Fall prevention for the elderly in a long-term care institution : Development of an exercise program based on EBN

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Our aim was to develop an exercise program for fall prevention, based on evidence-based nursing (EBN), to not only increase muscle strength in the lower extremities, balance, and mobility, but also to decrease fear of falling and to increase self-efficacy for fall prevention in the elderly in a long-term care institution. We developed an exercise program which consisted of a warm-up, static stretching exercise, muscle strengthening in the lower extremities, balance training (toe training and proprioceptive neuromuscular facilitation), and a cool-down, based on EBN. The study design was a clinical trial. We developed a program through two trials. In the first trial, the 30 elderly participants who agreed to our study were divided into an intervention group of 16 people and a control group of 14 people. The length of the program was three months, and we measured muscle strength, balance, mobility, fear of falling, self efficacy for fall, and the number of falls to evaluate the effectiveness of the program. As a result, the intervention group showed increased balance and mobility and a decreased number of falls, although muscle strength and self-efficacy for fall did not increase and arm strength decreased significantly. No training-related medical problems occurred. We modified the program to increase muscle strength in the lower extremities, to increase or maintain arm strength and self efficacy for fall. In the second trial, 40 elderly participants were divided into an intervention group of 21 people and a control group of 19 people. The results showed a maintaining of arm strength and an increase of self-efficacy for fall but no increase of muscle strength in the lower extremities. In conclusion, an exercise program for fall prevention in the elderly in a long-term institution may be useful.