title: Implementing exercise programs to prevent falls: systematic descriptive review.
abstract: BACKGROUND
  The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system.
  
  
  METHODS
  Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting. We synthesized descriptive information about each program with data on program features and implementation difficulties and facilitators.
  
  
  RESULTS
  We found that programs sponsored by primary care providers (PCPs) or specialists may help with recruitment into exercise programs. PCPs have the opportunity to identify people at risk and promote participation since most older adults regularly visit, and inquire about exercise from, their physicians. In terms of referral options, both home-based and group-based exercise programs have been shown effective in preventing falls; however, each approach carries strengths and limitations. Home-based programs can include participants who are reluctant or unable to attend group classes and can be individually tailored, but provide less opportunity for supervision and socialization than classes. Adherence to programs can be encouraged, and attrition minimized, through positive reinforcement. Successful programs ranged in expense for exercise sessions: a weekly class combined with exercises at home cost < $2 per participant per week, while frequent individual sessions cost > $100 per participant per week.
  
  
  CONCLUSIONS
  With increasing attention to population-based health management in the United States, clinicians and health system leaders need a deeper understanding of how to link patients in their healthcare systems with appropriate community programs. This review identifies key characteristics of successful fall prevention exercise programs that can be used to determine which local options conform to clinical evidence. In addition, we highlight tradeoffs between program options, such as home versus group exercise programs, to allow referrals to be tailored to local conditions and patient preferences. Finally, our work highlights the key role of the PCP in recruiting patients to participate in exercise programs, and identifies options, such as registries, to support referrals to the community.
authors.affiliation: Pardee RAND Graduate School, RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA. vshier@prgs.edu.
authors.forename: Victoria
authors.identifier: http://orcid.org/0000-0001-6338-5399
authors.initials: V
authors.lastname: Shier
authors.affiliation: Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Trieu
authors.affiliation: VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, RAND Corporation, 11301 Wilshire Blvd., Building 158, Room 128, Los Angeles, CA, 90073, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
keywords: Descriptive systematic review; Exercise program; Fall prevention