Otago Exercise Programme

Original Editor - Lauren Lopez Top Contributors - Gabriele Dara, Kim Jackson, Lucinda hampton, Lauren Lopez, Wendy Walker, Rucha Gadgil, Tony Lowe, Vidya Acharya, Tolulope Adeniji and Aminat Abolade  

Introduction

The Otago Exercise Program (OEP) was developed to reduce falls in older persons. The OEP consists of 17 strength and balance exercises and a walking program, performed three times a week by the older adult in the home, outpatient, or community setting. Exercises can be done individually or in a group setting. Studies demonstrate OEP participants experience a 35 – 40% reduction in falls. The program is most effective for frail older adults. It is recommended for frail older adults that a Physical Therapist (PT) assess and prescribe the initial exercises. The older adult does the exercises independently three times a week and completes a series of 4 visits with the PT, PT Assistant, or the appropriate provider over an 8-week period. Transitions to a self-management phase for 4 – 10 months. During the self-management phase, the older adult continues to independently do the exercises, and has the opportunity to check in with their program provider via monthly phone calls, and an optional face to face check in at 6 months.

Aim: Falls Risk Reduction

Falls in older adults can cause significant physical and psychological injury to the individual. As a consequence, falls also incur significant health care costs. The New Zealand Accident Compensation Corporation (ACC) implemented a project with the goal of reducing falls: The Otago Exercise Programme (OEP). 

The OEP was developed by Campbell and Robertson for the New Zealand Accident Compensation Corporation (ACC) which provides treatment and rehabilitation under a universal, no-fault accidental injury scheme.   

The main takeaway results from the research into Otago exercises include:   

• Falls among people participating in the Otago were reduced by 30% to 66% when compared to controls who were not doing Otago exercises.
• After one year, injuries due to falls were reduced by 28% in participants performing Otago exercises.
• The Otago exercise program was most effective at reducing falls for people over the age of 80 years, but people who were younger still found some benefit.
• Seventy percent of patients performing Otago exercises continued doing the program after one year.

Content of the program

See this here for booklet of the OEP.

1. Baseline Assessment

•  The program starts with the first home visit where the physiotherapist can discuss general information and goals of the program with the patient and collect relevant clinical history information. Additionally, an intake assessment of balance and strength is performed, with the 30 Seconds Sit To Stand Test and The 4-Stage Balance Test. Additional home visits and follow-up phone calls are performed during the program by the physiotherapist with the aim of encouraging adherence.       

2. Exercise and walking program

 Based on the results of the initial assessment, an exercise and a walking program are prescribed by the therapist. The OEP comprises       

1.  5 strengthening exercises and 12 balance exercises. Participants are instructed to perform the exercises three times a week. Depending on the individual’s strength and mobility, the exercises can be progressed, by increasing the amount of repetitions or weight (ankle cuffs with weight can be used and adjusted during the program).              
2.  Participants are provided with a walking program, aiming to include a 2x week 30 minutes walking session (can be broken into smaller periods e.g. three ten-minute blocks).               

The video below shows a lady doing the program at day 14 at home.       

Table 1: Exercises of the OEP.

Exercises	*start at 10 repetitions
Strength	Knee extensor
	Knee flexor
	Hip adductor
	Ankle plantarflexors (calf raises)
	Ankle dorsiflexors (toe raises)
Balance	Knee bends
	Backwards walking
	Walking and turning around
	Sideways walking
	Tandem stance (heel toe stand)
	Tandem walk (heel toe walk)
	One leg stand
	Heel walking
	Toe walk
	Heel toe walking backwards
	Sit to stand
	Stair walking

Indication

The OEP that improve balance and can help prevent falls, a common problem in many polulations eg

• Older adults The program is designed for older adults (65+)..Any elder person interested in preserving and improving their strength, balance and competency in Activities of Daily Living (ADLs) can benefit from participating in the program.
• Individuals who have already experienced a fall ( ie high risk group)
• Neuromuscular conditions (multiple sclerosis, parkinsonism, stroke),
• Cancer Rehabilitation
• De-conditioned Adults eg post lengthy hospital stays; long term corticosteroid medications.

Concluding Words

Falling down can be a scary thing, and it can cause injury and create a situation where a persons confidence with mobility is shaken. Performing Otago exercises three times a week has been shown to help improve balance and mobility and prevent falls.

The Otago exercise program is a simple, effective, and fun way to improve balance and hopefully prevent falls.