Danielle R. Bouchard

Background: Falls are a major public health concern due to their impact on individuals and the health system. StandingTall (Ylva Health Pty Ltd) is a digital balance exercise app that has demonstrated strong adherence and fall-reduction effects in Australia. Before considering implementation in Canada, its acceptability must be assessed. Objective: This study aimed to explore the prospective acceptability of the StandingTall app among Canadian community-dwelling adults aged 50 years and older with varying levels of physical activity and technological skills. Methods: A concurrent mixed methods design was guided by the Theoretical Framework of Acceptability (TFA). After viewing a demonstration video, participants completed an online survey in which they rated the 7 TFA constructs using a 5-point Likert scale. Participants also reported demographic and health characteristics. A subsample completed interviews that were also based on TFA constructs. Convergence between data sources was assessed through overall patterns. Results: In total, 314 individuals completed the survey (mean age 61.8, SD 8.0 y; n=279, 88.9% female participants) and 22 completed interviews. The mean acceptability score was 5.8 (SD 1.3; out of 7). Participants viewed the StandingTall app positively, valuing its convenience, flexibility, clear design, and alignment with their health and aging goals. Both data sources indicated strong acceptability, shaped by high affective attitude and self-efficacy and tempered by burden and opportunity cost factors related to technology issues and existing lifestyle commitments. Participants also reported mixed beliefs about its effectiveness, with some skepticism about the mechanisms by which the app’s exercises improve balance and ultimately reduce the risk of falls. Conclusions: Although the sample was heterogeneous, StandingTall was viewed as generally acceptable, with some heterogeneity across participants and with challenges that could be addressed using implementation strategies cocreated with potential users.

Background/Objectives : Prolonged sedentary time poses health risks for older adults, and residents in assisted living spend more time sedentary than peers who live independently. The purpose of this study was to examine the feasibility of Stand When You Can, a sedentary behavior intervention designed to encourage residents of assisted living to stand and move throughout the day without requiring structured program delivery or additional staff time. Methods : Five assisted-living residences in three provinces volunteered to use the Stand When You Can toolkit for 12 weeks. Feasibility outcomes included recruitment capability for ambassadors and participants, participant characteristics, and pre–post assessment of target outcome measures. Intervention fidelity was assessed at 6 weeks using on-site observations and informal interviews with staff and participants. Target outcomes included movement behaviors, physical function, and health status. Results : Sixty-eight older adults volunteered to participate, and a staff ambassador volunteered from each site. Only one site demonstrated good intervention fidelity by implementing a variety of different strategies to reduce sedentary time. Assessment of target outcomes was feasible, although there was significant attrition and >50% of individual participants did not complete follow-up testing at 12 weeks. Conclusion : While Stand When You Can was designed to be embedded in normal daily activities and require minimal staff time, it may not be feasible for most assisted-living residences to implement without additional staff. Significance : To help residents maintain function and quality of life, assisted-living residences must invest in adequate staff with the time and tools to promote a culture of movement.

Background and Objectives: Despite popular belief that adverse weather impacts the risk of falls, a multifactorial and leading cause of injury among older adults, this association is largely understudied. This study examined which individual characteristics are associated with increased risks of sustaining an injurious fall on snow/ice among Canadian older adults. Research Design and Methods: This cross-sectional secondary analysis used baseline data from the Canadian Longitudinal Study on Aging. Participants who retrospectively reported an injurious fall within 12 months of baseline testing were included (n = 2,587; agemean: 63.7 ± 10.4 years; 59.8% female). The main outcome was an injurious fall on snow/ice, with select sociodemographic factors as independent variables. Participants who fell on snow/ice (n = 254) were compared with those who fell elsewhere (n = 2,333) based on demographics, health, and fall injury status. Results: Participants who fell on snow/ice were younger (62.1 vs. 63.9 years; p = .006), more likely to be male (50.8% vs. 39.0%; p < .001), less likely to be retired (41.7% vs. 51.0%; p = .004), and reported fewer chronic conditions (3.5 vs. 4.1; p = .003). Logistic regression showed that men were 36% more likely to fall on snow/ice than women and that for every additional year of age, men had a reduced risk of injurious fall on snow/ice. Discussion and Implications: Middle-aged Canadian men are at higher risk for injurious falls on snow/ice. Results suggest that targeted public health guidelines may be needed for men under 65 to reduce this risk. More studies are needed to understand if this finding is generalizable to other countries with snow/ice.

Background/Objectives : Interventions targeting sedentary behavior in older adults have reported mixed success for behavior change. The previously proposed Staircase Approach offers a novel strategy to support long-term behavior change by targeting a reduction in sedentary time before progressing to increasing physical activity levels. The current study aimed to understand the perceptions of older adults, exercise/recreation professionals, and primary care providers (PCPs) about the critical components of a new intervention based on the Staircase Approach. Methods : Participants (older adults, 65+ years; PCPs; and exercise/recreation professionals) from three Canadian provinces (Alberta, Ontario, and New Brunswick), participated in semistructured focus groups. Transcripts from the sessions were analyzed using reflexive thematic analysis in the context of a previously conducted review by our team. Results : There were 17 focus groups ( n = 50): four in older adults ( n = 14), five with PCPs ( n = 14), and eight with exercise/recreation professionals ( n = 22). Participants expressed varying opinions on the components necessary for a relevant intervention. The need to embed options within the intervention, and to promote and deliver the intervention, was clear. Some themes were consistent across and within groups (e.g., simple, motivational messaging), whereas others differed (e.g., education, delivery mode, and contact). PCPs added insights about the needs of older adults who typically do not participate in research. Conclusion : Older adults have varied requirements, preferences, and skill levels that necessitate providing many options in any newly designed intervention. Significance/Implications : The intervention for the new Staircase Approach will require collaboration between multiple sectors to be successful.

Background: Zoomers in Balance is an evidence‐based fall prevention group exercise program offered for free to participants and led by peer‐volunteer leaders. Since 2009, it has been expanded to more sites, delivering to 800% more participants by adding capacity and online options. This program aims to reduce the risk of falls among adults aged 50+. To sustain and continue spreading the program as requests grow, it is crucial to understand the factors that drive success and pose challenges. Methods: Thirteen key informants (eight leaders and five key community partners involved in program delivery) participated in individual interviews examining barriers and facilitators to delivering Zoomers in Balance (the innovation). Content analysis was used to categorize participants’ barriers and facilitators into the five domains of the Consolidated Framework for Implementation Research (CFIR 2.0): intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Results: The analysis of the interviews revealed 249 factors that influenced the implementation of the Zoomers in Balance program: 150 facilitators and 99 barriers. All five domains were represented among the reported barriers and facilitators. Most perceived facilitators (55%) were from the innovation and individuals domains, while most perceived barriers (56%) were from the inner setting and implementation process domains. Interestingly, a large proportion of factors were related to the volunteer peer model for both facilitators and barriers. Conclusion: The results suggest that, while the program is highly valued by both leaders and participants, organizational capacity and implementation procedures pose significant challenges. Overall, the prominence of the volunteer peer leader model across both facilitators and barriers underscores its central role in the program. Strategies are therefore needed to support peer leaders while acknowledging the model’s limitations.

Background Although exercise is strongly recommended to prevent falls in older adults (exercise that challenges balance, performed three hours per week on an ongoing basis), few community-based programs meet these recommendations. Aims Assess the proportion of participants meeting fall prevention exercise recommendations in a community-based program and explore how adherence varies by individual characteristics and participation mode (in-person, tele-exercise, or hybrid). Methods A cross-sectional analysis of Zoomers in Balance participants who completed an online questionnaire about their demographic data, mode of participation, and their perceived balance intensity in a 12-week series using the Balance Intensity Scale (1-no effort at all to 5-maximal effort). Weekly attendance was self-reported after each 12-week series, and ongoing participation was assessed using registration data over one year. Results The average perceived balance intensity was 3.2 ± 0.7 (range 1–5), the average attendance was 1.3 ± 0.6 h/week (range 0.2–4.2), and participants attended an average of 3.4 ± 0.6 series/year (range 2–4). None of the participants met all three guidelines. The most fulfilled recommendation was ongoing participation (43%), which was greater in the hybrid (B = 2.68; p < 0.001) and tele-exercise (B = 1.28; p < 0.001) groups compared with the in-person mode. In addition, the mode of participation was associated with meeting one or more guidelines (χ² = 23.05; p < 0.001), without any significant difference between modes. Discussion Offering hybrid participation options could lead to greater adherence to evidence-based guidelines, thereby reducing the risk of falls. Conclusion The proportion of participants meeting fall prevention guidelines in a community-based program is low, with a trend indicating that hybrid options are more effective.