A Remotely Delivered Tai Ji Quan Intervention to Reduce Incidence of Falls in High Risk Community-Dwelling Older Adults

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PROJECT SUMMARY Among persons aged 65 and older, falls are the leading cause of morbidity and mortality and impose significant social and economic burdens on community health services and healthcare systems. Although evidence shows that group-based, in-person exercise interventions improve strength, balance, and dual-task abilities and consequently directly and indirectly reduce the incidence of falls effectively in older adults, such approaches are problematic in practice because they can be costly, have limited reach, can be logistically difficult to implement, and are often not scalable or generalizable. Therefore, timely identification of alternative implementation strategies that can overcome these limitations to expand delivery of fall prevention interventions to the aging population at greatest risk for falls is of high public health importance and clinical relevance. In response to implementation challenges and community care needs in fall prevention, the primary objective of this project is to evaluate a home-based virtual fall prevention exercise intervention that eliminates common barriers to older adults participating in group-based in-person intervention programs. The proposed intervention is founded on the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program, which has been specifically reconfigured into a virtual format (V-TJQMBB) delivered through real-time videoconferencing at home. Supported by promising data on feasibility, acceptability, and demand, we propose a 6-month randomized controlled virtual trial to determine the comparative effectiveness of the V-TJQMBB intervention, relative to a virtual multimodal exercise intervention, in lowering the incidence of falls (primary outcome) and improving dual-task performance and physical and cognitive functioning (secondary outcomes) among at-risk older adults living across the U.S. We will also (a) evaluate whether the benefits of the V- TJQMBB intervention on falls can be sustained following formal training and (b) examine the mechanisms (mediators of improved dual-task cost and executive function) through which the V-TJQMBB intervention reduces fall rates. In addition, we will explore implementation potential by examining practical issues, including intervention fidelity, compliance, acceptability, and perceived burdens and benefits of online exercise. The proposed project is novel because it represents a paradigm shift in program delivery from in-person to virtual and is significant because the clinical value of many home-based fall prevention interventions remains inconclusive. If successful, the proposed study will extend the reach and impact of the evidence-based TJQMBB intervention beyond locally situated community-facility settings to home settings where access is not weather limited, transportation dependent, or geographically bounded. Thus, this proposal advances dissemination and implementation research by providing a scalable, flexible, and fiscally responsible means for sustainable fall prevention that potentially could be implemented across the country.