Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study.
- Author(s): Wetherell, Julie Loebach;
- Bower, Emily S;
- Johnson, Kristen;
- Chang, Douglas G;
- Ward, Samuel R;
- Petkus, Andrew J
- et al.
Published Web Locationhttps://doi.org/10.1016/j.jagp.2018.04.001
OBJECTIVES:To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy. DESIGN:Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education. SETTING:Participants' homes. PARTICIPANTS:42 older adults with disproportionate fear of falling (high fear, low to moderate objective fall risk). MEASUREMENTS:Falls Efficacy Scale-International, modified Activity Card Sort, satisfaction, falls. RESULTS:Relative to education, the intervention reduced fear of falling (d = 1.23) and activity avoidance (d = 1.02) at 8 weeks, but effects eroded over a 6-month follow-up period. The intervention did not increase falls, and participants rated the exercise, exposure therapy, and non-specific elements as most helpful. CONCLUSIONS:An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling, but modifications to the intervention or its duration may be needed to maintain participants' gains.