility profiles.Significance/implicationsThis research confirms that participation in dance can contribute significantly to healthy, happy ageing. Findings detail program activities that were most strongly associated with process outcomes, offering guidance for further program development, implementation and scaling up.

Abstract Background Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack trial. Methods WalkBack is a prospectively registered, pragmatic, randomised controlled trial. The aim is to investigate the effectiveness and cost-effectiveness of a 6-month progressive and individualised walking and education program (intervention) for the prevention of low back pain recurrences, compared to a no-treatment control group. The primary outcome is days to the first recurrence of an episode of activity-limiting low back pain. Key secondary outcomes include days to any recurrence of low back pain, days to a care-seeking recurrence of low back pain, disability level, health-related quality of life, costs associated with low back pain and adverse events. All participants will be followed for a minimum of 12 months. Analysis will follow the intention-to-treat principle. Cox regression is planned to assess the effects for the outcomes of time to activity-limiting, minimal and care-seeking recurrence. Hazard ratios and median survival times with 95% confidence intervals will be calculated. The effect of the intervention on continuous outcomes will be estimated with repeated-measure linear mixed models. An economic evaluation will be performed from the societal perspective for recurrence prevented (yes/no) and quality-adjusted life years. The proportion of adverse events between groups will be compared using Fisher’s exact test. Discussion The WalkBack trial will provide evidence on the effectiveness and cost-effectiveness of a walking intervention to prevent low back pain recurrences. This statistical analysis plan provides transparency on the analysis of the trial. Trial registration WalkBack - Effectiveness and cost-effectiveness of a progressive individualised walking and education program for the prevention of a recurrence of low back pain. ACTRN12619001134112 . Date Registered: 14/08/2019.

Abstract Background In 2020, the World Health Organization (WHO) released the first global physical activity and sedentary behaviour guidelines for children and adults living with disability. The evidence informing the guidelines though is not specific to people living with traumatic brain injury (TBI), but rather comes from other disabling conditions such as Parkinson’s disease, and stroke. There remains a clear lack of direct evidence of the effects of physical activity for people living with TBI. The objective of this rapid review was to identify direct evidence of the effect of physical activity on health outcomes in people with moderate-to-severe TBI to inform adaptation of the WHO physical activity guidelines into clinical practice guidelines. Methods We conducted a rapid systematic review with meta-analysis of randomised controlled trials, including people of any age with moderate-to-severe TBI, investigating physical activity interventions compared to either usual care, a physical activity intervention with different parameters, or a non-physical activity intervention. Four databases (CENTRAL, SPORTDiscus, PEDro, Ovid MEDLINE) were searched from inception to October 8, 2021. The primary outcomes were physical function, cognition, and quality of life. Results Twenty-three studies were included incorporating 812 participants (36% females, majority working-age adults, time post-TBI in studies ranged from 56 days (median) to 16.6 years (mean)). A range of physical activity interventions were evaluated in rehabilitation (n = 12 studies), community (n = 8) and home (n = 3) settings. We pooled data from the end of the intervention for eight outcomes. Participation in a virtual reality physical activity intervention improved mobility, assessed by the Community Balance and Mobility Scale (range 0 to 96; higher score indicates better mobility) more than standard balance training (two studies, 80 participants, Mean Difference = 2.78, 95% CI 1.40 to 4.16; low certainty evidence). There was uncertainty of effect for the remaining outcomes, limited by small sample sizes, diverse comparators and a wide range of outcome measures. Conclusion This review consolidates the current evidence base for the prescription of physical activity for people with moderate-to-severe TBI. There remains a pressing need for further rigorous research in order to develop practice guidelines to support clinical decision-making when prescribing physical activity in this population.

Abstract Background The COVID-19 pandemic and associated social distancing regulations have led to an increased risk of social isolation and physical inactivity, particularly among older adults. The benefits of physical activity for reducing fall risk and improving mood and mental functioning have been well documented. The aim of this trial is to investigate the effect of the MovingTogether programme on psychological distress (primary outcome) and physical activity, social capital, cognition, concern about falling, loneliness, physical functioning, quality of life and physical activity enjoyment (secondary outcomes). Methods A randomised controlled trial with a waitlist control will be conducted, recruiting 80 adults aged 60+ years with access to Facebook and a computer or tablet and not currently meeting the aerobic physical activity guidelines. Randomisation will be completed using REDCap. The intervention group (n = 40) will join a private Facebook group where allied health facilitators will provide targeted healthy lifestyle education throughout the 10-week programme with weekly telehealth group calls. Intervention participants will also be provided access to tailored strength and aerobic exercise guidance and an evidence-based eHealth balance exercise programme. Psychological distress and secondary outcomes will be assessed at baseline, 11 weeks (post-intervention) and 16 weeks (1-month follow-up). Linear mixed models will be applied for each outcome measure as per an intention-to-treat approach to determine the between-group differences. Secondary analyses are planned in people with greater adherence and those with higher psychological distress. Discussion COVID-19 has highlighted the need for scalable, effective and novel methods to improve and protect the health of older adults. The integration of an evidence-based fall prevention programme with a mental health-informed online health promotion programme may help to improve mental and physical health outcomes among older adults. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001322820p. Registered on 29 September 2021

Abstract Background Yoga-based exercise is a promising strategy for promoting healthy ageing, with the potential to reduce falls and increase physical, cognitive and psychological wellbeing. Teleyoga (real-time yoga provided via interactive videoconferencing) can deliver yoga programs at scale, potentially reducing costs, increasing convenience, and reaching people who cannot attend studio-based classes. But better understanding of how older people perceive and engage with teleyoga is needed to optimise its design, implementation and promotion. Methods This study built on a previous realist process evaluation of the SAGE yoga trial which is testing the effect of a yoga-based exercise program on falls among 700 community-dwelling people aged 60 + years. In this second phase of evaluation we conducted focus groups with participants who had completed the SAGE program online and with the yoga instructors who were delivering it. We also conducted interviews with participants who had withdrawn from the trial. Six program theories developed in the earlier evaluation provided a framework for data analysis, supplemented by inductive coding and an analytical workshop. Results Participants described physical and psychological benefits from the SAGE teleyoga program. While noting that teleyoga cannot facilitate hands-on correction or the same quality of observation or interaction as studio classes, participants were highly appreciative of their yoga instructors’ strategies for optimising visibility, instruction, social connection and therapeutic alliance, and for adapting to constrained home environments. Some participants argued that teleyoga was superior to studio classes due to its accessibility and convenience, its lower exposure to potential embarrassment about physical appearance or capabilities, and a reduced sense of peer competition and distraction. Our program theories applied across studio and online modes of delivery. Conclusion Teleyoga increases accessibility for people in diverse locations and circumstances; it provides a psychologically safer space which combats self-consciousness and unwanted competitiveness; it may enhance embodiment and mindfulness for some; and it has the potential to be offered relatively cheaply at scale which could support free or reduced price classes for people on low incomes and pensions, thereby encouraging a wider population to engage in yoga for healthy ageing and fall prevention.

Abstract Background The Active Women over 50 trial tested a scalable program for increasing physical activity among women aged 50+. The program included information, activity tracker and email support. This study sought to describe the participant perspectives of the Active Women over 50 program and considerations for designing physical activity interventions for this demographic. Methods Women who completed the Active Women over 50 trial were purposively recruited for maximum variation in age, employment, carer responsibility, medical conditions and physical activity. Individual semi-structured interviews explored their perspectives on physical activity, Active Women over 50 program components and suggestions for future iterations. Data were thematically analysed. Results Participants’ capacity to be physically active was shaped by an interplay of factors. Our analysis generated four main themes relating to physical activity in general and to the program: Age and gender matters, Physical activity is social, Strategising for physical activity and the Self-responsibility discourse. At this midlife stage, physical activity participation was challenged by personal, life-stage and cultural factors, alongside a tension of the self-responsibility discourse which also impacted the program experience. Social factors and finding a suitable strategy for motivation were deemed integral aspects of being active. Future programs could consider facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility. Conclusion A range of strategies is key to supporting women over 50 to be more physically active due to the variety of circumstances and levels of agency experienced. We offer suggestions that do not need to be resource intensive but could be incorporated into a scaled program.

Abstract Background Physical activity mass media campaigns can deliver physical activity messages to many people, but it remains unclear whether they offer good value for money. We aimed to investigate the cost-effectiveness, cost-utility, and costs of physical activity mass media campaigns. Methods A search for economic evaluations (trial- or model-based) and costing studies of physical activity mass media campaigns was performed in six electronic databases (June/2021). The authors reviewed studies independently. A GRADE style rating was used to assess the overall certainty of each modelled economic evaluation. Results were summarised via narrative synthesis. Results Twenty-five studies (five model-based economic evaluations and 20 costing studies) were included, and all were conducted in high-income countries except for one costing study that was conducted in a middle-income country. The methods and assumptions used in the model-based analyses were highly heterogeneous and the results varied, ranging from the intervention being more effective and less costly (dominant) in two models to an incremental cost of US$130,740 (2020 base year) per QALY gained. The level of certainty of the models ranged from very low (n = 2) to low (n = 3). Overall, intervention costs were poorly reported. Conclusions There are few economic evaluations of physical activity mass media campaigns available. The level of certainty of the models was judged to be very low to low, indicating that we have very little to little confidence that the results are reliable for decision making. Therefore, it remains unclear to what extent physical activity mass media campaigns offer good value for money. Future economic evaluations should consider selecting appropriate and comprehensive measures of campaign effectiveness, clearly report the assumptions of the models and fully explore the impact of assumptions in the results. Review registration https://bit.ly/3tKSBZ3

Abstract Background Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. Methods We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2. Results Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented. Conclusion Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.

Objective This research identifies practical lessons regarding the delivery of teleyoga. Our objectives are to (1) describe challenges and opportunities experienced by yoga instructors when moving the Successful AGEing (SAGE) yoga programme online, and (2) describe how yoga instructors adapted to manage the challenges and leverage opportunities presented by teleyoga. Methods This study is a secondary analysis of the data from a previous realist process evaluation of the SAGE yoga trial. The SAGE yoga trial is testing the effect of a yoga-based exercise programme on falls among 700 community-dwelling people aged 60+ years. We draw on focus groups and interviews with four SAGE yoga instructors which we analysed using previously developed programme theories combined with inductive coding and an analytical workshop. Results The concerns of the yoga instructors about teleyoga can be characterised into four broad issues: threats to safety, altered interpersonal dynamics, facilitating mind–body connection and difficulties with technology. The SAGE instructors identified eight modifications they used to manage these challenges: a 1:1 participant interview prior to programme commencement, more descriptive verbal instructions, increased focus on interoception, increased attention and support, slower more structured class flow, simplifying poses, adapting the studio environment and IT support. Conclusions We have created a typology of strategies for addressing challenges in the delivery of teleyoga for older people. As well as maximising engagement with teleyoga, these manageable strategies could be applied by other instructors to a wide range of telehealth classes, improving the uptake and adherence of beneficial online programmes and services.

Abstract Background Falls are a significant public health issue. There is strong evidence that exercise can prevent falls and the most effective programs are those that primarily involve balance and functional exercises, however uptake of such programs is low. Exercise prescribed during home visits by health professionals can prevent falls however this strategy would be costly to deliver at scale. We developed a new approach to teach home exercise through group-based workshops delivered by physiotherapists. The primary aim was to determine the effect of this approach on the rate of falls among older community-dwelling people over 12 months. Secondary outcomes included the proportion of people falling, fear of falling, physical activity, lower limb strength, balance and quality of life. Methods A randomised controlled trial was conducted among community-dwelling people aged ≥65 in New South Wales, Australia. Participants were randomised to either the intervention group (exercise targeting balance and lower limb strength) or control group (exercise targeting upper limb strength). Results A total of 617 participants (mean age 73 years, +SD 6, 64% female) were randomly assigned to the intervention group (n = 307) or control group (n = 310). There was no significant between-group difference in the rate of falls (IRR 0.91, 95% CI 0.64 to 1.29, n = 579, p = 0.604) or the number of participants reporting one or more falls (IRR 0.99, 95% CI 0.76 to 1.29, n = 579, p = 0.946) during 12 month follow-up. A significant improvement in the intervention group compared to control group was found for fear of falling at 3, 6 and 12 months (mean difference 0.50, 95% CI 0.2 to 0.8, p = 0.004; 0.39, 95% CI 0.001 to 0.8, p = 0.049; 0.46, 95% CI 0.006 to 0.9, p = 0.047, respectively), and gait speed at 3 months (mean difference 0.09 s, 95% CI 0.003 to 0.19, p = 0.043). No statistically significant between-group differences were detected for the other secondary outcomes. Conclusions There was no significant intervention impact on the rate of falls, but the program significantly reduced fear of falling and improved gait speed. Other exercise delivery approaches are needed to ensure an adequate intensity of balance and strength challenge and dose of exercise to prevent falls.

Abstract Background Falls among older people are a major global health concern. This process evaluation investigates the experience of participants aged 60+ in a yoga program aimed at preventing falls which transitioned from studio-based classes to online classes in response to COVID-19 restrictions. We sought to understand how the Successful AGEing (SAGE) yoga program functioned in both settings and as a hybrid program, and to explain why it worked well for most participants. Methods Realist process evaluation was used to explore the factors that facilitated a successful transition for most participants, and to consider why it did not work for a minority. This approach develops program theories that describe which mechanisms an intervention is (or is not) activating, and how this is mediated by context to generate process outcomes. Data included interviews with participants (n = 21) and yoga instructors (n = 3), self-report feedback forms (n = 46), observation of classes and routine process measures. Results Factors that facilitated a successful transition for most participants included the quality of yoga instruction, the program format and inherent characteristics of yoga. Gains in transitioning online included continuity and greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. There were greater challenges for people struggling with pain and in disadvantageous home environments. We identified six program theories configured around 16 mechanisms: 1. It’s worth the effort and 2. In expert hands (these had the same mechanisms: value expectancy, therapeutic alliance and achievement/mastery), 3. A communal experience (these mechanisms were shared experience, social connection, social comparison and peer checking), 4. Putting yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability and continuity), and 6. Yoga’s special properties (embodiment and mindfulness). Conclusions This study showed that online delivery of a yoga program for people aged 60+ retained much of the value of a face-to-face program for the majority of participants, and increased the value for some. The structured, communal nature of an organised group program delivered by a skilled instructor, together with yoga’s intrinsic focus on mindfulness, facilitated continued engagement and perceived health benefits, despite the change in delivery mode.

Abstract Background There is currently little evidence of planning for real-world implementation of physical activity interventions. We are undertaking the ComeBACK (Coaching and Exercise for Better Walking) study, a 3-arm hybrid Type 1 randomised controlled trial evaluating a health coaching intervention and a text messaging intervention. We used an implementation planning framework, the PRACTical planning for Implementation and Scale-up (PRACTIS), to guide the process evaluation for the trial. The aim of this paper is to describe the protocol for the process evaluation of the ComeBACK trial using the framework of the PRACTIS guide. Methods A mixed methods process evaluation protocol was developed informed by the Medical Research Council (MRC) guidance on process evaluations for complex interventions and the PRACTIS guide. Quantitative data, including participant questionnaires, health coach and administrative logbooks, and website and text message usage data, is being collected over the trial period. Semi-structured interviews and focus groups with trial participants, health coaches and health service stakeholders will explore expectations, factors influencing the delivery of the ComeBACK interventions and potential scalability within existing health services. These data will be mapped against the steps of the PRACTIS guide, with reporting at the level of the individual, provider, organisational and community/systems. Quantitative and qualitative data will elicit potential contextual barriers and facilitators to implementation and scale-up. Quantitative data will be reported descriptively, and qualitative data analysed thematically. Discussion This process evaluation integrates an evaluation of prospective implementation and scale-up. It is envisaged this will inform barriers and enablers to future delivery, implementation and scale-up of physical activity interventions. To our knowledge, this is the first paper to describe the application of PRACTIS to guide the process evaluation of physical activity interventions. Trial registration Australian and New Zealand Clinical Trials Registry ( ANZCTR ) Registration date: 10/12/2018.

Background: Digital technologies provide new opportunities to promote, incentivise and support physical activity as an essential component of healthy ageing, but their potential is yet to be fully realised. There is mixed information about older people’s capacity to use digital technologies to support physical activity, and about how it can benefit them. Methods: This study focuses on older people who report some success in using digital technology to support physical activity. We conducted narrative interviews with 17 purposively sampled survey respondents aged 70+ who had reported using smartphones, tablets/computers or wearable/portable digital devices to support their physical activity. We sought to identify transferable lessons from their experiences and to explain how these experiences were shaped by contextual factors, including the COVID-19 pandemic. Data was analysed inductively and deductively. Results: Interviewees perceived digital technology as a facilitator and motivator for physical activity, describing multiple benefits. Many disparaged their technical skills yet they used technology creatively to access and enhance physical activity, driven by philosophies of active living which underpinned their refusal to “sit in God’s waiting room”. Most reported navigating challenges associated with ageing in a discriminatory society, compounded by COVID-19 impacts. We identified four ‘lessons’: 1. Embrace technology, 2. Find your thing, 3. Be adaptive and 4. Resist ‘being old’. Conclusions: Leveraging trusted social and health professional relationships to model and encourage technology-supported physical activity, and strengthening the value proposition of technology for older people 'with' older people, may encourage their use of digital technology to support physical activity.

Abstract Background To inform implementation and future research, this scoping review investigates the volume of evidence for physical activity interventions among adults aged 60+. Our research questions are: (1) what is the evidence regarding interventions designed to increase total physical activity in adults aged 60+ years, in accordance with three of the four strategic objectives of GAPPA (active societies, active environments, active people); (2) what is the current evidence regarding the effectiveness of physical activity programmes and services designed for older adults?; and (3) What are the evidence gaps requiring further research? Methods We searched PEDro, MEDLINE, CINAHL and Cochrane from 1 January 2010 to 1 November 2020 for systematic reviews and meta-analyses of physical activity interventions in adults aged 60+. We identified interventions designed to: (1) increase physical activity; and (2) deliver physical activity programmes and services in home, community or outpatient settings. We extracted and coded data from eligible reviews according to our proposed framework informed by TIDieR, Prevention of Falls Network Europe (PROFANE), and WHO’s International Classification of Functioning, Disability and Health (ICF). We classified the overall findings as positive, negative or inconclusive. Results We identified 39 reviews of interventions to increase physical activity and 342 reviews of programmes/services for older adults. Interventions were predominantly structured exercise programmes, including balance strength/resistance training, and physical recreation, such as yoga and tai chi. There were few reviews of health promotion/coaching and health professional education/referral, and none of sport, workplace, sociocultural or environmental interventions. Fewer reported outcomes of total physical activity, social participation and quality of life/well-being. We noted insufficient coverage in diverse and disadvantaged samples and low-middle income countries. Conclusions There is a modest but growing volume of evidence regarding interventions designed to increase total physical activity in older adults, although more interventional studies with long term follow-up are needed, particularly for GAPPA 1. Active Societies and GAPPA 2. Active Environments. By comparison, there is abundant evidence for GAPPA 3. specific programmes and services, but coverage of sport and workplace interventions, and diverse samples and settings is lacking. Comprehensive reviews of individual studies are now needed as well as research targeting neglected outcomes, populations and settings.

Abstract Background Physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in women in their middle and older age. This trial aims to establish the acceptability and feasibility of the Active Women over 50 programme involving online information, telephone health coaching and email or SMS support to promote physical activity behaviour change among women aged 50 years and over. Methods Sixty community-dwelling women who are insufficiently active according to national guidelines, will be recruited and randomised to 1) receive the Active Women over 50 programme or 2) a wait-list control. Active Women over 50 is a 3-month physical activity programme guided by behaviour change science, providing access to a website, one telephone-delivered health coaching session from a physiotherapist and 8 email or 24 SMS messages. The primary outcome is the proportion of participants at 3 months post-randomisation who would recommend participation in the programme to another person like themselves. Secondary outcomes are feasibility measures: rates of recruitment, retention, completeness of outcome data and uptake of telephone support; and intervention impact measures: accelerometer-assessed average steps/day, proportion of participants meeting national guidelines on moderate to vigorous physical activity; and questionnaire-assessed quality of life, exercise perceptions, mood, physical functioning and self-reported physical activity. Intervention participants will also complete a follow-up survey to assess impressions of the intervention and adoption of strategies for physical activity participation. Data will be analysed descriptively to guide the design of a larger trial. Between-group differences in secondary outcomes will be used to estimate effect sizes for sample size calculations for a fully powered randomised controlled trial. Discussion This feasibility pilot trial of an efficient eHealth and health coaching intervention guided by user input and behaviour change theory, will inform future interventions to address low physical activity participation among an under-active group at risk of future disability. Trial registration ANZCTR, ACTRN12619000490178 , registered 26 March 2019

Objectives and importance of study: Exercise prevents falls among community-dwelling older adults. Therefore, it is crucial that health and exercise professionals have the knowledge and skills to prescribe appropriate fall prevention exercise. This study evaluated the effect of a fall prevention education program, compared with a waitlist control group, on health and exercise professionals’ fall prevention knowledge and behaviour, and their confidence to prescribe fall prevention exercises for older people. Study type: Randomised controlled trial. Methods: Participants were 200 health and exercise professionals recruited in New South Wales (NSW), Australia. The intervention group participated in a 1-day face-to-face education workshop on exercise to prevent falls in older age. The waitlist control group received the education intervention after completion of the 3-month follow-up. Primary outcomes were self-reported fall prevention knowledge, and change in prescribing behaviour for fall prevention exercise. Secondary outcomes were: confidence to prescribe fall prevention exercise; proportion of people aged 60 years and older seen in the past month who were prescribed fall prevention exercise; and proportion of fall prevention exercises prescribed in the past month that were evidence based. Data were analysed using analysis of covariance models for continuously scored outcomes and the differences in proportions between groups (relative risk [RR]). Results: The intervention significantly improved knowledge (between-group difference [BGD] 0.27 points out of a possible 6; 95% confidence interval [CI] 0.03, 0.51; p = 0.03), perceived clinical behaviour (RR 5.58; 95% CI 3.25, 9.59; p < 0.001), confidence (BGD 1.02/10 points; 95% CI 0.65, 1.39; p < 0.001) and the proportion of evidence-based exercise prescribed, in both the number of exercises (BGD 0.36; 95% CI 0.03, 0.68; p = 0.03) and percentage of participants who prescribed at least 2 hours/week of fall prevention exercise (RR 1.53; 95% CI 1.08, 2.15; p = 0.015). Conclusion: The education workshop significantly improved participants’ knowledge, confidence and behaviour regarding fall prevention exercise prescription.

Abstract Background Falls are common among older people, and General Practitioners (GPs) could play an important role in implementing strategies to manage fall risk. Despite this, fall prevention is not a routine activity in general practice settings. The iSOLVE cluster randomised controlled trial aimed to evaluate implementation of a fall prevention decision tool in general practice. This paper sought to describe the strategies used and reflect on the enablers and barriers relevant to successful recruitment of general practices, GPs and their patients. Methods Recruitment was conducted within the geographical area of a Primary Health Network in Northern Sydney, Australia. General practices and GPs were engaged via online surveys, mailed invitations to participate, educational workshops, practitioner networks and promotional practice visits. Patients 65 years or older were recruited via mailed invitations, incorporating the practice letterhead and the name(s) of participating GP(s). Observations of recruitment strategies, results and enabling factors were recorded in field notes as descriptive and narrative data, and analysed using mixed-methods. Results It took 19 months to complete recruitment of 27 general practices, 75 GPs and 560 patients. The multiple strategies used to engage general practices and GPs were collectively useful in reaching the targeted sample size. Practice visits were valuable in engaging GPs and staff, establishing interest in fall prevention and commitment to the trial. A mix of small, medium and large practices were recruited. While some were recruited as a whole-practice, other practices had few or half of the number of GPs recruited. The importance of preventing falls in older patients, simplicity of research design, provision of resources and logistic facilitation of patient recruitment appealed to GPs. Recruitment of older patients was successfully achieved by mailed invitations which was a strategy that was familiar to practice staff and patients. Patient response rates were above the expected 10% for most practices. Many practices (n = 17) achieved the targeted number of 20 or more patients. Conclusions Recruitment in general practice settings can be successfully achieved through multiple recruitment strategies, effective communication and rapport building, ensuring research topic and design suit general practice needs, and using familiar communication strategies to engage patients. Trial registration The trial was prospectively registered on 29 April 2015 with the Australian New Zealand Clinical Trial Registry www.anzctr.org.au (trial ID: ACTRN12615000401550).

Abstract Background There is compelling evidence that physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in working women in their middle age. This trial aims to establish the impact of a low-dose information program, incorporating follow-up support using behaviour change techniques, compared with a wait-list control group, on physical activity among women aged 50+ years. Methods 100 female university or health service employees aged 50 years and over who are not sufficiently active according to national guidelines will be recruited and randomised to: [1] attend one information session at the worksite with follow-up email support and provision of resources including use of an activity tracker (Fitbit) for 3 months and free trial class at the university sports facility, or [2] a wait-list control to receive the intervention after the 3-month follow-up period. The primary outcome will be the proportion of people achieving 10,000 steps/day at 3 months post randomisation. Secondary outcomes will include the proportion of people achieving national guideline-recommended physical activity levels, the average self-reported hours of physical activity per week, perceived benefits of and barriers to exercise participation, physical functioning, and mood. Analyses will be planned, conducted while masked to group allocation and will use an intention-to-treat approach. Discussion This randomised controlled trial will evaluate the impact of a simple intervention using behaviour change techniques to increase physical activity participation in insufficiently active working women over the age of 50. Trial registration ACTRN12617000485336, prospectively registered, approved 04/04/2017.

Abstract Background Low back pain is one of the most prevalent musculoskeletal conditions and the highest contributor to disability in the world. It is characterized by frequent relapses leading to additional care-seeking. Engagement in leisure physical activity is associated with lower recurrences and better prognosis and potentially reduced care-seeking. Our aim was to investigate the feasibility and preliminary efficacy of a patient-centred physical activity intervention, supported by health coaching and mobile health, to reduce care-seeking, pain and disability in patients with chronic low back pain after treatment discharge. Methods We conducted a pilot randomised controlled trial with blinded outcome assessment. Sixty-eight participants were recruited from four public outpatient physiotherapy departments and the general community in Sydney. The intervention group received a physical activity information booklet, plus one face-to-face and 12 telephone-based health coaching sessions. The intervention was supported by an internet-based application and an activity tracker (Fitbit). Control group (standard care) received the physical activity information booklet and advice to stay active. Feasibility measures included recruitment rate, intervention compliance, data completeness, and participant satisfaction. Primary outcomes were care-seeking, pain levels and activity limitation. Outcomes were assessed at baseline, 6-month follow-up and weekly for 6 months. Results Ninety potential participants were invited over 15 months, with 68 agreeing to take part (75%). Overall, 903 weekly questionnaires were answered by participants from a total of 1107 sent (89%). Participants were largely satisfied with the intervention (mean = 8.7 out of 10 on satisfaction scale). Intervention group participants had a 38% reduced rate of care-seeking (Incidence Rate Ratio (IRR): 0.62, 95% CI: 0.32 to 1.18, p = 0.14, using multilevel mixed-effects Poisson regression analysis) compared to standard care, although none of the estimates was statistically significant. No between groups differences were found for pain levels or activity limitation. Conclusion The health coaching physical activity approach trialed here is feasible and well accepted by participants and may reduce care-seeking in patients with low back pain after treatment discharge, although further evaluation with an adequately powered trial is needed. Trial registration Australian and New Zealand Trial Registry ACTRN12615000189527. Registered prospectively on 26–02–2015.

Objective With the growing representation of older adults in the workforce, the health and fitness of older employees are critical to support active ageing policies. This systematic review aimed to characterise and evaluate the effects on physical activity (PA) and fitness outcomes of workplace PA interventions targeting older employees.Design We searched Medline, PreMedline, PsycInfo, CINAHL and the Cochrane Controlled Register of Trials (CENTRAL) for articles published from inception to 17 February 2020. Eligible studies were of any experimental design, included employees aged ≥50 years, had PA as an intervention component and reported PA-related outcomes.Results Titles and abstracts of 8168 records were screened, and 18 unique interventions were included (3309 participants). Twelve studies were randomised controlled trials (RCTs). Seven interventions targeted multiple risk factors (n=1640), involving screening for cardiovascular disease risk factors, but had a non-specific description of the PA intervention. Four interventions targeted nutrition and PA (n=1127), and seven (n=235) focused only on PA. Interventions overwhelmingly targeted aerobic PA, compared with only four interventions targeting strength and/or balance (n=106). No studies involved screening for falls/injury risk, and only two interventions targeted employees of low socioeconomic status. Computation of effect sizes (ESs) was only possible in a maximum of three RCTs per outcome. ESs were medium for PA behaviour (ES=0.25 95% CI −0.07 to 0.56), muscle strength (ES=0.27, 95% CI −0.26 to 0.80), cardiorespiratory fitness (ES=0.28, 95% CI −22 to 0.78), flexibility (ES=0.50, 95% CI −0.04 to 1.05) and balance (ES=0.74, 95% CI −0.21 to 1.69). Grading of Recommendations Assessment, Development and Evaluation criteria-rated quality of evidence was ‘low’ due to high risk of bias, imprecision and inconsistency.Conclusions The lack of high-quality effective workplace PA interventions contrasts the importance and urgency to improve the health and fitness in this population. Future interventions should incorporate strength and balance training and screening of falls/injury risk in multi risk factors approaches.PROSPERO registration number CRD42018084863. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=84863).

Objective: The Stepping On program has been shown to prevent falls among community-dwelling people in a research setting and was implemented statewide by the New South Wales (NSW) Ministry of Health in 2008. This study measured ongoing fall prevention strategies and behaviours undertaken by Stepping On participants during the 6 months after program completion. Secondary objectives were to document participant satisfaction with the program, and to identify motivators for, and barriers to, fall prevention behaviour and uptake of the strategy. Methods: We conducted a pre–post prospective study among Stepping On program participants, with 6-month follow-up. Participants commenced Stepping On in 2015 and 2016 in 15 Local Health Districts across NSW. A study-specific survey was completed at baseline and 6 months after completion of Stepping On. Measures were current self-reported fall prevention strategies and behaviours; the Falls Behavioural (FaB) Scale; the Incidental and Planned Exercise Questionnaire (IPEQ); and motivators for, and barriers to, uptake of fall prevention strategies and behaviours. Results: Baseline questionnaires were completed by 458 participants (mean age 77; standard deviation [SD] 6.7; 76% female). Both baseline and follow-up surveys were completed by 291 participants (64%; mean age 78; SD 6.9; 76% female). Program satisfaction was high – 251 participants (86%) completed the whole program, 284 (98%) said it increased their awareness of falls, and 284 (98%) would recommend Stepping On to others. There were statistically significant increases in the proportion of participants who reported doing regular balance and strength exercise (74% vs 24%; p < 0.0001), and using safe walking strategies (78% vs 51%; p < 0.0001) at follow-up compared with baseline. There was also a significant improvement in the FaB Scale, indicating less risk-taking behaviour (mean increase 0.15 out of 4; 95% confidence interval [CI] 0.12, 0.19; p < 0.0001), and an increase in IPEQ-reported structured exercise (mean increase 2.0 hours per week; 95% CI 1.6, 2.5; p < 0.0001). The main motivators for, and barriers to, uptake of structured exercise included participants’ health, availability and access to local programs, and the amount of time available to take part. Conclusion: This study demonstrates the appeal of the Stepping On program, and its positive impact on fall prevention behaviours among adults in the community aged 65 years and older. It is important to note the study limitations – namely, the self-reported nature of the measures used and the large amount of missing data.

Background Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. Methods We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory—autonomy, competence and relatedness—was used to explore if and how this theory fit with and helped to explain our data. Results Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention’s demonstrated potential to support self-determination needs could be conveyed more effectively. Conclusions Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.

Introduction Falls in older adults are associated with increased healthcare costs. Falls may be prevented or minimised with multifactorial interventions including exercise and behavioural modification. Objectives and Approach To describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged 65 years and older in NSW, Australia; and fall-related ambulance service use and fall-related hospitalisations after scale-up. Routinely-collected data on program reach, fall-related ambulance usage and fall-related hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following implementation of Stepping On using multilevel models. Results From 2009 to 2014 the program was delivered in 1,077 sites to 10,096 people with an average (SD) age of 81.0 (7.2) years. Rates of fall-related ambulance use and hospital admissions per 100-person-years were 1-2 in people aged 66-74, 4-5 in people aged 75-84 and 12-13 in people aged ≥85. These rates increased over time (p

Introduction Mobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists.Methods and analysis This pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources); (2) the enhanced intervention package compared with no intervention (6-month waiting list control group); and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, individualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other.Ethics and dissemination Ethical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers.Trial registration number ACTRN12618001983291.

Introduction Low back pain (LBP) is recognised globally as a prevalent, costly and disabling condition. Recurrences are common and contribute to much of the burden of LBP. Current evidence favours exercise and education for prevention of LBP recurrence, but an optimal intervention has not yet been established. Walking is a simple, widely accessible, low-cost intervention that has yet to be evaluated. This randomised controlled trial (RCT) aims to establish the effectiveness and cost-effectiveness of a progressive and individualised walking and education programme (intervention) for the prevention of LBP recurrences in adults compared with no treatment (control).Methods and analysis A pragmatic, two-armed RCT comparing walking and education (n=349) with a no treatment control group (n=349). Inclusion criteria are adults recovered from an episode of non-specific LBP within the last 6 months. Those allocated to the intervention group will receive six sessions (three face to face and three telephone delivered) with a trained physiotherapist to facilitate a progressive walking programme and education over a 6-month period. The primary outcome will be days to first recurrence of an episode of activity-limiting LBP. The secondary outcomes include days to recurrence of an episode of LBP, days to recurrence of an episode of LBP leading to care seeking, disability and quality of life measured at 3, 6, 9 and 12 months and costs associated with LBP recurrence. All participants will be followed up monthly for a minimum of 12 months. The primary intention-to-treat analysis will assess difference in survival curves (days to recurrence) using the log-rank statistic. The cost-effectiveness analysis will be conducted from the societal perspective.Ethics and dissemination Approved by Macquarie University Human Research Ethics Committee (Reference: 5201949218164, May 2019). Findings will be disseminated through publication in peer-reviewed journals and conference presentations.Trial registration number ACTRN12619001134112.

Introduction Falls significantly reduce independence and quality of life in older age. Balance-specific exercise prevents falls in people aged 60+ years. Yoga is growing in popularity and can provide a high challenge to balance; however, the effect of yoga on falls has not been evaluated. This trial aims to establish the effect on falls of a yoga exercise programme compared with a yoga relaxation programme in community-dwellers aged 60+ years.Method and Analysis This randomised controlled trial will involve 560 community-dwelling people aged 60+ years. Participants will be randomised to either: (1) the Successful AGEing (SAGE) yoga exercise programme or (2) a yoga relaxation programme. Primary outcome is rate of falls in the 12 months post randomisation. Secondary outcomes include mental well-being, physical activity, health-related quality of life, balance self-confidence, physical function, pain, goal attainment and sleep quality at 12 months after randomisation. The number of falls per person-year will be analysed using negative binomial regression models to estimate between-group difference in fall rates. Generalised linear models will assess the effect of group allocation on the continuously scored secondary outcomes, adjusting for baseline scores. An economic analysis will compare the cost-effectiveness and cost-utility of the two yoga programmes.Ethics and dissemination Protocol was approved by the Human Research Ethics Committee at The University of Sydney, Australia (approval 2019/604). Trial results will be disseminated via peer-reviewed articles, conference presentations, lay summaries.Trial registration number The protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).

Abstract Objectives: Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was to examine the perspectives of Australian First Nation people about healthy ageing. Methods: We used a conversational method to gather knowledge from older First Nation people from established communities in New South Wales, Australia. Discussions were audio recorded and transcribed and analysed using an Indigenous research standpoint methodology. Eight yarning circles were held in six locations with 76 participants aged 45 years and over. Results: Key issues around healthy ageing were identified; particularly, what the impact of chronic disease means to individuals. Study participants reported that healthy ageing is essential to continue to share knowledge of their history and culture. Conclusion: This article highlights the need for culturally appropriate healthy ageing programs addressing issues related to chronic disease among First Nation communities. Implications for public health: Research into what constitutes healthy ageing for older First Nation people is necessary for the development of culturally appropriate chronic disease interventions.

Abstract Background While there is strong evidence that fall prevention interventions can prevent falls in people aged 65 and over, translating evidence into routine practice is challenging. Research regarding how allied health professionals (AHPs) respond to this challenge is limited. As part of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project, this study aimed to explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice. Methods In-depth qualitative interviews were conducted with fifteen AHPs who had attended evidence-based workshops associated with the iSOLVE project. AHPs had backgrounds in physiotherapy, occupational therapy, exercise physiology and podiatry. Interviews explored how fall prevention was being incorporated into routine practice and the factors that influenced routinisation, including the project workshops. Thematic analysis was used to analyse the data. Results We found fall prevention was valued in practice and recognised as complex. AHPs worked through challenges relating to clients (multi-morbidity, complex living situations, client motivation), challenges working alongside other health professionals (understanding respective roles/overlapping roles, sense of competition, communication) and challenges associated with funding systems perceived as complicated and constantly changing. Despite these challenges, AHPs were adopting strategies for integrating fall prevention routinely. The iSOLVE workshops were perceived as important in supporting existing practice and in providing strategies to enhance practice. Conclusions Policy makers, program managers, educators and AHPs can adopt strategies identified in this research for routinising fall prevention such as being alert that falls are common, asking every client about falls, having processes for assessing clients for fall risk, and having structured and evidence-based programs to work with clients on fall prevention. Adapting and streamlining funding systems are also important for facilitating fall prevention work.

Abstract Background Falls are an emerging public health issue in India, with the impact set to rise as the population ages. We sought to evaluate the acceptability, feasibility and likely impact of a yoga-based program aimed at improving balance and mobility for older residents in urban India. Methods Fifty local residents aged 60 years and older were recruited from urban Hyderabad, Andhra Pradesh. They were invited to attend a 1-h yoga class, twice weekly for 3 months. Mixed methods were used to evaluate the acceptability and feasibility (qualitative) and likely impact (quantitative). Two focus groups and eight interviews with participants were conducted to evaluate the acceptability and feasibility of a yoga program. Thematic analysis was conducted in context of perceptions, barriers and benefits of yoga participation and fall ascertainment. Physical performance using the Short Physical Performance Battery, fear of falling, blood pressure and weight loss were measured before and after the program. Results The interviews and focus groups provided insights into the preferred format for classes, including session times, level of supervision and location. Improvements were seen in the Short Falls Efficacy Scale-International (Short FES-I (15.9 ± 4.0 vs 13.8 ± 2.1 s, p = 0.002)), the number of steps taken in the timed 4-m walk (T4MW (9.0 ± 1.8 vs 8.6 ± 1.8, p = 0.04)), Short FES-I scores (9.4 ± 2.9 vs 8.6 ± 2.9, p = 0.02) and weight (63.8 ± 12.4 vs 62.1 ± 11.6, p = 0.004) were lower. No changes were seen in standing balance, blood pressure or T4MW time. Conclusion Yoga was well accepted and resulted in improved ability to rise from a chair, weight loss, increased step length and reduced fear of falling. These results provide impetus for further research evaluating yoga as a fall prevention strategy in India.

Abstract Background Physical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients’ behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP. Methods This study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation. Discussion This study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP. Trial registration ClinicalTrials.gov, ID: NCT03200509 . Registered on 28 June 2017.

Objectives: To test the external validity of 4 approaches to fall prediction in a rehabilitation setting (Predict_FIRST, Ontario Modified STRATIFY (OMS), physiotherapists’ judgement of fall risk (PT_Risk), and falls in the past year (Past_Falls)), and to develop and test the validity of a simpler tool for fall prediction in rehabilitation (Predict_CM2). Participants: A total of 300 consecutively-admitted rehabilitation inpatients. Methods: Prospective inception cohort study. Falls during the rehabilitation stay were monitored. Potential predictors were extracted from medical records. Results: Forty-one patients (14%) fell during their rehabilitation stay. The external validity, area under the receiver operating characteristic curve (AUC), for predicting future fallers was: 0.71 (95% confidence interval (95% CI): 0.61–0.81) for OMS (Total_Score); 0.66 (95% CI: 0.57–0.74) for Predict_FIRST; 0.65 (95% CI 0.57–0.73) for PT_Risk; and 0.52 for Past_Falls (95% CI: 0.46–0.60). A simple 3-item tool (Predict_CM2) was developed from the most predictive individual items (impaired mobility/transfer ability, impaired cognition, and male sex). The accuracy of Predict_CM2 was 0.73 (95% CI: 0.66–0.81), comparable to OMS (Total_Score) (p = 0.52), significantly better than Predict_FIRST (p = 0.04), and Past_Falls (p

Abstract Background Fall related injury is an emerging issue for older Indigenous people worldwide, yet few targeted fall prevention programs are currently available for Indigenous populations. In order to inform the development of a new Aboriginal-specific fall prevention program in Australia, we conducted community consultation with older Aboriginal people to identify perceptions and beliefs about falls, and to identify desired program elements. Methods Yarning Circles were held with Aboriginal and Torres Strait Islander people aged 45 years and over. Each Yarning Circle was facilitated by an Aboriginal researcher who incorporated six indicative questions into each discussion. Questions explored the impact of falls on Yarning Circle participants, their current use of fall prevention services and investigated Yarning Circle participant’s preferences regarding the design and mode of delivery of a fall prevention program. Results A total of 76 older Aboriginal people participated in ten Yarning Circles across six sites in the state of New South Wales. Participants associated falls with physical disability, a loss of emotional well-being and loss of connection to family and community. Many participants did not use existing fall prevention services due to a lack of availability in their area, having no referral provided by their GP and/or being unaware of fall prevention programs in general. Program elements identified as important by participants were that it be Aboriginal-specific, group-based, and on-going, with the flexibility to be tailored to specific communities, with free transport provided to and from the program. Conclusions Older Aboriginal people reported falls to be a priority health issue, with a significant impact on their health and well-being. Few older Aboriginal people accessed prevention programs, suggesting there is an important need for targeted Aboriginal-specific programs. A number of important program elements were identified which if incorporated into prevention programs, may help to address the rising burden of falls.

Introduction There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.Methods MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.Results 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.Conclusions The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.

Abstract Objective: To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall‐related injury in older indigenous people. Methods: Relevant literature was identified through searching 14 electronic databases, a range of institutional websites, online search engines and government databases, using search terms pertaining to indigenous status, injury and ageing. Results: Thirteen studies from Australia, the United States, Central America and Canada were identified. Few studies reported on fall rates but two reported that around 30% of indigenous people aged 45 years and above experienced at least one fall during the past year. The most common hospitalised fall injuries among older indigenous people were hip fracture and head injury. Risk factors significantly associated with falls within indigenous populations included poor mobility, a history of stroke, epilepsy, head injury, poor hearing and urinary incontinence. No formally evaluated, indigenous‐specific fall prevention interventions were identified. Conclusion: Falls are a significant and growing health issue for older indigenous people worldwide that can lead to severe health consequences and even death. No fully‐evaluated, indigenous‐specific fall prevention programs were identified. Implications for Public Health: Research into fall patterns and fall‐related injury among indigenous people is necessary for the development of appropriate fall prevention interventions.

Objectives and importance of study: Yoga improves balance and mobility, and therefore has potential as a fall prevention strategy, yet its validity for preventing falls has not been established. The Otago Exercise Programme (OEP) and tai chi are proven to prevent falls. This study aimed to evaluate the perceptions and preferences of older people towards a yoga-based program with potential to decrease falls, to compare these perceptions to the views expressed about the OEP and tai chi, and to identify participant characteristics associated with a preference for the yoga program. Study type: Survey. Methods: Participants were 235 community-dwellers aged 60 years or older who were not participating or had not previously participated (within the past 10 years) in yoga-based exercise. Participants completed a self-report survey measuring demographics, physical activity level and attitude. They then viewed explanations of the yoga-based program, the OEP and tai chi. Participants completed the Attitudes to Falls-Related Interventions Scale (AFRIS) to measure program acceptability and identified their preferred program. Acceptability scores and preference were compared between the programs, and factors associated with yoga preference were identified with analysis of variance. Results: The mean age of participants (69% female) was 69.4 years (standard deviation 7.4). All programs were rated as equally acceptable (p = 0.17), with AFRIS scores ranging from 28.1 to 29.4. Eighty-two people (35%) preferred yoga, 32% chose the OEP and 33% chose tai chi. Overall, people who preferred yoga were significantly younger, healthier, less fearful of falling, and perceived exercise more positively than people who preferred the OEP (p values ranged from 0.03 to

Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Study type: Retrospective population-based descriptive study. Methods: Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. Results: There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Conclusions: Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.

Objective: Well-designed exercise can prevent falls in older people but previous research indicates that promoting general physical activity may increase falls. This study aimed to evaluate uptake and adherence to a physical activity promotion and fall prevention intervention among community-dwelling people aged 60+ years. Methods: This was a process evaluation of intervention group data from an ongoing randomised controlled trial. Participants were 38 Australian community-dwelling older people assigned to intervention group who had completed 3 months of a physical activity and fall prevention intervention. Study measures included baseline daily step count assessed by Actigraph accelerometers, 12 week follow-up step count assessed by Fitbit pedometers and rating of participant engagement with the health coaching intervention. Results: 35 participants remained in the study at week 12 and were analysed. Mean daily steps significantly increased in week 12 compared with steps at baseline (change in mean = 1101 steps, 95% CI: 285–1917, p = 0.01). Health coaching engagement was rated as high for 19 people (54%), medium for 12 (34%) and low for 4 people (12%). All participants used the Fitbit to provide feedback about daily activity. Conclusion: The excellent intervention compliance and promising physical activity results demonstrate the acceptability and feasibility of this novel intervention.

Falls are a common, costly and preventable consequence of sensorimotor impairments that increase in prevalence with advancing age. A fall occurs when the physical ability of the individual is unable to match the immediate demands of the environment and/or of the activity being undertaken. Targeted exercise aimed at improving the physical ability of the individual, such as balance and strength training, is crucial for promoting functional independence and mobility and reducing the risk of falling in older age. Exercise programs that provide a high challenge to balance, have a high dose, include progression of intensity over time and are ongoing are most effective for preventing falls. This paper provides guidance to health professionals involved with the prescription of physical activity and exercise to older people regarding the safe and effective provision of programs aimed at improving strength and balance and preventing falls in older age.

Abstract Objective : This prospective cohort study describes older non‐transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Methods : Participants were 262 people aged 70 years or older with a fall‐related ASNSW attendance who were not transported to an emergency department. They completed a questionnaire about health, medical and physical factors previously associated with falling. Falls were monitored for six months after ambulance attendance with monthly fall calendars. Results : Participants had a high prevalence of chronic medical conditions, functional limitations and past falls. During follow‐up, 145 participants (58%) experienced 488 falls. Significant predictors of falls during follow‐up were three or more falls in the past year, being unable to walk more than 10 minutes without resting, and requiring assistance for personal‐care activities of daily living (ADLs). Sixty‐two participants (25%) required repeat, fall‐related ambulance attendance during the study. Predictors of repeat ambulance use were: 3+ falls in past year, requiring assistance for personal‐care ADLs and having disabling pain in past month. Conclusions : Older, non‐transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions. Implications : Onward referral for preventive interventions may reduce future falls and ambulance service calls.

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult.

Promotion of physical activity by health professionals can increase physical activity participation among patients, however, implementing physical activity promotion within hospital systems is lacking. The Promotion of Physical Activity by Health Professionals (PROMOTE-PA) study is a hybrid type I effectiveness-implementation cluster randomised controlled trial evaluating the effectiveness of support for physical activity promotion by health professionals on physical activity participation of patients. Health professionals delivering outpatient healthcare services within four local health districts and one specialty health network in New South Wales, Australia will be included. The target patient population is children (5–17 years) and adults (18+ years) who are willing to receive additional support to be more physically active. The evidence-based intervention is brief physical activity promotion informed by the ‘5As’ physical activity counselling model and behavioural theory, embedded into routine clinical practice. Our multi-faceted strategy to support implementation of physical activity promotion was developed based on preliminary research and consultation with key stakeholders. The implementation strategy includes education and training as well as a selection of the following (tailored to each clinical team): community referral strategies, experts and clinical mentors, and clinical champions. 30 outpatient clinical teams will be randomised to receive the implementation strategy immediately or after a 3-month delay (waitlist control). Each team will seek to recruit 10–30 patients (n=approx. 720) to report moderate-vigorous physical activity (minutes per week, primary outcome), frequency of balance and strength exercise, mobility, and quality of life at baseline, 3-month and 6-month post patient recruitment. This study aims to address the increasing burden of physical inactivity in a high-risk population using the existing health workforce.Trial registration number Australian and New Zealand Clinical Trials Registry (ACTRN12623000920695).