Background
Method
Criteria for considering studies for this review
Types of studies
Participant criteria
Inclusion criteria
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majority of participants being aged ≥ 60 years (see above)
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living in the community or in care home settings, with any medical condition[s]
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presented the views and preferences on fall prevention exercise programs by the older people
Exclusion criteria
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studies not reporting views on exercise to prevent falls
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studies not specific to fall prevention
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studies which only reported adherence to a program or program components, not reasons for non-adherence
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studies limited to perspectives of significant others or personnel
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patients within a hospital ward setting
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studies not presented in English
Literature search
Study selection process and data extraction
Data synthesis
Results
Characteristics of the included studies
Article | Aim | Methods | Participants | Reported gender analysis |
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Whitehead et al. [43] | Investigating the reason for not taking up fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department. | Structural individual interviews Results presented in counts and percentages | 60 (44 women and 16 men) community dwelling participants who attended the emergency department of a public hospital with a fall. Mean age 78 years. Country: Australia | Considerably more women than men mentioned already being active enough (women 27.3%, men 18.8%); can’t do exercises (women 22.7%, men 12.5%); and can’t leave house/spouse (women 13.3%, men 0%), as reason for reluctance to take part in exercise classes. |
Yardley et al. [46] | To determine whether threat or coping appraisal are most closely related to older people’s intention to undertake strength and balance training. | Postal survey (n. 451) and structural interviews (n.107) Structural equation modeling | 558 (397 women and 161 men) older people. Aged between 60 and 95 years, mean age 74. Country: UK | Younger respondents and women were somewhat more positive in their coping appraisal than were older respondents and men. Female gender was positively related to threat appraisal (r = .11, p = 009) and coping appraisal (r = .18, p = .001). Women were slightly less inclined than men to undertake SBT. |
Yardley et al. [47] | To determine the extent to which older people, in different sectors, are willing to engage in different falls prevention activities. | Postal survey Logistic regressions | 5440 (2846 women and 2482 men) patients from 10 general practices. Aged > 54 years. Country: UK | Substantially more women than men indicated that they were likely to attend group sessions (p < 0.001), and carry out SBT at home (p < 0.001). |
Lin et al. [32] | To explore attitudes and beliefs of Taiwanese older women regarding SBT programs and their intentions to attend such programs. | Survey Multiple linear regressions and Pearson’s correlations | 221 women recruited from college for people with a wish to learn in later life. Aged between 55 and 94 years, mean age 72. Country: Taiwan | Only women included. |
Snodgrass and Rivett [39] | To explore the views and perceptions of older people about falls and falls injury prevention services, to identify incentives and barriers to attending a falls injury prevention service. | Survey 95% confidence interval (CI) | 75 members of community groups. No experience of fall prevention exercises required. Aged between 61 and 93 years, mean age 74. Sex not reported. Country: Australia | Statistics not reported according to gender. |
Hedley et al. [26] | To explore the reasons why the participants either did or did not adhere to an RCT intervention with both group and home exercises. | Mixed design: Qualitative: Individual interviews and one focus group Quantitative: Attendance rates, gait and balance assessments Thematic analyses and descriptive statistics | 5 community dwelling women. Participants in the Staying Steady program with 32 weeks of group and home based exercises. Aged between 60 and 88 years, mean age 77. Country: UK | Only women included. |
Robinson et al. [36] | To explore the process of behavior change in a small sample of older people with the fall-associated chronic liver disease primary biliary cirrhosis (PBC) receiving either a standard or an enhanced program of strength and balance training. | Mixed design: Individual interviews and graphical representations of patient-reported outcomes measures (PBC-40; FES-I; SEE Scale) Critical realist paradigm of enquiry | 9 community dwelling women with PBC who participated in a 6-week or 6-month strength and balance training program. Aged between 63 and 80 year. mean age 70 year. Country: UK | Only women included. |
Article | Aim | Methods | Participants | Reported gender analysis |
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Clark et al. [24] | To explore older, community-dwelling adults’ attitudes and values about proposed church-delivered balance classes for fall prevention to inform a social marketing campaign. | Focus groups (n = 6) Inductive analysis | 60 church members and potential users of the fall prevention exercise classes. Aged ≥60 year. Sex not reported. Country: USA | Women respond to a fall-prevention message more than men, and men rely on women for motivation. Women’s gendered identities positioned them to be the primary motivators who could soften their “stubborn” men to enroll in health programs. Men’s gendered identities positioned them to protectively identify women as high-priority recipients of balance and fall-prevention messages. |
Jagnoor et al. [30] | To investigate fall prevention as a health priority among older people; to understand people’s perception of risk and concepts of fall injury prevention; and to explore acceptability of yoga as an intervention for falls prevention in the community. | Focus groups (n = 6) Thematic analysis | Gender divided focus groups in three sociodemographic clusters. 12–18 participants in each constellation. Aged >60 year. Sex not reported. Country: India | The experience, knowledge, perceptions and health priorities were diverse and differed across the three sociodemographic groups, although these were similar among men and women within each sociodemographic group. Women considered themselves active enough with domestic work. No gender discussion. |
Berlin Hallrup et al. [23] | To explore the lived experience of fall risk from a life world perspective. | Individual interviews Phenomenological reflective lifeworld approach | 13 community dwelling older women with previous fragility fractures. Participants in a hip fracture prevention program comprising a bone mineral density scanning, and written fall preventive advice including advice on exercises. Aged between 76 and 86 years. Country: Sweden | Only women included. |
Hawley [25] | To explore what might encourage older people to exercise at home after falls rehabilitation. | Individual interviews Grounded theory approach | 8 community dwelling, 1 nursing home resident. All had been through falls rehabilitation and offered home exercise programs Aged ≥60 year. Sex not reported. Country: UK | Quotes from both men and women but no comparison. |
Horne et al. [27] | To explore the beliefs of both South Asian and White British community dwelling older adults in their 60s about falls and exercise for fall prevention. | Focus groups (n = 15) and individual interviews Framework analysis | 87 + 40 (81 women and 46 men) community dwelling participants. Aged between 60 and 70 year, Focus group mean age 65. Individual interviews mean age 64. Participants with different experiences of participation or nonparticipation in exercise. Country: UK | Quotes from both men and women but no comparison. |
Horne et al. [28] | To identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian in UK. | Ethnographic study participant observations, focus groups (n = 15) and individual interviews Framework analysis | 87 + 40 (81 women and 46 men) community dwelling participants. Aged between 60 and 70 year, Focus group mean age 65. Individual interviews mean age 64. Participants with different experiences of participation or nonparticipation in exercise. Country: UK | Quotes from both men and women but no comparison. |
Hutton et al. [29] | To develop an understanding of the perceptions that older adults at risk at of falls, and previously involved in organized group exercise, have of physical activity. | Focus groups (n = 5) Thematic analysis | 20 community dwelling persons (90% females) recruited from a RCT investigating the effectiveness of Tai Chi in reducing falls. Aged between 68 and 81 year, mean age 73. Country: New Zealand | Gender not reported in quotes. |
Lam et al. [31] | To examine older people’s perceptions and experiences of falls, physiotherapy and exercise. | Individual interviews Phenomenological approach | 19 (10 women and 9 men) community dwelling Australian-born and Italian-born older persons who had more than one fall in the past 12 months and completed a community-based physiotherapy program. Aged between 65 and 89 years. Country: Australia | Quotes from both men and women but no comparison. |
Lindgren De Groot and Fagerström [33] | To describe motivating factors and barriers for older adults to adhere to group exercise in the local community. | Individual interviews Descriptive content analysis | 10 (5 women and 5 men) community dwelling persons and former participants in a fall preventive exercise program. Aged between 71 and 91 year, mean age 83. Country: Norway | Gender not reported in quotes. |
Meyer et al. [34] | To understand the perspectives of older people in adopting a home-based balance exercise program to address mild balance dysfunction, and to identify barriers and opportunities facing community health PTs in delivering this program. | Focus groups (n = 2) with older participants, (focus groups, written surveys, and data recording sheets for PTs). Phenomenological approach. Thematic content analysis | 9 (6 women and 3 men) community dwelling participants who had completed a six-month program. Aged between 67 and 86 years. 10 PTs Country: Australia | Gender not reported in quotes |
Moody et al. [35] | To investigate participants’ perceptions of a twelve week aqua-aerobics program on falls risk and physical function in older adults with lower extremity osteoarthritis. | Focus groups (n = 4), one individual interview General inductive approach | 17 (13 women and 4 men) community dwelling participants with lower extremity osteoarthritis who had completed a 12 week water-based exercise program. Aged between 68 and 89 years, mean age 78. Country; New Zealand | Gender not reported in quotes. |
Robinson et al. [37] | To involve older people and PTs in the development of acceptable strategies to promote uptake and adherence with an exercise-based fall prevention program | Focus groups (n = 3) with older people and with local PTs (n = 4) Framework analysis | 12 (8 women and 4 men) older people attending a regional falls and syncope service including exercises. Aged between 72 and 88 years, mean age 79. 18 (14 women and 4 men) PTs in the region. Country: UK | Quotes from both men and women but no comparison. |
Simpson et al. [38] | To examine the extent to which older people are willing to adopt any of the following strategies in order to avoid falling: balance and lower limb strengthening exercises. home safety advice, and ‘taking care’. | Individual interviews Method of analysis not reported | 32 (26 women and 6 men) persons discharged from acute elderly care medical wards. No experience of fall prevention exercises required. Aged >65 years, mean age 83. Country: UK | Quotes from both men and women but no comparison. |
Stathi and Simey [40] | To explore the exercise experiences of nursing home residents who participated in a 6-month falls prevention exercise intervention. | Individual interviews, 14 at baseline and 7 at follow-up Interpretive phenomenological analysis | 14 (12 women and 2 men) nursing home residents who participated in a 6-month chair-based exercise program. Aged between 86 and 99 years. Country: UK | Quotes from both men and women but no comparison. |
Suttanon et al. [41] | Identify factors that influence commencement and adherence to a home-based balance exercise program for older people with mild to moderate Alzheimer’s disease (AD). | Individual interviews Phenomenological theoretical framework | 10 (7 women and 3 men) participants with AD and 9 (6 women and 3 men) of their caregivers, who had completed a six-month home-based balance exercise program. Participants with AD aged between 75 and 89 years, mean age 81. Caregivers aged between 58 and 85 years, mean age 71. Country: Australia | Mostly quotes from women, no comparison. |
Vernon and Ross [42] | To explore the reasons older people had for attending local postural stability exercise classes. | Individual interviews, 22 at baseline and 17 at follow up Thematic analysis | 22 (20 women and 2 men) community dwelling participants who had fallen and attended balance exercise classes. Aged between 65 and 94 years. Country: UK | Gender not reported in quotes. |
Wong et al. [44] | To estimate the uptake rate of a fall prevention program To explore the attitudes towards acceptance of the exercise class included in a fall prevention program. among older fallers and explore related factors | Focus groups (n = 3) Content analysis (Baseline telephone interviews (n. 1194) and a 1-year follow-up telephone survey (n. 969) with older people or their carers) | Focus Groups: (9 women and 4 men) previous fallers among who attended exercise classes based on the FaME protocol. Aged between 65 and 91 year, mean age 76. Country: Hong Kong | Gender not reported in quotes. |
Yardley et al. [45] | To identify factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls related interventions | Individual interviews Framework analysis | 69 (50 women and 19 men) older people, two thirds (46) had been offered an intervention, and half (32) had taken part in an intervention. Aged between 68 and 97 years, mean age 79. Countries: Denmark, Germany, Greece, Switzerland, The Netherlands, and UK | Quotes from both men and women but no comparison. |
Gendered views of older adults to falls prevention exercise
Older participants views and preferences on fall prevention exercise
Examples of codes | Themes | Reported in quantitative or mixed studies (see Table 1) | Reported in qualitative studies (see Table 2) |
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Facilitators | |||
“Recommendations from health professionals” “Support from professional” “Professional exercise instructor” “Family support” “Social approval “ “Positive social identity” “Being accompanied by a friend” | Support from professionals or family | ||
“Socialization” “Relationships” “Valued companionship” “Enjoyable and sociable atmosphere” “Having a coffee/tea as part of activity” “prefer group exercises” | Social interaction | Quantitative: Snodgrass and Rivett [39] Mixed: Hedley et al. [26] | |
“Staying independent” “Increase independence” “Functional improvements” “Maintaining health” “Believe that exercise has benefits” “Feeling improvements” “Improved mental health” “Reduction of fall risk” “Recent falls” “improved self-efficacy” | Perceived benefits | ||
“Trust-based atmosphere” “Small size classes” “Suitable and nearby facility” “At home or group” “Participants of similar age” “Program characteristics” “Individually adapted” “Feeling ownership of the program” “High self-efficacy” | A supportive exercise context | Mixed: Robinson et al. [36] | |
“Commitment to a structured program” “Exercise recording sheet” “Measurable goals” “Minimizing caregivers burden” “Contribute to research” | Feelings of commitment | ||
“Interest and enjoyment” “Enjoyable and joyful” “Activity sounds like fun” | Having fun | Quantitative: Snodgrass and Rivett [39] | |
Barriers | |||
”Transportation to exercise venue” “Environmental factors” “Lack of suitable place at home” “Lack of time” “Bad weather” | Practical issues | Mixed: Hedley et al. [26] | |
“Fear of adverse effects” “fear of falling again” “Anxiety at start” “Unable to keep up with others in class” “A competitive atmosphere” “Too difficult exercises” “Different functional levels among participants” “Previous unpleasant experiences” “Dislike group activities” “Program not tailored” | Concerns about exercise | Mixed: Robinson et al. [36] | |
“Misunderstandings of benefits” “Denial of risk of falling” “Perceive oneself as too young and fit” “Being active enough” | Unawareness | Yardley et al. [45] | |
“Deterioration in health” “Pain and pathology” “Feeling unwell” “Fatigue” “Feeling too old” | Reduced health status | Quantitative: Whitehead et al. [43] | |
“Unprofessional instructor” “Withdrawal of professional support” “Lack of support from home” “Caregivers health” | Lack of support | Quantitative: Whitehead et al. [43] Mixed: Hedley et al. [26] | |
“Lack of motivation” “Not interested” | Lack of interest |