Otago Exercise Programme: Difference between revisions

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[[File:Geriatrics physical activity.jpg|center|thumb]]


== Description  ==
== Description  ==
[[File:Geriatrics physical activity.jpg|thumb]]


[[Falls in elderly|Falls]] in older adults can cause significant physical<ref name=":1">World Health Organisation. [http://www.who.int/news-room/fact-sheets/detail/falls Falls]. 2018. Accessed 16 October 2018.</ref> and psychological injury<ref>Parry SW, Deary V. [https://www.bmj.com/content/328/7441/680.full?int_source=trendmd&int_medium=trendmd&int_campaign=trendmd How should we manage fear of falling in older adults living in the community?]BMJ, 2013; 346. Accessed 16 October 2018.</ref> to the individual. As a consequence, falls also incur significant health care costs<ref name=":1" /><ref>Morello RT, Barker A, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA Stoelwinder JU. [https://www.mja.com.au/system/files/issues/203_09/10.5694mja15.00296.pdf The extra resource burden of in-hospital falls: a cost of falls study]. Med J Aust 2015; 203;9: 367e1-8. Accessed 16 October 2018.
[[Falls in elderly|Falls]] in older adults can cause significant physical<ref name=":1">World Health Organisation. [http://www.who.int/news-room/fact-sheets/detail/falls Falls]. 2018. Accessed 16 October 2018.</ref> and psychological injury<ref>Parry SW, Deary V. [https://www.bmj.com/content/328/7441/680.full?int_source=trendmd&int_medium=trendmd&int_campaign=trendmd How should we manage fear of falling in older adults living in the community?]BMJ, 2013; 346. Accessed 16 October 2018.</ref> to the individual. As a consequence, falls also incur significant health care costs<ref name=":1" /><ref>Morello RT, Barker A, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA Stoelwinder JU. [https://www.mja.com.au/system/files/issues/203_09/10.5694mja15.00296.pdf The extra resource burden of in-hospital falls: a cost of falls study]. Med J Aust 2015; 203;9: 367e1-8. Accessed 16 October 2018.

Revision as of 13:26, 28 September 2020

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  


Description[edit | edit source]

Geriatrics physical activity.jpg

Falls in older adults can cause significant physical[1] and psychological injury[2] to the individual. As a consequence, falls also incur significant health care costs[1][3][4]. Hence, the New Zealand Accident Compensation Corporation (ACC) implemented a project with the goal of reducing falls: The Otago Exercise Programme (OEP). 

OEP is an evidenced-based, "home-based, individually tailored strength and balance retraining programme”[5]. The program is carried out by physiotherapists (and/or trained providers such as community nurses). It is designed to be carried out over 12 months (or more recently, six months).  

Background Evidence[edit | edit source]

The OEP was developed by Campbell and Robertson[5] for the New Zealand Accident Compensation Corporation (ACC) which provides treatment and rehabilitation under a universal, no-fault accidental injury scheme.   

The development and testing of the program is based on 4 controlled trials carried out at the Medical School of the University of Otago, New Zealand. All the research and tests conducted involved 1016 community-dwelling individuals from 65 until 97 years of age[5]. In one of their studies, Campbell and Robertson reported that falls in older adults were reduced by 35%[6]. The OEP has also been shown to be a cost effective intervention, particularly for adults over 80 years old[7]. The program has been modified and used in other health systems in Australia[8] and the United States[9]. However, the effectiveness of the program in modified formats is unclear[10].   

Besides the studies performed by the team in charge for the development of OEP, a systematic review with meta-analysis showed that the OEP is effective in reducing the risk of death and incidence rate of falls over a one year period in older adults[11]. A 2018 systematic review entitled "Does modified Otago Exercise Program improves balance in older people? " concluded that interventions with modified OEP improve balance and reduce falls in older adults.[12] Additionally, a retrospective analysis among community-dwelling older adults participating in a community-based falls prevention program (Otago Exercise Program) showed an improvement in individuals with younger age, with better balance and baseline physical performance, and no use of an assistive device[13].  

Content of the program[edit | edit source]

Baseline Assessment[edit | edit source]

 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[5]. Additional home visits and follow-up phone calls are performed during the program by the physiotherapist with the aim of encouraging adherence[14].       

Exercise and walking program[edit | edit source]

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

 The OEP comprises five strengthening exercises and 12 balance exercises[5]. Participants are instructed to perform the exercises three times a week[15]. In addition, 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)[15]. 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).              

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

[16]

Table 1: Exercises of the OEP[6].
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[edit | edit source]

  • The program is designed for older adults (65+). Nevertheless, the population at high risk (individuals who have already experienced a fall or who are 80 or older) showed a higher decrease in falls incidence [5].  
  • Individuals with strength and balance deficits can also benefit for the program. Failure to complete either the chair stand test or four-test balance scale can give an indication of their physical capability[15].  
  • An elder person interested in preserving and improving their strength, balance and competency in Activities of Daily Living (ADLs) can also benefit from participating in the program.  

Additional reading[edit | edit source]

"How to do it:Practical implementation of an exercise-based falls prevention programme" by Gardner et al, 2001.

References[edit | edit source]

  1. ↑ 1.0 1.1 World Health Organisation. Falls. 2018. Accessed 16 October 2018.
  2. ↑ Parry SW, Deary V. How should we manage fear of falling in older adults living in the community?BMJ, 2013; 346. Accessed 16 October 2018.
  3. ↑ Morello RT, Barker A, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA Stoelwinder JU. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust 2015; 203;9: 367e1-8. Accessed 16 October 2018.
  4. ↑ Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc, 2018; 66:693–698. Accessed 16 October 2018.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Campbell AJ, Robertson MC. Otago exercise programme to prevent falls in older adults. Wellington: ACC Thinksafe. 2003 Mar;3.
  6. ↑ 6.0 6.1 Campbell AJ, Robertson MC for the New Zealand Accident Compensation Corporation. Otago Exercise Programme to prevent falls in older adults. 2003. Accessed 2 October 2018.
  7. ↑ Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan Km, Marra CA. Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 2010;44:80-89. Accessed 16 October.
  8. ↑ Queensland Government. Queensland Health: Otago Exercise Programme - Qld Stay On Your Feet. 2013. Accessed 16 October 2018.
  9. ↑ Shubert TE, Goto LS, Smith ML, Jiang L, Rudman H, Ory MG. The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults. Front Public Health 2017; 5: 54. Accessed 16 October 2018.
  10. ↑ Martins AC, Santos C, Silva C, Baltazar D, Moreira J, Tavares N. Does modified Otago Exercise Program improves balance in older people? A systematic review. Prev Med Rep. 2018; 11: 231–239. Accessed 16 October 2018.
  11. ↑ Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing, 2010; 39 (6): 681–687. Accessed 16 October 2018.
  12. ↑ Martins AC, Santos C, Silva C, Baltazar D, Moreira J, Tavares N. Does modified Otago exercise program improves balance in older people? A systematic review. Preventive medicine reports. 2018 Jul 10. Available from: https://www.sciencedirect.com/science/article/pii/S2211335518301116 (last accessed 7.5.2019)
  13. ↑ Scronce G, Zhang W, Smith ML, Mercer VS. Characteristics associated with improved physical performance among community-dwelling older adults in a community-based falls prevention program. International journal of environmental research and public health. 2020 Jan;17(7):2509.
  14. ↑ Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin. 2001,22;3–4: 78-83. Accessed 13 October 2018.
  15. ↑ 15.0 15.1 15.2 Gardner MM, Buchner DM, Robertson MC, Campbell AJ. How to do it: practical implementation of an exercise-based falls prevention programme. Age Ageing 2001; 30: 77-83. Accessed 16 October 2018.
  16. ↑ Walkers get active. Otago strength and balance program. Day 14. Available from: https://www.youtube.com/watch?v=cC0JTSO3oww (last accessed 7.5.2019
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