Integrated exposure therapy and exercise reduces fear of falling and avoidance in older adults: A randomized pilot study

Wetherell JL, Bower ES, Johnson K, Chang DG, Ward SR, Petkus AJ.
Am J Geriatr Psychiatry, 2018 26(8):849-859. Epub 2018 Apr 12.


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.

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