Implementing home-based exercise programs for community-dwelling older adults in New South Wales, Australia

Abstract

This thesis investigated new approaches to delivering home based exercise programs for community dwelling adults aged 65+. It included a large pragmatic randomised controlled trial (617 participants) and a feasibility study in the Illawarra and Shoalhaven regions of NSW, Australia.

Exercise, especially balance and functional training, can reduce falls, yet participation at recommended levels is low. Home based programs are effective but often resource intensive. This thesis examined whether simpler, scalable models could prevent falls and reduce shoulder dysfunction.

The randomised trial tested two 12-month home based programs: a lower limb balance strength program and an upper limb mobility strength program. Participants attended three group instruction sessions and completed exercises at home three times per week for a 12-month period.

The lower limb trial showed no reduction in fall rate but improved fear of falling and gait speed. Adherence averaged fewer than two sessions per week. Participants rated the program positively. Findings suggested greater benefit for more deconditioned or frail adults.

The upper limb trial showed no significant improvement in upper limb function or strength. Adherence averaged two sessions per week. Results indicated the program may be more suitable for those with existing dysfunction, but further investigation is recommended.

A pilot study in older adults with COPD showed significant improvements in physical performance and high acceptability, supporting evaluation in a larger trial.

Overall, this thesis provides evidence to guide scalable home-based exercise interventions and highlights the need for targeted approaches and strategies to improve adherence.