Effectiveness of statewide falls prevention efforts with and without group exercise

Group-based falls prevention programs vary in use of exercise, education, home modification, and other program elements. Pennsylvania's Department of Aging offers two large-scale falls prevention programs that differ in these components, allowing a strong test of the effectiveness of exercise in reducing falls incidence relative to less intensive education-based programs. In 2016-2017, we followed three groups of older adults attending senior centers: (i) older adults who completed Healthy Steps in Motion (HSIM, n=560), an 8-week exercise program, (ii) older adults completing Healthy Steps for Older Adults (HSOA, n=651), a falls education workshop with assessment and referral; and (iii) older adults not completing falls prevention programs (n=787). Participants were followed for up to 6months with monthly ascertainment of falls. We estimated Poisson regression models to compare incidence rate ratios. The groups did not differ in falls risk at baseline or attrition over follow-up. HSIM participants reported 5.3 fall months per 100 person-months of follow-up. The group not completing falls prevention programming reported 7.3 (incidence rate ratio [IRR], 0.72 [0.59, 0.89]), and the group completing HSOA 6.5 (IRR, 0.82 [0.66, 1.02]). In stratified analyses, falls incidence was lower in HSIM for older adults reporting better balance and no falls in the prior 12months. Non-exercise-based falls prevention programs may also reduce falls, perhaps through indirect physical benefits such as greater social engagement and increased activity.