Counselling for physical activity, life-space mobility and falls prevention in old age

INTERVENTION: Participants are randomly allocated to one of two groups: Current interventions as of 04/05/2018: Control group: Participants will receive a placebo intervention including five face to face sessions of mindfulness relaxation exercises. Exercise program will be up dated during each face to face session and each exercise is provided on CD. Intervention group: There will be five Health Kiosk‐based 1.5‐hour sessions including a 30‐minute counselling session for motivation together with a 1‐hour exercise education session. Exercise education contains strengthening exercises for lower extremity muscles. The program also includes balance, walking and stair climbing exercises and active range of movement exercises (for example, neck rotations and hip and knee extensions). During the sessions the exercise referral to the local community specialized gym will be also given. The participants will receive a progressive written exercise program with schematic drawings. In addition, 11 supportive telephone calls will be provided. The safety issues of physical activity, counselling to reduce alcohol consumption and smoking, recommendation to use anti‐slippery shoe devices will be advised. The total duration of the intervention is 24 months. Both groups are followed up 24 months after the intervention. Previous interventions as of 30/08/2016: Control group: Participants will receive a placebo intervention including five face to face sessions of mindfulness relaxation exercises. Exercise program will be up dated during each face to face session and each exercise is provided on CD. Intervention group: There will be five Health Kiosk‐based 1‐hour sessions including a 20‐minute counselling session for motivation together with a 40‐minute exercise education session. Exercise education contains strengthening exercises for lower extremity muscles. The program also includes balance, walking and stair climbing exercises and active range of movement exercises (for example, neck rotations CONDITION: Falls ; Injury, Occupational Diseases, Poisoning PRIMARY OUTCOME: 1. Life‐space mobility assessed by a validated questionnaire (Life‐spece mobility measures mobility based on distance through which a person reports moving during the 4 weeks preceding the assessment. Questions establish movement to specific life‐space levels ranging from within one’s dwelling to beyond one’s town) at baseline, 12, 24 and 48 months; 2. Number of falls and fall‐related injuries: monthly collected fall‐diaries will be used to collect information on falls and fall‐related injuries and registers will be used to verify severe injuries at baseline, 12, 24 and 48 months INCLUSION CRITERIA: 1. Aged 65 years or over 2. Community‐living people 3. Living in Ylöjärvi, Finland, or neighbouring municipalities 4. At least minor mobility difficulty Removed 30/08/2016: 4. History of fall(s) SECONDARY OUTCOME: Current secondary outcome measures as of 04/05/2018:; 1. Physical activity is assessed using a Finnish Hookie AM 20 triaxial accelerometer for 7 days and physical activity diary for 4 weeks at baseline, 12, 24 and 48 months; 2. Physical performance is measured using the Timed Up and Go‐test (TUG) , Short Physical Performance Battery (SPPB) and Jamar hand dynamometer at baseline, 12, 24 and 48 months; 3. Quality of life is measured using The World Health Organization Quality of Life (WHOQOL) questionnaire at baseline, 12, 24 and 48 months; 4. Living‐arrangements are determined by asking patients at baseline, 12, 24 and 48 months; 5. Number of fallers based on monthly collected fall‐diaries at baseline, 12, 24 and 48 months; 6. Fracture risk is assessed using the WHO Fracture Risk Assessment Tool at baseline, 12, 24 and 48 months; 7. Mental status is assessed using the Geriatric Depression Scale (GDS‐15) at baseline, 12, 24 and 48 months; 8. Cognitive status is assessed using the Mini‐Mental State Examination (MMSE) at baseline, 12, 24 and 48 months; 9. Balance confidence as a measure of fear of falling is assessed using the Activities‐specific Balance Confidence scale (ABC) at baseline, 12, 24 and 48 months; ; Previous secondary outcome measures:; 1. Physical activity is assessed using a Finnish Hookie AM 20 triaxial accelerometer for 7 days and physical activity diary for 4 weeks at baseline, 12, 24 and 48 months; 2. Physical performance is measured using the Timed Up and Go‐test (TUG) , Short Physical Performance Battery (SPPB) and Jamar hand dynamometer at baseline, 12, 24 and 48 months; 3. Quality of life is measured using The World Health Organization Quality of Life (WHOQOL) questionnaire at baseline, 12, 24 and 48 months; 4. Living‐arrangements are determined by asking patients at baseline, 12, 24 and 48 months; 5. Falls rate is measured using a short risk profile interview (i.e. “Have you fallen (and if so, how many times) during the previous year (without substantial external force)?) at baseline, 12, 24 and 48 months; 6. Fracture risk is assessed using the WHO Fracture Risk Assessment Tool at baseline, 12, 24 and 48 months; 7. Mental status is assessed using the Geriatric Depression Scale (GDS‐15) at baseline, 12, 24 and 48 months; 8. Cognitive status is assessed using the Mini‐Mental State Examination (MMSE) at baseline, 12, 24 and 48 months