Life After Falls prevention therapy involving ExeRcise (LAFTER)

Background: Exercise programmes addressing problems of gait, balance and lower limb strength, are effective in reducing rate and risk of falls in community-dwelling older people. There is a lack of evidence regarding the long-term effects of falls prevention exercises. Aim: To investigate whether a falls prevention exercise intervention had any long-term effects on health-related outcomes compared to advice only, in older adults who have participated in a falls prevention clinical trial. Methods: This study used mixed methods. A cohort study followed-up a subset of 4891/9803 (50%) older people recruited to a larger RCT; The Prevention of Fall Injury Trial (PreFIT). Data on falls, health-related quality of life, frailty, cognition and general health were collected from participants allocated to advice only and advice plus exercise, up to six-years after randomisation. Interviews were undertaken with 23 participants randomised to the exercise intervention to explore their experiences of the trial. Results: 2980/4891 (61%) participants responded to a postal survey (advice: n=1507; exercise: n=1473). At six years, there were no long-term effects of exercise on falls or other health outcomes. There were no differences by treatment arm or by adherence to exercise. Overall health of the whole cohort gradually declined over time, in multiple domains. Analysis of interviews identified five themes: happy to help; exercise behaviours; “It keeps me going”; “It wasn’t a real fall”; and loss. Participants were no longer undertaking the strength and balance exercises prescribed during their intervention. They preferred walking as their main form of exercise, and no-one reported preventing falls as a motivator to continuing to exercise. Conclusions: There were no long-term effects of falls prevention exercises in this cohort of older people. This may be because older people stop their specific strength and balance exercises when their supervised intervention comes to an end.