In February 2008 the National Institute for Public Health and Environment Research (RIVM) will launch a report concerning falls-prevention in the framework of national policy and health insurance. This report will be important for the further implementation of the In Balance program.
Falls in the aging population pose a major threat to independence, and to quality of life. The consequences of falls can be severe, including fractures, worsening of mobility, gait, and increases in the risk of mortality and morbidity. Falls in the elderly are a major health concern due to the financial impact on the public health care system.
In the year 2000 the Netherlands Institute for Sports and Physical Activity (NISB) started to develop a fall prevention program based on the therapeutic elements of T’ai Chi, that have been identified as most beneficial for elderly persons. We designed a program with a low psychological threshold because many seniors with a fall risk are rather inactive. We built a 3-phase system; the elderly can choose whether they will continue their participation after every phase. After the program there has to be continuation in regular local exercise groups with permanent attention of balance-exercises. The instructors, who were experienced in providing exercise activities for elderly people were trained in carrying out the program in a 1-day training course. Now 5 years after the design of the program it is embedded in regular activity programs in hospitals, nursing homes, welfare and care suppliers and in the national campaign FLASH! 55+. The program counted 6,500 participants at the beginning of 2008.
Results: The Free University in Amsterdam (Faber et al., 2005) did a 20-week, multicenter randomized controlled trial in 15 homes for the elderly with 278 participants with a mean age of 85 years. Positive effects of the program became apparent after 11 weeks of exercise. The program did not use exercises with a maximum intensity. The power of the program is to create a situation that can be incorporated into daily life. The "In Balance" moderately intensive group-exercise program has positive effects on falling and physical performance in prefrail elderly that can rise to over 60%. Also the feelings of the participants give us important information. People say: I’m more supple (65%), I can rise more easy from a chair (60%), my balance has been increased (40%), I feel better (38%) and my gait corrected positively (37%). 85% of participants continue the program, 50% once a week and 35% twice. The conclusion is that the high score of fall reduction compared with the effects of other effective interventions is highly promising.