Trajectories of adherence to a falls prevention exercise intervention in Singapore: A mixed methods study

• Published in: Aging and health research Vol. 4; no. 1; p. 100181
• Main Authors: Lee, June May-Ling, Sung, Pildoo, Tan, Kok Yang, Duncan, Pamela, Sim, Rita, Koh, Karen, Chan, Angelique
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.03.2024; Elsevier
• Subjects: Adherence; Asia; Falls-prevention exercise; Latent class growth modelling; older adults; Adherence; older adults; Falls-prevention exercise; Asia; Latent class growth modelling
• ISSN: 2667-0321; 2667-0321
• DOI: 10.1016/j.ahr.2024.100181

•Adherence to falls prevention exercise intervention influences the effectiveness of the intervention.•Attendance trajectories identified were high, moderate, low, and non-adherence.•Younger age, ethnic minority, and exercise self-efficacy were associated with low or non-adherent trajectories.•Low or non-adherent trajectories were associated with poorer physical functioning outcomes post-intervention. The success of falls prevention exercise intervention is dependent on adherence. This study investigated the trajectories of adherence to an instructor-led, face-to-face, community group-based falls-prevention exercise intervention, baseline factors associated with these trajectories, and the impact of these adherence trajectories on post-intervention physical functioning. Qualitative interviews were also examined to gather insights into participants’ profiles. Attendance data from 144 older adults who participated in a 12-week falls prevention exercise intervention were used to assess adherence. Physical functioning was assessed at baseline and post-intervention using Short Physical Performance Battery. We used Latent Class Growth Modelling to identify the types of adherence trajectories. Multinomial logistic regression and multivariate linear regression were used to examine antecedents and consequences associated with the adherence trajectories. Content and cross-tabulation analysis were conducted on 30 semi-structured qualitative interviews. We identified four types of adherence trajectories: high adherence, moderate adherence, low adherence, and non-adherence. Non-adherent participants were younger than those with a high adherence trajectory. Those with low adherence trajectory were younger, more likely to be an ethnic minority, and had lower exercise self-efficacy. Older adults with low or non-adherence trajectories had lower post-intervention physical functioning than those with high adherence trajectory. Qualitative analysis indicated that participants with low adherence trajectory had prioritized exercise lower than other life commitments and had frequent hospitalizations and multiple medical appointments. Non and low adherence trajectories attenuate the impact of falls prevention exercise intervention. Findings from this study can be used to develop strategies to improve adherence.