Journal of Aging and Physical Activity, 2012, 20(Suppl.), S102-S201 ©2012 Human Kinetics, Inc. Wednesday 15th August 2012 Day Theme: Falls and Fractures/Balance and Bone Health Plenary Keynotes PREVENTING FALLS AND FRACTURES WITH PHYSICAL ACTIVITY AND EXERCISE Skelton, Dawn A School of Health and Life Sciences, Glasgow Caledonian University, UK. Epidemiological evidence suggests that, compared with a sedentary lifestyle, over three hours targeted exercise each week can halve the risk of osteoporosis, falls-related injuries and hip fracture. People spending less than 4 hours a day on their feet also have a greater risk of osteoporosis. To maintain healthy bone mass, three 20-30 min sessions of weight- bearing exercise each week are recommended. To reduce falls, weight bearing balance exercise is also recommended, but with the caveat of a 50 hour dose. But we know some forms of exercise, in certain groups of older people, can actually increase the risk of a fall or fracture. Brisk walking, although has many endurance benefits, is often unsafe in those with poor balance and strength. There have been literally hundreds of studies that have looked at different types of exercise, different durations or intensities, different progressions and dif- ferent frequencies per week. Do we have to exercise three times a week and are the effects better when we exercise in groups or alone? Once we are a faller or have osteoporosis, do the exercises change and does it matter who delivers them? How are we to make sense of the array of evidence and guidelines? Although this lecture cannot answer all of these, there will be some common-sense thoughts on research so far and where we can go in the future. PROMOTING AND MARKETING PHYSICAL ACTIVITY TO OLDER PEOPLE Milner, Colin CEO, International Council on Active Aging, United States. Most govemments, healthcare systems and corporations remain ill prepared for population aging. Significant gaps exist in all areas that need to be filled—gaps that provide challenges and opportunities for society. One such gap is the health and well-being of older adults. One opportunity to fill these gaps is the promotion and marketing of physical activity to the older population. However, research shows that relatively few marketers focus on the older- adult demographic, and most of those who do get a failing grade. How can this change? By attending this forward-thinking session, you will joumey into the mind of the older adult to leam about their core needs, and to better understand why current sales and marketing efforts fail to address them. In addition, you will leam how to transform your marketing S102 Wednesday 15th August S103 efforts to capture this group's hearts and minds and learn more about what it takes to make your marketing relevant to their lifestyles, capabilities, needs, dreams, aspirations and expectations, while achieving a response. Symposia OCCUPATIONAL THERAPY AND FALLS : PROMOTING ACTIVE ENGAGEMENT WITH OLDER PEOPLE IN FALLS PREVENTION Ballinger, Claire'; Clemson, Lindy^; Robertson, Kate'; Brooks, Charlotte'; Schwab, Petra" 'University of Southampton, UK; ^University of Sydney, Australia; ^University of Derby, UK; ''Akademie für Ergothérapie Wien, Austria. Elders' falls are recognised internationally as a cause of significant morbidity and mortality. Good evidence exists for multifactorial interventions, and strength and balance exercises in the prevention of falls. However, environmental and behavioural factors in the prevention of falls have, until recently, been poorly understood. Falls prevention initiatives may also be compromised by poor uptake of and adherence to interventions. Occupational therapists are well placed to work together with older people to minimise their falls risk, and optimise confidence, function, health and wellbeing. Keywords: Morbidity and Mortality; Strength; Balance; Prevention of Falls. Exploring visually impaired elders' views about occupational therapy falls prevention interventions: How focus group findings will inform the VIP2UK trial Ballinger C , Waterman H ,̂ Todd C ,̂ Skelton D', Brundle C ,̂ Stanford P2, McEvoy U 'University of Southampton UK; ^University of Manchester, UK; ^Glasgow Caledonian University, UK Visual impairment is a risk factor for falls. The 'VIP' trial (Campbell et al 2005) evaluated the effectiveness of a home safety intervention and an exercise programme in preventing falls among older people with visual impairment. Although fewer participants randomised to the home safety arm of the trial experienced a fall, adherence to both interventions was sub-optimal. This paper reports on research exploring visually impaired elders' views about falls prevention, with the aim of enhancing uptake and adherence within the VIP2UK trial. Four focus groups were held with older people and their carers, and two with health care professionals (HCPs). Individual interviews were carried out with nine people in their homes, and with an additional two HCPs. Barriers to uptake and adherence included potential stigma, lack of perceived risk, poor HCP education around visual impairment and inap- propriate supporting written material. Enablers included careful and sensitive explanation, peer acceptability, demonstration and appropriate supporting material, individually tailored interventions and the involvement of carers. We will discuss the implications of these find- ings for the two occupational therapy interventions to be delivered in the VIP2UK trial (home safety and exercise), and also how the trial peer mentors might use this information. Reference: Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, Jacobs RJ, Sharp DM, Hale LA (2005) Randomised controlled trial of prevention of falls in people aged >75 with severe visual impairment: the VIP trial British Medical Journal 331,817-20. S104 World Congress Abstracts The design, development and application of LiFE, the Lifestyle-integrated Functional Exercise program to reduce falls in older people Clemson, Lindy. Ageing, Work & Health Research Unit, The University of Sydney, Australia. In the LiFE approach balance and strength activities are individually tailored for the older person and embedded within their daily routines. It involves changing everyday habits and draws on concepts of self-efficacy to prescribe and teach an individualised tailored program. A nationally funded randomized trial, led by Clemson, dgorously examined the efficacy of this novel approach to falls prevention. It was proven to significantly reduce falls and to have very positive and significant functional outcomes for older at-dsk community resid- ing older people. Lii^E expands our knowledge about the role of functional balance and strength activities in falls prevention. It provides another exercise choice that can be taught by occupational therapists and physiotherapists. There are positive outcomes that can be marketed to potential participants: having enhanced energy to do more, improved function in doing activities and enhanced participation in daily life. LiFE has the potential to chal- lenge and to expand our home visit focus working with older people to find opportunities to incorporate balance and strength training into daily life. The presentation will discuss the design, development and explore the application of the program to current practice. It will conclude with an outline of future research plans. Thinking falls, taking action: Development of the Guide to Action for Falls Prevention Tools Robertson, Kate. County Health Partnerships, Nottinghamshire, UK. Background: We developed a multiagency tool for use with community dwelling older people which highlights falls dsk factors for the individual and suggests actions to take to reduce falls. This tool was then adapted for use within a care home setting. Methods: The Guide to Action for Falls Prevention Tools was developed through an iterative process by a team of clinicians, academics, older people and carers. Appraisal of evidence of dsk fac- tors for falling in older people and successful interventions to reduce faUs was completed. The Tools were developed, tdalled and embedded in clinical practice. Results: Audit of the community based tool showed it was easy to use, highlighted previously unrecognised falls risk factors but required clinicians to be trained in its use to be most effective. A study of the use of the Care Homes Tool showed it was quick and easy to use and acceptable to care home staff, increased understanding of falls dsks and actions to reduce falls and that training in the tool's use improved implementation within care home settings. The readability of English language falls prevention websites aimed at the public Brooks, Charlotte; Ballinger, Claire; Adams Jo; Nutbeam, Don. University of Southampton, UK. Background: Low literacy levels are associated with poor health outcomes and increasing age (1,2). Older people are increasingly accessing the internet for health-related matedals (3). Previous studies have explored the quality and representations of old age in falls preven- tion websites (4,5). However, no other literature has been identified assessing the readability of such websites. Objective: To evaluate the literacy levels of frequently accessed English Wednesday 15th August S105 language falls prevention websites offering advice on falls risk and prevention for the public. Methods: Websites will be searched for using the strategy previously employed in both a systematic-style review and a qualitative analysis of falls prevention websites. Fifty-four searches will be implemented on three search engines. The reading grade level of text selected from the websites will be established using the standardised Gunning -FOG and Simple Measure of Gobbledygook formulas. Findings: Preliminary findings indicate the websites are not reaching recommended literacy levels for health education material. Conclusion I Impact: If falls prevention websites are not accessible or understandable to individuals with lower literacy levels, current government initiatives to increase patient control may result in widening healthcare inequalities. References: 1. Dewalt D, Berkman N, Sheridan S, Lohr K and Pignone M (2004) Literacy and health outcomes: a systematic review of the hterature. Journal of General Internal Medicine 19(12): 1228-39; 2. Von Wagner C, Knight K, Steptoe A and Wardle J (2007) Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology and Community Health 61(12): 1086-90; 3. Office for National Statistics (2008) Internet access 2008; households and individuals. Newport: ONS; 4. Nyman S, Hogarth H, Ballinger C and Victor C (2011) Representations of old age in falls prevention websites: Implications for likely uptake of advice by older people British Journal of Occupational Therapy 74(8):366-74; 5. Whitehead S, Skelton D and Todd C (2012) The quality of websites offering falls related advice to older members of the public and their families: a systematic style review. Health Informatics Journal 18 (1): 50-65. Fall prevention—A matter of balance: Experiences of occupational therapists concern- ing fall prevention for community-dwelling elderly Schwab, Petra. Section Occupational Therapy, University of Applied Sciences, Vienna, Austria. Background/Aim: Given the aging population and falls as challenge to individuals and soci- ety, the area of working with community-dwelling elderly people will expand in the future. In consideration of the societal importance of falls and the lack of knowledge concerning the Austrian situation of occupational therapy fall-prevention, this study aims to explore how Austrian occupational therapists experience the current practice of fall-prevention interven- tion for community-dwelling elderiy people. Method: For this study, a grounded theory approach was used. Focus group and single-in-depth interviews with in total seven occupa- tional therapists from a major city in Austria were conducted. All participants had experi- ence of 10 - 25 years working within the field of fall prevention with community-dwelling elderly. Findings: 'Balancing autonomy and safety' was found to be the core-category and OTs central concern in fall-prevention. To keep the balance between autonomy and safety 'balancing responsibilities' emerged to be the second major category accompanied by 'managing various OT roles ', 'affecting client's habits and values ' and 'balancing the roles of relatives'. Conclusion: Occupational therapists experienced fall-prevention as a highly challenging matter of balancing autonomy and safety. A client-centred approach is suggested to achieve successful fall-prevention which aims as much on client's autonomy as on safety. IDENTIFYING AND ADDRESSING FEAR OF FALLING IN HIP FRACTURE PATIENTS: PRELIMINARY RESULTS OF A MULTIFACTORIAL INTERVENTION Pfeiffer, Klaus'; Kuepper, Michaela'; Stranzinger, Karin'; Klein, Diana'; Becker, Clemens'; Hautzinger, Martin^ S106 World Congress Abstracts 'Robert-Bosch-Krankenhaus, Stuttgart, Germany; ̂ Psychologisches Institut der Universität Tübingen, Germany. Hip fractures cU'e one of the most serious consequences of a fall and a high risk for becoming community immobile and functionally dependent. There is some evidence that fear of fall- ing (FoF), self-efficacy and perceived control are important psychological variables in the recovery from hip fracture. In contrast to interventions for community-residing older people, there is little knowledge about sensitive screenings and cognitive behavioural interventions targeting such psychological variables during inpatient rehabilitation. Based on the Short Falls Efficacy Scale International (FES-I) a set with 16 icon cards including less demanding activities (e.g. transfer situations) was developed. Together with single questions on fall- related post-traumatic stress and fears of future falls the icon set are part of the FoF screening. This approach will be discussed in regard to the clinical judgment of physiotherapists, the patient's experience of the injurious fall and psychological variables like anxiety control and psychological flexibility. Based on a theoretical framework a multifactorial intervention to improve physical activity and falls efficacy was developed. Six components (1. relaxation techniques, 2. mobility goals, 3. falls-related cognitions and emotions, critical situations, 4. individual physical exercise programme for home-based training of strength and bal- ance plus functional floor exercises if feasible, 5. implementation of physical exercises and activities into daily life, 6. fall hazards) are delivered by physiotherapists in 8 face-to-face sessions during rehabilitation plus 4 telephone contacts and one home visit after discharge. The goals of the components, the impact of the psychological supervision, first results and patient examples of the ongoing randomized controlled trial will be presented. Keywords: Fear of Falling; Hip Fractures; Fall Risk; Multifactorial Intervention. AGEUK FALLS AWARENESS WEEK Mitchell, Michelle'; Charters, Amy'; Mamon, ZuF; Redhead, Ruth'. 'AgeUK UK; ^ Avicenna, UK; ' Central London Community Healthcare NHS Trust, UK. Falls Awareness Week was originally set up in 2005 to provide a focus for local action and encourage organisations working with older people to organise events to raise awareness of the practical ways to reduce the risk of falls. This symposium will give an overview of the last eight years and present some of the highlights to demonstrate the impact of a coordinated local and national approach to raising awareness and reducing falls. It will include the follow- ing sessions with allocated time for questions at the end of the symposium. Introduction: A background to the campaign, including: Why do we do it?; Background to the issue of falls; Putting policy & research into practice: engaging with older people and delivering effective health promotion; What does it achieve?; Reach: media coverage, participants; Partnerships/ ongoing programmes of work; How do we do it?; Using different themes: from pavements to vision. The following three 'case studies' will be presented as examples of FAW events and initiatives that can lead on to ongoing programmes of work and local partnerships. 1. The role of pharmacists in falls prevention (Zul Mamon, Avicenna). This session will focus on the pharmacy campaign run by Avicenna pharmacy group to enable their members to identify older people at risk from falls and ensure appropriate signposting for effective treatment and rehabilitation. During Falls Awareness Week 2010 Avicenna members were invited to take part in a specially devised training programme, encompassing osteoporotic treatments, medicines and combinations of medicines linked to falls, and put this to use with the Falls Risk Assessment Tool to reduce falls among individual older people. In addition to training and guidance for members, the group produced additional materials for use in Wednesday 15th August S107 ongoing awareness raising, including leaflets and home safety checklists, as well as links to local community services, NHS falls prevention teams and voluntary sector services. Outcomes from one participating pharmacy included: 26 FRAT assessments conducted; 18 Medicine Use Reviews conducted; six patient referrals to optometrist; one patient referral to GP; postural hypotension found in three patients; eight patients recommended calcium and vitamin D supplements. 1. The voluntary sector perspective. The session will include an example from an AgeUK event at this year's Falls Awareness Week to highlight the issue of falls and bone health. 3.'On the Buses': working with local bus companies. This session will highlight the work conducted by Central London Community Healthcare NHS Trust to raise awareness of the risks of falls on buses, including activities that were run on Falls awareness Day in 2009 to educate bus drivers and bus company managers about falls and their impact on older people, as well as those that were targeted towards older bus users. The session will also showcase the work done by CLCH, Help the Aged and First Group in producing safety information and materials for older passengers, including a Safe Joumey card, and follow-up work with local councils and Transport for London to raise awareness among Freedom Pass holders, and introduce a component on falls within ongoing training for bus drivers. Keywords: Falls Awareness; Charity; Reduction of Risk of Falls; Training of Professionals. ENHANCING PARTICIPATION IN EXERCISE INTERVENTIONS FOR THE PREVENTION OF FALLS Nyman, Samuel R'; Tiedemann, Anne^; Campbell, John'; Rose, Debbie"* 'Bournemouth University, UK; ^The George Institute, Australia; ^University of Otago, New Zealand; ''California State University, United States. Falls are recognised around the world as a major cause of morbidity and mortality among older people. Exercise interventions are proven to prevent falls, yet sedentary activity is prevalent among older people. The aim of this symposium is to stimulate discussion of the potential factors that might enhance participation among older people. Current evidence on older people's participation in exercise interventions for the prevention of falls Nyman, Samuel R'; Victor, Christina R̂ 'Bournemouth University, UK; ^Brunei University, UK. Rationale: Low uptake and adherence from participants can threaten the effectiveness of interventions, but little is known about the issue in regard to falls prevention. Therefore, we conducted a review to collate the evidence on older people's participation and engagement in falls prevention trials with an emphasis on exercise interventions. Method: A recent authoritative Cochrane systematic review evaluated interventions to prevent falls among older people in the community (Gillespie et al., 2009). We supplemented this review by re-analysing the single and multi-factorial randomised controlled trials (RCTs) (n = 99) on four outcome variables: 1) recruitment into the RCT, 2) attrition from the RCT at 12 months, 3) adherence to the intervention, and 4) any tests for whether adherence moderated the effect of the intervention on falls. Descriptive statistics were conducted using medians, ranges, and interquartile ranges. Results: The average recruitment rate into the RCTs was high (median = 70.7%, range 64.2-81.7%), and the average attrition rate at 12 months (excluding mortality) was low (median = 9.3%, range = 7.5-10.8%). Exercise interventions S108 World Congress Abstracts had the lowest recruitment rate (64.2%), but a very low attrition rate at 12 months (median = 8.0%). Adherence rates were -80% for vitamin D/calcium supplementation; -70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally -75% but ranged 28-95% for individual components. Moderator analyses were tested in 13 studies that had mixed results, with five exercise interventions reporting non-significant moderator effects of adherence on trial outcomes. Conclusion: Using median rates for recruitment (64%), attri- tion (10%), and adherence (52-70%), we estimate that, at 12 months, on average 30-40% of community-dwelling older people are likely to be adhering to exercise interventions for the prevention of falls. Predictors of exercise adherence among community-dwelling older people Tiedemann, Anne; Sherrington, Catherine; Lord, Stephen R. The George Institute, Australia. Background: It is widely acknowledged that physical activity has wide-ranging benefits for the health and well-being of people of all ages. In older people in particular, there is clear evidence that structured exercise can prevent falls (Gillespie, et al. 2009). However, a major limitation of physical activity and exercise as a public health intervention is low rates of participation. Objective: This study aimed to identify physiological, psychological, health and lifestyle factors associated with poor exercise adherence in retirement village residents. Methods: The study involved 344 people, aged 62 years and over who participated in a falls- prevention exercise program in Sydney, Australia. 163 low adherers (those who attended less than 30% of exercise classes over a six-month period) were compared to the rest of the sample. Results: Several baseline measures of balance, cognition, walking speed and health and mobility were impaired in the low adherers compared to the rest of the sample. Logistic regression analysis identified three variables: postural instability (OR = 1.83, 95% CI 1.17-2.87), taking four or more medications (OR = 1.75,95%CI 1.12-2.73) and poor Mini Mental State Examination (MMSE) score (OR = 1.79, 95% CI 1.14-2.80), as significant, independent predictors of poor adherence. The area under the curve (AUC) for this model was 0.64 (95% CI 0.58 to 0.70), bootstrap-corrected AUC = 0.64. Conclusion: Logistic regression modelling identified postural instability, polypharmacy and poor cognition as the most significant independent predictors of poor exercise adherence. These findings may assist in the development of pre-exercise screening techniques that could be used in public health programs. References: Gillespie LD, Robertson MC, et al. 2009. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews: Issue 2. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub2. Barriers to Otago exercise participation among older people with visual impairment Campbell, John University of Otago, New Zealand. Fall prevention exercise programmes need to be maintained for continued effectiveness and this may be more difficult than usual for those with disability. In a trial of an exercise programme, proven to reduce falls when used in older people with normal sight, we found no significant reduction in falls in those with severe visual impairment in the intention to Wednesday 15th August S109 treat analysis. There are a number of possible reasons for this but lack of adherence to the programme contributed. Those who carried out the exercise programme regularly had a significant reduction in falls compared with those who did not exercise regularly. Those with severe visual impairment may not consider that they are able to take regular exercise and may be especially concerned about the safety of any programme. Modifications may need to be made to a programme proven to be of value in those with normal sight. For example, if an outside walking schedule is part of a programme it may not be safe and need to be modified or omitted. The information about the programme and instructions for each exercise may need to be given by audiotape. All illustrations need to be simple, and clearer than usual. The instructor overseeing the person's programme should look for a suitable and safe place within the home for the person to carry out the exercises. Initial participation in groups may increase confidence. Involvement of special organisations such as the Royal Foundation of the Blind may help with the establishment of groups and provide assistance and encouragement to continue the programme at home. Families also can be very helpful in providing initial support and reinforcing the need for continuation. Intercurrent illness or injury is a common reason for stopping participation in any exercise programme for older people. People with impaired sight are at greater risk of falls and injury and processes need to be in place to reassess and restart the programme when it has been discontinued for a period for health reasons. Maximising uptake and adherence when implementing an exercise intervention to prevent falls Rose, Debbie California State University, United States. The development of a broad continuum of fall risk reduction programs that address the needs of older adults at different levels of fall dsk are becoming increasingly important as the older adult segment of the population worldwide continues to rapidly expand. Multi- component exercise interventions have been particularly effective in lowering fall dsk and/or fall incidence rates in the short-term (Gillespie et al., 2009). When designing these types of interventions, however, it is important to consider the factors that influence client uptake and adherence, both dudng and after the acute phase of the program ends. To date, very little fall-dsk-reduction research has systematically included any strategies designed to effect long-term changes in behaviour and compliance with recommended fall preven- tion activities. Recommended strategies for increasing uptake include matching the needs, preferences, and capabilities of the older adult to the intervention, promoting the specific benefits of an intervention relative to improving balance and reducing fall risk, and fostedng self-management skills by having the participant take an active versus passive role in the intervention process. Ascertaining the behavioural readiness of potential enroUees is also central to facilitating uptake. Patient activation and/or profiling tools have been success- fully used in health behaviour research to better match clients to a particular intervention. Systematically including strategies aimed at changing attitudes and actual behaviours that contribute to heightened fall risk are important for achieving long-term engagement in physical activity and other supportive fall-dsk-reduction behaviours (e.g., modifying the home and immediate environment for added safety, getting regular vision and headng check-ups, eliminating dsky behaviours). Finally, designing a step-down approach aimed at fostering the older adults self-direction and management of risk following the acute phase of the intervention has also been shown to foster long-term adherence. Examples of effec- S110 World Congress Abstracts tive methods used to foster regular engagement in physical activity and/or the adoption of protective behaviours include post-program social support groups, and/or scheduling of in-person refresher training sessions, and telephone counselling. CULTURE, ETHNICITY & PHYSICAL ACTIVITY: PROMOTING ACTIVE AGEING IN OLDER PEOPLE FROM BLACK & MINORITY ETHNIC GROUPS Home, Maria'; Cacchione, Pamela^; Horton, Khim' 'University of Manchester, UK; 'University of Pennsylvania, United States; ^University of Surrey, UK. Increasing physical activity (PA) levels in older adult's remains an intemational concem of health policy (WHO, 2010). Levels of physical activity decrease with increasing age among all groups of older adults, but higher rates of inactivity are seen among Black and Minority Ethnic (BME) groups across the world. Ethnicity and culture may affect attitudes towards and participation in exercise and PA. This symposium focuses on the influence of culture and ethnicity on exercise and PA uptake and adherence. The symposium explores key issues and challenges concemed with older adults' experiences and factors influencing exercise and PA uptake and adherence among BME groups. The symposium will conclude by drawing together issues, implications and recommendations for practice, research and policy. Reference: World Health Organization (2010). Global recommendations for physical activity and health. Geneva: World Health Organization. Attitudes and beliefs associated with uptake and maintenance of physical activity among South Asian older adults aged 60-70 Home, Maria University of Manchester, UK. Background: Sedentary behaviour among South Asian (SA) older adults is common, with only 11% of SA men and 8% of SA women aged 55 years and over in the UK meeting the recorrmiended levels for physical activity (PA) (Sproston & Mindell 2006). At the same time these individuals experience greater levels of heart disease, stroke and type-2 diabetes; conditions that can be prevented or improved through regular participation in PA (Gill et al., 2007). This presentation reports on research undertaken to identify attitudes and beliefs associated with the uptake and maintenance of PA among SA older adults aged 60-70 to inform our understanding of how PA programmes could be designed and presented to motivate SA older adults to take up and adhere to a regular PA programme. Method: An exploratory qualitative approach was utilized using five focus groups (n = 29) and 17 in-depth interviews were conducted to explore the motivational factors associated with initiating and maintain- ing PA among SA older adults. Data analysis followed the framework approach. Findings: Health, maintaining independence, and social support were important in terms of initiating PA activity, whereas social support, psychosocial elements of activity, health and integrating physical activity within everyday activities were important for adherence. Gendered physical activity sessions were important to initiating exercise among Muslim South Asian 60-70 year-olds. Conclusions: Building PA in and around day-to-day activities and promoting active lifestyles are important strategies to increasing activity levels. Culturally appropriate facilities and peer mentors, who could assist those with language barriers, specific tailored advice and general social support, could promote uptake and subsequent adherence among this population group. References: Gill PS, Kai J, Bhopal RS, Wild S. (2007). Health Care Wednesday 15th August Sil l Needs Assessment of Black and Minority Ethnic Groups. In: Stevens A, Raftery J, Mant J, Simpson S (Eds). The Epidemiologically Based Health Needs Assessment Reviews. London: Radcliffe. Sproston, K. & Mindell, J. (Eds) (2006). Health Survey of England 2004: The health of minority ethnic groups. London: Information Centre. Living Independently for Elders: Increasing physical activity for nursing home eligible urban African Americans Cacchione, Pamela University of Pennsylvania, United States. Background: Living Independently for Elders (LIFE) at the University of Pennsylvania (UPenn) is an academic nurse run community based long-term care practice. The focus of this interdisciplinary practice is to prevent institutionalization in community dwelling frail older adults who qualify for nursing home placement. This practice serves dual eligible older adults who are covered by Medicaid (State) and Medicare (Federal) insurance. LIFE UPenn is both the members' provider and insurer. Project: The LIFE UPenn program currently has 430 members age 55+, 95% of whom are African American with 5 or more chronic illnesses. Urban African American typically have low vitamin D levels which impacts not only their bones but their mobility (Wilkins et al. 2009).This population is already frail, predispos- ing them to increased vulnerability, poorer health outcomes, institutionalization and death (Lang et al. 2009). Engaging this population in PA is essential in maintaining them in the community (Duru et al. 2010). The LIFE UPenn day center provides an interdisciplinary setting to engage the members in physical activities (Sullivan-Marx et al., 2010). Mem- bers of LIFE UPenn are assigned to Nurse Practitioner led teams. Each team consists of a physical, occupational and recreational therapist, primary nurse, physician, social worker and a consulting nurse practitioner who focuses on mental health of the members. The team focuses is on keeping members well enough to live in the community which includes keeping them physically active. Discussion: This presentation will describe the success- ful interdisciplinary programs used to facilitate increased physical activity and discuss the techniques used to motivate and increase engagement and adherence to physical activity programs e.g. Vitamin D repletion, structured walking programs, fall reduction program and innovative recreational therapy including Tai Chi, line dancing and movement therapy. Successful techniques to increase engagement and adherence to PA programs will also be described, such as identifying and training African American caregiver staff to champion activity and motivate members to participate and receiving guidance from the Council of Elders to identify culturally appropriate PA programs for the Members (Sullivan- Marx et al. 2011). References: Duru, C.K., Sarkisian, CA., Leng, M., Mangione, CM. (2010). Sisters in motion: A randomized controlled trial of a faith-based physical activity intervention. Journal of the American Geriatrics Society, 58, 1863-1869; Sullivan-Marx, EM, Bradway, C, Bamsteiner, J. (2010). Innovative collaboration: A case study for academic owned nurs- ing practice. Journal of Nursing Scholarship. 42(1), 50-57; Sullivan-Marx, EM, Mangione, KK, Ackerson, T., Sidorove, I., Mailin, G.G., Volpe, S., Craik, R. (2011); Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program. Gerontologist, 51, Suppl. 1:S73-81. Active ageing and fall prevention among older Chinese people Horton, Khim University of Surrey, UK. S112 World Congress Abstracts Background: To promote active ageing cultural awareness is needed since culture influ- ences how people understand and interpret their experiences and how they respond to active ageing (Horton & Dickinson, 2011). Ethnicity and culture may affect attitudes towards and participation in exercise and fall prevention strategies although there is little understanding of this influence (Horton & Dickinson, 2011 ; Home et al., 2009). This presentation aims to report on research undertaken to explore the perceptions of older Chinese people in rela- tion to falls and fear of falling, and the barriers and facilitators identified to taking up fall prevention interventions (Horton & Dickinson, 2011). Method: Grounded Theory approach with a purposive sample of 30 Chinese older people (9 men and 21 women) who attended Tai Chi classes, two focus groups with ten people in each and ten face-to-face in-depth interviews were conducted in Mandarin or Cantonese. Interview transcripts, back translated were analysed using constant comparative analysis. Findings: A range of health-seeking behaviours were identified following a fall. Chinese culture, rooted in the beliefs and prac- tices of the Chinese philosophical assumptions about health, illness and healing, and their acquired ways of coping with the experience of falls influenced Chinese older people's decisions to taking up fall prevention interventions. Although the family is still regarded as the comerstone of their society they remain fairly conservative in clinging to the 'social' aspect traditional Chinese society as cultural intergenerational relations had an impact on taking actions to prevent falls and whether or not to take up Tai Chi as a 'Chinese' option. Conclusion: Cultural diversity affects Chinese older adults' acceptance of fall prevention interventions. References: Home, M., Speed S., Skelton D. & Todd C. (2009). What do community dwelling Caucasian and South Asian 60-70 year olds think about exercise for fall prevention? Age and Ageing, 38 (1): 68-73; Horton, K. & Dickinson, A. (2011). The Role of Culture and Diversity in the Prevention of Falls among Older Chinese People. Canadian Joumal of Ageing, 30; 1: 57-66. FALLS, FALL PREVENTION AND PHYSICAL ACTIVITY IN OLDER PEOPLE WITH INTELLECTUAL DISABILITIES Freiberger, Ellen'; Finlayson, Janet^; Carmeli, Eli'; Salb, Johannes' 'University of Erlangen, Nuremberg, Germany; ^Glasgow Caledonian University, UK; ^Tel Aviv University, Israel. People with intellectual disabilities have different pattems of health when compared with the general population, and can experience health inequalities. They have higher rates of mortality compared to the general population, although life expectancy is increasing (1). As longev- ity increases for people with intellectual disabilities, promoting healthy and active ageing becomes even more important. Falls are a recognised problem for people with intellectual disabilities. Previous research has demonstrated that adults with intellectual disabilities expe- rience high rates of falls, which are similar to those of older adults in the general population (2,3), but they are experiencing falls at a younger age3. Despite this however, there has been little or no investment to date, in developing falls assessment or prevention strategies for people with intellectual disabilities. The purpose of this symposium is to present an overview of falls experienced by people with intellectual disabilities, including risk factors identified for falls, with a view to drawing on the expertise and good practice guidelines of researchers working with older adults to prevent falls; to develop falls assessment and falls prevention strategies which are tailored for people with intellectual disabilities. Physical activity and exercise interventions will be presented and considered in relation to this topic, as part of healthy and active ageing (4,5). References: 1. Emerson et al. (2012) Health Inequalities & Wednesday 15th August S113 People with Learning Disabilities in the UK: 2011. Improving Health and Lives: Learning Disabilities Observatory: Durham, UK; 2. Finlayson et al. (2010) Injuries, falls and accidents among adults with intellectual disabilities: Prospective cohort study. Journal of Intellectual Disability Research 54 (11): 966-980 ; 3. Cox et al. (2010) Incidence of and risk factors for falls among adults with intellectual disability. Journal of Intellectual Disability Research 54 (12): 1045-1057; 4. Carmeli et al. (2005) Can physical training have an effect on well- being in adults with mild intellectual disability. Mechanisms of Ageing and Development 126: 299-304; 5. Carmeli et al. (2008) Perceptual-motor coordination in persons with mild intellectual disability. Disability & Rehabilitation 30 (5): 323-329. Preventing falls and promoting physical activity in people with intellectual disabilities Finlayson, Janet Glasgow Caledonian University, UK. Background: People with intellectual disabilities (IDs) have different patterns of health and experience some health problems more commonly when compared with the general popula- tion. Previous research has demonstrated that adults with IDs high rates of falls, which are similar to those of older adults in the general population, but they are experiencing falls at a younger age. In addition, previous research has also demonstrated that adults with IDs are more likely to have low patterns of regular physical activity (PA), that are similar to those found in sedentary adults who do not have intellectual disabilities in the general popula- tion. Aim: The aim of this research was to investigate the incidence of falls in a population and community-based cohort of adults with IDs, and to identify risk factors for i) falls/fall injury, and ii) low levels of PA. Participants and Methods: Interviews were conducted with 511 adults with IDs and their carers who live in Glasgow, UK at time 1 (baseline), and at time 2 (two-year follow up). Self/proxy-reported data was collected on falls/fall injuries experienced over the previous 12 months, and PA undertaken in a typical week. Results: 40.1% (205) adults experienced at least one fall in the previous 12 months, and incident injury due to falls was 12.1% (62). Independently predictive risk factors for incident fall injury were epilepsy (epilepsy-related included), and urinary incontinence and not having Down syndrome (epilepsy-related excluded). Only 150 (34.6% of 433) undertook any regular physical activity of at least moderate intensity. Older age, having immobility, epilepsy, no daytime opportunities, living in congregate care and faecal incontinence were independently predictive of low levels of PA. Conclusion: Adults with IDs require tailored strategies and interventions for preventing falls and promoting PA. As longevity increases for adults with IDs, promoting healthy and active ageing becomes increasingly important. Keywords: Falls Prevention; Physical Activity; Risk Factors; Healthy Active Ageing. Physical exercises to improve strength, balance and coordination in older adults with intellectual disabilities Carmeli, Elie Tel Aviv University, Israel. Background: Older adults with intellectual disability (ID) are often physically inactive and frequently show signs of 'premature aging', with a greater tendency towards de-conditioning and morbidity. The causal influences and possible barriers to participation in physical exer- cises (PE) may be related to lack of PE appreciation on one hand, and on the other hand lack of caregiver support and difficulty finding experienced personnel to train them. There S114 World Congress Abstracts is a strong correlation between low muscle strength, poor balance and physical inability in activities of daily living and well-being. The aim of the study was to investigate the effect of PE on balance, coordination, strength, and general well-being in adult people with ID. Participants & Methods: The target population comprised of persons with ID who were the permanent care center resident, and aged 50 or older. Mobility and balance tests were measured by a Timed Get-up and Go test and Beam forward walking, and Posture Scale Analyzer system used to examine postural stability; Seven sensory-motor tasks included elements of hand-eye coordination; Knee muscles strength were measured on a Biodex dynamometer; The self-concept of well-being was measured by direct interview with a questionnaire consisting of 37 structural statements. Intervention: PE program was conducted four times a week for six consecutive months: twice a week treadmill walking or biking, and twice a week general exercises including ball games and dancing. Results: Six months of PE significantly improved balance, coordination, muscle strength, and well-being among older adults with ID. Fall prevention in people with intellectual disability: Pilot risk assessment study Salb, Johannes'; Freiberger, Ellen'; Becker, Clemens^ 'University of Erlangen, Nuremberg, Germany; ^Robert Bosch Krankenhaus, Stuttgart, Germany. Introduction: In people with intellectual disabilities (ID) falls are a threat for the functional status and quality of live. Compared to older persons the consequences are similarly multi- factorial. As some research has indicated [1], there can be more injudes, higher costs for the health system, reduced physical activity, additional workload for staff members and increased fear of falling. But in depth information regarding the number and frequency of falls are rare. This is in contrast to the scientific expertise on falls in older people, living in a nursing home or independently at home. In addition information on fall dsk factors, possible assessment tools for risk factors, and designs as well as effects of a multifactodal interven- tion for fall prevention is lacking. Because of this deficit, our study is focused on obtaining and defining dsk factors in people with ID. Furthermore information on the circumstances and consequences of a fall are gathered. In addition the study analyses the adaptability and reliability of approved assessment tools in persons with ID to screen for dsk of falling. Assessment Tools: The Timed „Up and Go" Test, Chair-Stand and Romberg-Balance-Test are very well known for assessing fall dsk in older people in the general population. These tests have already been used to measure strength, balance and complex movement in people with intellectual disability. But little is known about the feasibility of these assessment-tools in the ID-population or even the reliability and interrater-reliability. In a pilot-study, we focus on the adaptability and reliability of these approved assessment tools. Setting and Sample: Study will take place in a special residential institution for people with ID. More than 200 residents are living there, with different grades of ID, and support needed. Two-thirds are female and the mean age is 54.11 years. Development of a physical activity based intervention (PrefalllD) Freiberger, Ellen'; Salb, Johannes'; Becker, Clemens^ 'University of Erlangen, Nuremberg, Germany; ^Robert Bosch Krankenhaus, Stuttgart, Germany. Wednesday 15th August S115 In people with intellectual disabilities (ID) falls are a threat for the functional status and quality of live. Compared to older persons the consequences are similarly multi-factorial. In contrast to fall prevention research in community-dwelling older persons or in nursing homes settings, knowledge and evidence for appropriate interventions are rare and missing. In a recent review on balance and gait capacities in persons with ID, it has been demonstrated that due to delayed balance and gait capacities in the developmental process persons with ID start on a lower functional balance and gait level. But these are the limiting factors - among others - for mobility and fall risk, and therefore it seems mandatory to address both, balance and gait, in a physical activity based intervention. In addition, this approach is in line with evidence of exercise intervention in community-dwelling older persons. Some research has already been done to investigate the trainability of both balance and gait in persons with ID but the evidence is weak. Due to the multifactorial nature of falls in persons with ID, physical activity based intervention have to target other domains as well. This approach is nested in the model of the ICF, and taking into account the personal factors e.g. motivation for physical activity also in account as environmental factors (accessibility of gymnastic rooms). The presentation will outline first planning and structuring a physical activity based exercise program in persons aged 18 and older with ID. THE PROACT65+ EXERCISE TRIAL SYMPOSIUM: AN OVERVIEW, PRACTICAL IMPLICATIONS AND LESSONS LEARNED Iliffe, Steve'; Haworth, Deborah'; Stevens, Zoe'; Barlow, Cate'; Gawler, Sheena'; Pearl, Mirilee'; Belcher, Carolyn'; Gage, Heather^; Carpenter, Hannah'; Kendrick, Denise3; Dinan- Young, Susie'; Bowling, Ann"*; Masud, Tahir^; Skelton, Dawn A* 'Royal Free arul University College Medical School, UK; 'University of Surrey, UK; ^The University of Nottingham, UK; ''Southampton University; ^Nottingham University Hospitals NHS Trust, UK; ^Glasgow Caledonian University, UK. Background: The ProAct65+ Trial is a multi-centre cluster randomised controlled trial com- paring two exercise interventions, the Otago home based exercise programme (OEP), and, the Falls Management Exercise (FaME) programme, with a control group, in patients aged 65 and over in primary care. The study has recruited a total of 1256 participants through GP practices in London and Nottingham/Derby. Aims: To give an overview of the ProAct65+ Trial and how it has worked in practice and the lessons that have been leamed from con- ducting the research and how these may be applied to its practical implication in "the real world." Method: After a brief overview of the study, the symposium will be divided into four presentations and conclude with a group discussion. 1 : The Interventions: a discussion of the home and community based exercise programmes, how these have worked in practice, the challenges that have been faced and the quality assurance techniques that have been utilised. 2: Participant Recruitment and characterisation: how do we get GPs and participanis to join an exercise promotion trial run through general practice and what are the people like who do join? 3: Money Matters: what financial costs are associated with running a trial like this and how does this relate to the "real world"? 4: Safety Issues: how have we ensured that people who have participated in the trial have stayed safe and how have we dealt with any safety issues or concems that we have come across. S116 World Congress Abstracts Recording adverse events for a complex intervention such as exercise in older people: How can we achieve consistency? Belcher, Carolyn on behalf of the ProAct65+ team Introduction: An adverse event (AE) is any unfavourable and unintended sign, symptom, syndrome or illness that develops or worsens during a period of observation in a trial. Adverse events were recorded from participants taking part the ProAct65+ trial. This was especially important since exercise within this age group may be associated with an increased risk of AEs, particularly falls. All AEs were assessed for seriousness and causality. If a non-serious AE was judged to be possibly, probably or definitely related to the trial, this was recorded as an Adverse Reaction. A system of comparing results, for improved consistency, between the two participating centres was developed and modified. Methods: AEs were recorded in a several ways. Participants were questioned about possible AEs at follow-up appointments through falls and health-service-utilization diaries throughout the trial; and during telephone physi- cal activity questionnaires. If insufficient information was included in diaries a researcher collected those details by telephone. As a measure of consistency, blinded AE forms were exchanged between the two centres and graded. Mismatches between sites were identified, and blinded forms then passed to the principal investigators who agreed a final category. Results: An initial comparison of 269 AEs showed a mismatch of 19% with the category of "possibly related" being open to subjective interpretation. As a result of these findings, a category of Possible Adverse Reaction was introduced. The mismatch rate in subsequent comparisons went down to less than 6%. Conclusion: Researchers on complex intervention trials need to set up a well-defined system of AE reporting which allows for consistency checking. Results from early comparisons can be used to modify categories if necessary. Working with volunteer peer mentors and paid professional exercise instructors in a trial of exercise interventions Stevens, Zoe & Pearl, Mirilee on behalf of the ProAct65+ team Introduction: ProAct65+ tests whether a home-based (OEP) or group-based (EaME) exercise intervention promotes a long-term change in exercise behaviour. This presentation will discuss the use of health promoters in each exercise intervention; Postural Stability Instructors (PSI) in the FaME arm and Peer Mentors (PM) in the OEP arm, and describe the PMs experiences. Methods: Specialist PSIs were recruited through Later Life Training, or trained specifically for the trial, and employed by ProAct65+. Regular quality assurance visits reviewed performance against specific criteria and provided individual feedback to the PSI. PMs were recruited locally through exercise classes, email and newspaper adver- tisements on a voluntary basis. They were trained in OEP as Peer Mentors and attended quality assurance events regularly during the intervention period. Ten PMs were interviewed about their experiences on the trial and data was analysed using Thematic Content Analysis. Results: Despite quality assurance visits to standardise delivery, PSIs efforts to test and extend participants' skill level varied considerably. They were also less consistent than PMs in completing research documentation (attendance diaries, participant achievements etc). Recruiting PMs was difficult with significant regional variations between sites. PMs found home visits more useful than telephone contact to assist with exercise promotion, but barri- ers included difficulty making contact and locality issues. As lay volunteers, PMs' exercise promoting activity varied considerably as did their motivational expertise. PMs indicated they enjoyed meeting OEP participants and watching them progress throughout the intervention. Conclusions: It can be easier to recruit PSIs than volunteer peer mentors by training exist- Wednesday 15th August S117 ing exercise instructors and PSIs are better equipped to deliver a standardised intervention. PSIs however, appear less focused on the research aspects of the intervention. ProAct65-i- PMs experiences are consistent with other research on peer mentors. It is important that face-to-face contact is included in any PM intervention involving exercise. ProAct65+: Resource implications of ProAct65+ exercise interventions for the NHS Gage Heather & Jackson, Daniel on behalf of the ProAct65+ team Introduction: ProAct65-i- is investigating the health benefits of two existing exercise interven- tions, delivered over 24 weeks, to people aged 65+, in two sites (London, and Nottingham- shire/ Derbyshire), compared with usual care (no specific exercise intervention). An economic evaluation is being conducted alongside the clinical trial. This paper reports the relative costs of delivering the interventions within the NHS. Methods: A 'top-down' approach was used to capture the resource implications for the NHS of delivering the interventions. FaME (Falls Management Exercise) is a community-centre based group programme delivered by Postural Stability Instructors (PSIs). OEP (Otago Exercise Programme) is a home-based exercise and walking plan comprising a professional-led induction and assessment meeting, followed by trained peer mentor support through home visits and telephone calls. Data were collected prospectively from PSIs and peer mentors (using specially designed logbooks) and from study records. Resource use will be converted into costs; total and average (per participant). Costs incurred by the NHS to deliver the interventions will be compared between FaME and OEP. Results: Four categories of resources were involved: SET UP: appointment of PSIs, peer mentors and training of mentors; FACILITIES: Hire of halls (24 sessions per group for PSI) and hire of halls for induction meetings; EQUIPMENT: Therabands, mats and instruction booklets for PSI and ankle cuff weights and booklets for OEP; HUMAN RESOURCES: remuneration and travel cost for PSIs and travel and phone call reimburse- ment for mentors. Conclusion: Intervention costs incurred by the NHS are only one element of overall costs. Others include: private / participant out-of-pocket expenses (e.g. travel to exercise classes, purchase of exercise clothing); costs of treating any new exercise-related injuries. Costs may be offset if exercise improves health and thereby reduces other service utilisation. Overall costs will be combined with measures of effectiveness to indicate the relative value-for-money of the interventions. How do we recruit participants to an exercise promotion trial run through general practice and who joins? The experience of the ProAct65+ trial Carpenter, Hannah & Haworth, Deborah on behalf of the ProAct65-i- team Introduction: The ProAct65-i- exercise trial has recruited 1256 participants, aged 65 and over in Nottinghamshire, Derbyshire and London. Participants were recruited through their GP practice and various barriers to recruitment were encountered. This presentation will describe this process and the type of people recruited to the study. Methods: General practices were recruited to the study through local Primary Care Research Networks. GP practices excluded unsuitable patients and posted an invitation pack to randomly selected eligible patients. Participants were recruited from 43 practices in the study areas. Baseline data collected included: age, sex, ethnicity, educational attainment, number of long-term conditions and repeat medications. Data were also collected on socioeconomic group, income and current level of physical activity. Participant characteristic data were compared with data from The Active People Survey 5 from Sport England. Results: The trial invited 20507 patients to participate. After a higher than expected response rate, the conversion rate from S118 World Congress Abstracts 'expression of interest' to 'recruited' was lower than anticipated. The mail-out size at each GP practice was increased from 450 to 600 to account for this. Of the 1530 patients booked in for assessment, 1256 were consented. Small list sizes at some GP practices meant that additional GP practices had to be recruited. The average age of participants was 73 with 84% of participants younger than 80. 62% of participants were female. 34 languages were spoken and 14% of participants were non-white. 43% of participants had completed some form of further education. On average, each individual had 2 co-morbidities and were on 4 medications. Conclusion: The ProAct65+ trial successfully reached its recruitment target due to a number of strategies, including adapting its methods when faced with barriers to recruitment. Participants in this trial are more likely to be female and under the age of 80. Compared to The Active People Survey participants, ProAct65+ participants were more educated, had a higher income and were more ethnically diverse. SUSTAINABLE COMMUNITY-BASED EALLS PREVENTION: THE EXPERIENCE OF STEPPING ON Clemson, Lindy University of Sydney, Australia. Falls are common with injury costs far exceeding motor vehicle accidents, and the conse- quences can result in institutionalisation. For many people there are resultant quality of life issues with a third reporting they curtail usual activities. Reducing risk of falls, enabling people with the right tools as well as a sense of control will keep people safe, active and connected with their community. However, the challenge is to implement and sustain evidence-based programs. Stepping On, a community-based falls prevention program based on adult learning principals, self efficacy and a decision making framework, was found to reduce falls by 31% (P = .025)) and is being widely implemented in the US and Australia. A Delphi review by experts and qualitative findings of interviews with program leaders and participants from several projects provides an understanding of the underlying concepts and how these translate for older people to enable them to apply preventive techniques and enhance their sense of control. Drawing on research from Australia and the US, this presentation will explore some of the experiences in the development of Stepping On and the models of service delivery used to give a wider reach and support sustainability of the program. Keywords: Falls; Prevention; Quality of Life; Wellbeing. AGILE: CHARTERED PHYSIOTHERAPISTS WORKING WITH OLDER PEOPLE SYMPOSIUM Thomas, Janet', Townley Bex^; Rochester, Lynn' ' Queen Margaret Hospital, UK; 'Carmarthenshire County Council, UK; ^Institute for Ageing and Health, Newcastle University, UK. The AGILE Symposium aims to focus on specific factors related to falling that are of interest to both Physiotherapists working in this area, and other Allied Health Professionals. Both sessions will have a strong practical element with take home messages that can be directly applied to practice. Firstly, Professor Rochester will examine gait, and the motor and non- motor characteristics of gait. She will focus on the requirements for successful mobility, especially in a community setting and the features of gait that predict functional decline and reduced mobility. Secondly, Bex Townley will take us through the exercise continuum. Wednesday 15th August S119 with a particular focus on integrating service and how safe and effective exercise formats can be achieved for frailer older people at dsk of falls. Exercise formats for strength and balance programmes in the falls prevention exercise continuum: The Carmarthenshire model: An integrated approach to delivering evidence based exercise programmes Townley, Bex Carmarthenshire County Council, UK. Maintaining and extending rehabilitation gains made within physiotherapy exercise sessions is a key aim of exercise professionals working in leisure/community settings. Physiotherapy exercise interventions within hospital settings work either on a one to one basis or small group numbers and operate at fixed term programme durations enabling ease of baseline, mid-point and end point assessment. They also focus on outcomes for the pdmary clinical pathology (i.e. cardiac rehab, pulmonary rehab, stroke rehab, and falls). This presentation focuses on the challenges faced by specialist exercise-referral services receiving referrals from multiple exercise pathways/ physiotherapy teams for patients presenting with multiply pathologies. The session will provide an overview of Carmarthenshire's integrated approach to evidence based exercise programmes within a falls-prevention exercise continuum service and its strong links with primary and secondary prevention teams. It will provide practical examples of how safe and effective exercise formats can be achieved for frailer older people at risk of falls. Gait, mobility and falls Rochester, Lynn Institute for Ageing and Health, Newcastle University, UK. Increasing life expectancy challenges us to age successfully in order to remain safe and independently mobile. A life ffee from dsk of falls and their negative consequences includes retaining the ability to mobilise independently at home and in the community. This requires a higher level of motor control as well as cognitive flexibility to address necessary motor skills whilst attending to a range of environmental stimuli and concurrent tasks. Gait is a complex motor function requidng input from multiple motor and non-motor domains in Ihe central nervous system. In particular, recognition of the important role of non-motor charactedstics such as cognitive and executive function to gait in older adults has influenced our understanding of complex gait performance. Important insights into the role of cogni- tion have also been gained using dual-task paradigms which address automatic control of gait. Selected characteristics of gait are predictive of falls dsk, mobility impairment and cognitive decline whilst cognitive decline in older adults predicts falls and loss of mobility. Impaired dual-task performance highlights potential difficulties faced in more challenging environments or dudng multiple task performance with subsequent increased dsk of postural instability and falls. This presentation priodtises the requirements for successful mobility rather than falls prevention presuming that these skills will be protective against falls dsk. The presentation will address: control of gait, including ambulation in complex environ- ments such as the community; features of gait that are predictive of functional decline and reduced mobility; and strategies to address these. S120 World Congress Abstracts A NEW APPROACH FOR PERSONALIZED FALL RISK PREDICTION & PRE- VENTION: TAILORED EXERCISES, UNOBTRUSIVE SENSING & ADVANCED REASONING Wieching, Rainer'; Kaartinen, Nico^; DeRosario, Helios'; Baldus, Heribert"; Eichberg, Sabine'; Drobics, Mario*; Delbaere, Kim' 'University of Siegen, Germany; 'Kaasa Solution GmbH, Germany; ^Instituto Biomechanica de Valencia, Spain; ''Philips Research Europe, Netherlands; ^German Sports University, Germany; ^Austrian Institute of Technology, Austria; ^Neuroscience Research Australia, Australia. In our ageing society, falls and their consequences cause tremendous problems as related to fractures, quality of life and health care costs. Due to the ongoing changes in the age structure of the population, this problem with all its consequences will further increase in the near future and innovative solutions to avoid falls in community dwelhng older adults are urgently needed. The aim of iStoppFalls is to develop and implement ICT-based technolo- gies which can be easily integrated in daily life practices of older people living at home, and which allow for continuous exercise training, reliable fall risk assessment, and appropriate feedback mechanisms, based on discreet measuring technologies and adaptive assistance functions. The Senior Mobility Monitor (SMM) as a component of the iStoppFalls system will unobtmsively and continuously monitor mobility in daily life. It will evaluate quan- titative information on frequency, duration and type of mobility activities and qualitative information on balance function and muscle power. On the other hand, our Kinect based fall preventive exercise training game (Exergame) will facilitate real preventive exercise train- ing at home (3 times a week), where data is acquired by unobtrusive sensing together with biomechanical modeling and optional heart rate data assessment. Our Knowledge Based System for Fall Prediction & Prevention correlates these two types of mobility analysis information (SMM & Exergame), and in tum provides sufficient data to perform a trend analysis of these entities, thus evidencing valid fall prediction & sustainable fall prevention in terms of tailored home based exercises for community-dwelling older adults. Our iTV component and the whole iStoppFalls system will be based on user-centered design and living-lab approaches, and thus provides advanced HCI adjusted to the capabilities of our elderly users (usability & accessibility). Keywords: Fall Risk Prediction; Balance Function; Technology; Fractures; Quality of Life. Introduction to the iSTOPPFALLS project Wieching, Rainer; Wulf, Volker University Siegen, Germany. In our ageing society, falls and their consequences cause tremendous problems as related to fractures, quality of life and health care costs. Due to the ongoing changes in the age structure of the population, this problem with all its consequences will further increase in the near future and innovative and cost effective solutions to avoid falls in community-dwelling older adults are urgently needed. Hereby active prevention plays an important role, especially in terms of fall-specific exercises and training programs. Modem information and com- munication technologies (ICT) in the field of home-based sensor technology, telemedicine and video games can support appropriate activities excellently as they are motivating and increasingly used by older people living at home. The aim of iStoppFalls is to develop and implement ICT-based technologies which can be easily integrated in daily life practices Wednesday 15th August S121 of older people living at home, and which allow for continuous exercise training, reliable fall risk assessment, and appropriate feedback mechanisms, based on discreet measuring technologies and adaptive assistance functions. The Senior Mobility Monitor (SMM) as a component of the iStoppFalls system will unobtrusively and continuously monitor mobility in daily life. It will evaluate quantitative information on frequency, duration and type of mobility activities and qualitative information on balance function and muscle power. On the other hand, our Kinect based fall preventive exercise training game (Exergame) will facilitate real preventive exercise training at home (3 times a week), where data is acquired by unobtrusive sensing together with biomechanical modelling and optional heart rate data assessment. Our Knowledge Based System for Fall Prediction & Prevention correlates these two types of mobility analysis information (SMM & Exergame), and in turn provides suffi- cient data to perform a trend analysis of these entities, thus evidencing valid fall prediction & sustainable fall prevention in terms of tailored home based exercises for community-dwelling older adults. Our iTV component and the whole iStoppFalls system will be based on user- centered design and living-lab approaches, and thus provides advanced HCI adjusted to the capabilities of our elderiy users (usability & accessibility). Our first iStoppFalls prototype will be evaluated and further enhanced based on the results of an initial pilot trial with 20 participants in Germany and Australia. The final iStoppFalls demonstrator will be evidenced by a randomized clinical trial with 360 participants which will be implemented in Germany (90), Finland (45), Spain (45), and Australia (180). Home-based exergaming: An effective fall preventive measure for the elderly Smith, Stuart T; Delbaere, Kim; Lord, Stephen R Neuroscience Research Australia, Australia. With the expected increase in the number of people living to an older age, fall-related injury threatens to place significant demands on our public health care system. Fall-related injuries are the leading cause of injury-related hospitalisation in old age and with at least one third of community dwelling adults aged 65 and over fall once or more per year, the health burden within the community associated with falls is enormous. Over the past few decades, there has been a wealth of published scientific evidence for the physical, cogni- tive and social health-related benefits of increased exercise, especially in older adults. In particular, improvements in strength, balance, coordination and aerobic capacity leading to reduced levels of disability and better mobility function, as well as reduced fall risk in older populations, have been shown following exercise interventions. Despite the clear evidence base demonstrating the health-related benefits of PA, uptake and adherence to PA programs is often disappointing. Barriers to adherence may include lack of interest in the program, low outcomes expectation, the weather or even a fear of falling during exercise. Yardley and colleagues [1] report that home-based exercise has the widest appeal to older adults, and is also most attractive to those more socially deprived people who have the greatest need for undertaking falls prevention measures. One method by which compliance with exercise programs could be improved involves the use of fun and engaging videogames. Interactive videogames that combine player movement, engaging recreation, immediate performance feedback and social connectivity via competition, have been shown to promote motivation for, and increase adherence to, physical exercise amongst children and young adults. In older adults, videogames have also been shown to improve cognitive abilities, to be a feasible alternative to more traditional aerobic exercise modalities for middle-aged and older adults [2] and can be used to train stepping ability in older adults to reduce the risk of falls [3]. S122 World Congress Abstracts We discuss the results of pilot data showing that exergames are an acceptable technology to older adults for home-based exercise and that a relatively short intervention period using Dance Dance Revolution significantly reduces some measures of fall risk. References: 1. Yardley L. et al. Preventative Medicine, 2008,47, 554-558; 2. Guderian B. et al. Joumal of Sports Medicine and Physical Fitness. 2010,50(4):436-42; 3. Smith ST et al. British Joumal of Sports Medicine. 2011. 45(5),441-5. Fall preventive exercises: A tailored fall preventive exercise program for older adults Kroll, Michael', Marston Hannah R', Delbaere, Kim^, Eichberg, Sabine' 'German Sport University Cologne, Germany; ^University of New South Wales, Australia. It is well established that physical activity can decelerate age-related loss of physical func- tion. Furthermore, exercise has a major role to play in the prevention of falls and fall-related risk factors among older people. In addition, active older people who exercise are less likely to develop physical disability, cardiovascular disease, hypertension, type 2 diabetes mel- litus and osteoporosis. The iStoppFalls project aims to develop an innovative home-based exercise program for older adults using an information and communication technology (ICT) approach with a core component of both strength and balance exercises. The strength component is inspired on the Otago exercise program, which has proven effectiveness in the context of fall prevention and is also conducted in a home setting. The balance component will be incorporated into the exergame. The level of difficulty of the balance exercises will be increased within the exergame by (1) reducing hand support, (2) reducing base of support, and (3) weight shifting tasks through leaning, knee bending, and stepping. As the iStoppFalls exergame will be conducted in the comfort of people's own homes, built-in safety measures insight the exergame using algorithms to detect falls with the Microsoft Kinect camera will ensure the participants' safety during the exercises. This project provides an active translation of evidence-based approaches to falls prevention by using innovative ICT technologies. The iStoppFalls exergame has the potential to offer people a home-based individualized exercise program that might ultimately also be effective at reducing falls in older adults. A Senior Mobility Monitor for regularly measuring and evaluating daily life activities and movements Annegam, Janneke Philips Research Europe, Netherlands The iStoppFalls consortium and project will develop an embedded AAL system that can predict and prevent falls by monitoring mobility-related activities and other risk factors of falls in real-life. The iStoppFalls Senior Mobility Monitor plafform (SMM) bases on proven technological validity towards objective assessment of balance function and muscle power. ' Beyond continuous Fall Risk monitoring, this enables tailoring individualized exercise pro- grams coached by iStoppFalls. The SMM is an inertial sensor system which can be wom as a necklace without restrictions. The SMM has two modes: 1) the daily monitoring mode and 2) the exercise mode. During the daily monitoring mode, the SMM provides solutions for continuously monitoring relevant mobility features of the user. The SMM will detect and evaluate sit-to-stand transfers, which reflects balance function and muscle power. Moreover, the SMM will provide information on the activity profile of the elderly. The SMM reports these mobility features on a daily basis. During the exercise mode, the SMM will be used to improve the fall risk assessment by improving the estimations of body sway during quit Wednesday 15th August S123 standing and power during sit-to-stand transfers. With the SMM, fall risk assessment and trend analysis of balance capabilities can be performed not only in clinical tests, but also in daily life. Furthermore, this trend analysis provides information on the effect of the training exercises for the daily life of the user, and can give feedback to the training system for user specific tailoring of the exercises. Reference: Zijlstra, W., et al , A body-fixed -sensor-based analysis of power during sit-to-stand movements. Gait and Posture, 2010. 31(2): p. 272-278. Measurement of balance-related biomechanical variables with video game devices de Rosario, Helios; Belda, Juanma Instituto de Biomecánica de Valencia, Spain. In recent years, the computer and video games industry has experienced an important technol- ogy push that has brought to the market devices for enabling new forms of human-machine interaction. This includes motion capture technologies, like accelerometers and markerless optical systems that have long been used in human movement science for research in bio- mechanics. The low cost of these technologies, and the possibility of integrating them in home-based systems, makes the combination of video games and biomechanical analysis a feasible reality. The iStoppFalls project takes advantage of this opportunity for measuring balance-related biomechanical variables with a Kinect sensor and the Senior Mobility Moni- tor that will be used for assessing the risk of falling during the interaction of users with the "exergame." One of the challenges of this approach is how to adapt the assessment criteria that depend on high-quality biomechanical measures, to a system that is originally designed for capturing gross movements, with fast and inexpensive resources, but lower precision than laboratory instruments. This problem is solved by a redefinition of the measurement protocols, plus advanced analysis of the variables captured by the video-game sensors, in order to reduce the distance between required and achieved precision. Fall risk assess- ment criteria that were previously validated in extensive field studies have been adapted to exercises that can be made at home, without supervision or additional instrumentation. A skeleton model with 10 joints has been tracked by Kinect, with joint angles corrected by an extended Kaiman filter, in order to achieve kinematic parameters that can be compared with the results of a high-quality photogrammetry system. Empirical analysis of end-user requirements: Designing ICT artifacts for the elderly exercising at home Meurer, Johanna; Schöning, Sima; Stein, Martin; Wieching, Rainer University Siegen, Germany. We want to present first insight of designing community-oriented exergames for elderlies to motivate them to use fall preventive exercise training at home over a longer period of time. Older adults are often reluctant to use ICT systems in their homes, but fall preventive exercises need to be performed at least 3 times a week for 6 months to be effective'. Thus, motivation and compliance plays a crucial role in this setting and ICT systems can provide very good support, if they are adjusted to the needs of the elderiy end-users. End-user needs assessments were performed by participatory design sessions with end-users for discussion and idea generation by using market available input/output devices in order to develop user settings and scenarios for primary (exercising older adults at home) and secondary (care givers and relatives) end users. Implications based on empirical interviews^ and workshops were retrieved from 17 users from Germany and Spain so far. We build mock-ups that SI 24 World Congress Abstracts illustrate our design idea of that elders might be interested in online communities while playing. Discussing the mock-up and the underlying assumptions with the elderly people in a participatory design workshop, however, showed that they have another perspective on this topic. For them, the design should focus on the necessary features to exercise fall preventive training in the most effective and efficient way instead of looking on nice-to-have community features. In this symposium, we want to discuss, how to deal with this different perspectives in participatory design and if and how community approaches could support motivation of older people to play fall preventive exergames. References: 1. Gillespie, L., Robertson, M., Gillespie, W., Lamb, S., Gates, S., Cumming, R. et al. (2010). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (Online) (2), CD007146; 2. Maydng, P. 2007. Qualitative Inhaltsanalyse. Grundlagen und Techniken (9. Auflage, erste Auflage 1983). Weinheim: Deutscher Studien Vedag, 2007. Modern fall prediction algorithms: Self-adaptive exercise training plans based on fall related data analysed over time Drobics, Mario; Ejupi, Andreas; Kreiner, Karl AIT Austrian Institute of Technology GmbH, Austria. To provide individual fall-prevention training plans within the project iStoppFalls it is necessary to assess the individual fall risk and training progress of each user in frequent pedods. In conventional approaches for fall risk prediction, assessments are conducted in a clinical environment, supervised by a physician. Regular repetitions of the assessments are necessary to monitor the progress of the patient and to adapt the intervention strategy. This is very time consuming (for the patient and the physician) and thus expensive. Additional information, such as the daily activity of a person, can normally not be considered. In the project iStoppFalls, the risk assessments are conducted at the beginning and in regular intervals further on. These assessments are automated and can be done by the older adults in their own homes. Based on these risk assessments, an individual training plan is provided. As a baseline progression of the exercises will be increased linearly, based on the individual performance of the user and the repeated assessments, which guarantee a constant and realistic judgment of the performance of the user This baseline is further modified based on an automatic analysis of the dsk assessment data as well as data captured dudng the training sessions (duration, quality of execution, etc.) and data on the daily activity of the users (activity level over time, sit-to-stand time, etc.). To derive the according optimization models the data is analysed by experts dudng a test phase. They can make suggestions for changing the individual training plans (e.g. if the strength of a person is below average, then he has to do more strengthening exercises) and comment on the reason for their decision. This information is then analysed using statistical and machine leaming methods to automate the determination of the individual fall dsk and the regular adaption of the training plan to the individual needs. ISPAPOEF SPECIAL SYMPOSL^: EXERCISE FOR FALLS AND FRACTURES Invited lecture: Which balance assessment tests are fit for purpose? Masud, Tash Nottingham University Hospitals NHS Trust, UK. The two main basic balance conditions are static balance and dynamic balance and humans employ different strategies to keep the centre of mass between the base of support in order Wednesday 15th August S125 to stop falling over: 1. Proactive (anticipation of a predictive disturbance); 2.Reactive (compensation of the disturbance); 3.Static and Dynamic Steady State (maintain a steady position on sitting, standing or walking). A number of balance assessment tools are used in clinical practice and research. In order to decide which balance test to use, it is important to consider the purpose of the test: screening, falls prediction, clinical decision making, elucidation of pathophysiology, assessment of disease progression, and detection change after an intervention. The intra-rater and inter-rater reliability and test-retest reliability are also important properties of the tests. Simple chnical test include the "on leg stand", "tandem walk", "sit to stand", "nudge test", and "number of steps taken to tum 180 degrees". "Gait speed" and "timed walk" (different versions) have a large associated literature and different cutoffs have been associated with falls risk, functional decline, hospitalisation, cognitive impairment and frailty. Many studies use the <1 m/s cutoff. Similarly the "timed up and go (TUG) test" has different versions (commonest is the 3m TUG) and assesses muscle power, dynamic steady state balance and tuming ability. A >13-15 seconds cut-off for the 3m TUG has been associated with falls risk and in several settings has been shown to have good test-retest reliability and ability to detect change. The "BERG Balance Scale" (BBS) is commonly used by physical therapists. It is composed of 14 items scoring 0-4 (max score 56). Scores of 21-40 are associated with medium falls risk and <21 is associated with high falls risk. An 8-point change in BBS is considered cUnically relevant. Other tests include the "Dynamic Gait Index," "Elderiy Mobility Scale", "Functional Reach", "Tinetti Performance Orientated Mobility Assessment" and "Functional Reach". More sophisticated biomechani- cal tests include measurement of body sway, use of force plates, computerised dynamic posturography, and the multidimensional "Physiological Profile Assessment." A popular recently developed tool is the "Gaitrite" mat which can measure gait variabihty. The latter parameter has been shown to be highly associated with falls risk. It is also a useful tool to research balance impairment in dual tasking conditions which have also been associated with increased falls risk. Measurements of confidence and "fear of falling" include differ- ent versions of the "Falls Efficacy Scale" and the "Activities Specific Balance Confidence (ABC) scale." Invited lecture: What do we know about exercise and bone health? Brooke-Wavell, Katherine School of Sport, Exercise and Health Sciences, Loughborough University. Loss in bone density and strength with age, combined with increased risk of falls, contributes to increasing risk of osteoporotic fracture. One in two women, and one in five men aged 50, will sustain a fracture in their lifetime. Exercise can increase bone gains during puberty, and these benefits may persist into adulthood. Starting exercise in adulthood has more modest effects on bone density, and in older adults (particularly postmenopausal women) benefits may be smaller still, although exercise interventions that are adequate in terms of type and intensity have been found to benefit bone density at all ages. The optimal types of exercise for increasing bone density exert high forces on bone at the skeletal sites susceptible to fracture; for instance impact exercise and high magnitude resistance exercise. The ideal frequency and duration of exercise are not yet known, although extremely high training volumes, particularly when associated with menstrual dysfunction, may adversely affect bone and animal studies suggest brief loading bouts separated by rest pauses are most effective at increasing bone mass. Mechanical loading can increase bone strength to a greater extent than bone density. This may be a consequence of adaptations in the distribution, as well as the quantity, of SI 26 World Congress Abstracts bone. Recent research using computed tomography techniques has demonstrated changes in structural parameters in humans. Exercise interventions can also reduce fall incidence in older people, so exercise may reduce fracture risk to a greater extent than expected from bone density changes alone. Most observational studies have reported substantially lower fracture incidence in regular exercisers, although there have been no intervention studies large enough to evaluate changes in fracture risk. Exercise that adequately loads relevant skeletal sites can thus produce modest increases in bone density and could further reduce fracture risk through benefits to bone structure and fall risk. Effectiveness of primary care physical activity interventions in older adults: A nar- rative review Stevens, Zoe'; Barlow, Cate'; Kendrick, Denise^; Masud, Tahir'; Skelton, Dawn A''; Dinan- Young, Susie'; Iliffe, Steve'. ' University College London; ^ University of Nottingham; 'Nottingham University Hospitals NHS Trust and University of Derby; •* Glasgow Caledonian University. Background: Primary care is an important setting to promote physical activity to older adults. Current interventions provide counselling, advice, and exercise on prescription; their effectiveness is presently unknown. Aim: To review the effectiveness of physical activity interventions which have recruited older adults through primary care and/or were delivered through primary care. Design: Narrative review. Method: Studies pubUshed between 1998 to July 2011 were found in electronic databases. We searched for studies providing structured physical activity interventions, regardless of study design, to older adults (aged 50 plus) through primary care. The search and selection process was not restricted to any outcome measures or comparison groups. Full texts were obtained of eligible studies. Studies were selected by two reviewers who independently assessed for quality using Jiini et al.'s criteria and in accordance with the RE-AIM criteria. Results: Six out of 4170 studies met the inclu- sion criteria, with 1522 participants included. The interventions ranged from 12 weeks to one year. Three studies showed a statistically significant increase in activity in the interven- tion compared to the control group (p<0.05). The three studies that measured quality of life and presented results from the SF-36 reported inconsistent results. Conclusion: Studies in this review show some evidence for the effectiveness of physical activity interventions in primary care for older people. More research in this area is needed to expand the evidence base for effective interventions in primary care for older adults, and make recommendations to primary care staff and settings. Keywords: Primary care, older adults, physical activity, exercise, general practice. A comparison of the ground reaction forces of the pas de basque Scottish country dance step and three exercises used in osteoporosis exercise classes Thow, Morag K; Stewart, Sabita; Rafferty, Danny Glasgow Caledonian University, UK. Background: It is acknowledged that impact forces are required for good bone health. How- ever, few studies have measured impact force in postmenopausal women. Scottish country dancing (SCD) pas-de-basque step may be an appropriate activity although the specific ground reaction forces (GRF) are unknown. Kemmler et al., (2004) reported that activities which generated GRF ranging between 1.5 to 3.5 times bodyweight (x BW) were sufficient to offset bone loss in this population. Aims: This study aimed to compare the GRF generated Wednesday 15th August S127 during the pas de basque, to marching, sidestepping and walking weight bearing exercises that are often used in osteoporosis classes. Methods: A within subject study was carried out to measure ground-reaction force. Twenty one postmenopausal women aged 65.62 (+ 7.45 years) who were regular Scottish counu^ dancers provided the sample After a five min warm up measurements of walking, left and right marching, left and right side stepping and left and right pas-de-basque were carried out on a Kistler force plate three times and the mean was established. Results: The median GRF for the pas-de-basque was 1.94 x BW and significantly higher (p < 0.001) than the mean values for marching 1.39 x BW, sidestepping 1.31 X BW or walking 1.21 x BW. Conclusion: These findings suggest that Scottish country dance that includes the pas de basque step may provide GRF that can offset bone loss and maintain bone health in postmenopausal women. Keywords: Postmenopause; Measurement of Walking; Osteoporosis; Bone Health; Scottish Country Dance. Factors associated with initiation of weight-bearing activity in older men and women: Influence of osteoporosis screening and education intervention McLeod, Katherine M.'; Johnson, C Shanthi'; Rasali, Drona^; Verma, Ashok3 'University of Regina, Canada; ^Saskatchewan Ministry of Health, Canada; ^Regina Qu 'Appelle Health Region, Canada. Objective: Weight-bearing physical activity has been shown to improve bone health and prevent osteoporosis; however many older men and women do not engage in such activity. This study determined the factors associated with men and women's decision to start or increase weight-bearing activity to prevent or manage osteoporosis. Methods: The study population consisted of men and women 50 years of age and older (range 50-80 years), enrolled in a 6-month randomized controlled trial assessing health behaviour change after screening alone or combined with a theory-based education program. Eligible men (n = 25, mean age 64.1 ± 7.3) and women (n = 157, mean age 59.1 ± 6.8) were referred by their healthcare provider to undergo dual energy x-ray absorptiometry (DXA) screening for the first time at the local hospital. All participants underwent screening and completed a series of measurements and questionnaires assessing osteoporosis health and lifestyle behaviours, including physical activity and dietary intake. The intervention group also received theory- based osteoporosis education. Six months after baseline, participants completed a series of follow-up measurements and questionnaires to determine change in health behaviours. Results: Based on Worid Health Organization criteria, 11.6% of men and women were newly diagnosed with osteoporosis and 48.1% with osteopenia. Only 25.8% of men and women reported change in weight-bearing physical activity at follow-up. After adjustment for confounding covariates in logistic regression analysis, factors associated with change were osteoporosis diagnosis (OR, 2.78; 95% CI, 1.01-7.61) and receiving recommendation from a healthcare provider (OR, 4.90; 95% CI, 2.17-11.04). Conclusions: This study provided evidence that osteoporosis diagnosis and healthcare provider recommendations influence decisions to initiate weight-bearing activity; however improvement in initiation rates are needed in order to prevent and manage osteoporosis. Keywords: Osteoporosis; Bone Health; Weight-Bearing Physical Activity; Healthcare Provider. UPTAKE AND ADHERENCE TO EXERCISE AND PHYSICAL ACTIVITY IN DEVELOPED AND DEVELOPING COUNTRIES Hawley, Helen'; Home, Maria'; Skemp, Lisa^ 'University of Manchester, UK; ̂ Our Lady of the Lake College, United States. S128 World Congress Abstracts Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, maintaining social networks and independence. A variety of physical activity (PA) interventions are readily available for older adults. However, the uptake and adherence to these activities remains problematic with dropout rates from structured programs being high. This symposium explores uptake and adherence to physical activity with a range of older adults in different settings looking at both exercise instructor and older adults' perspectives. The symposium will conclude by drawing together issues of how to design programs that promote uptake and adherence to exercise and PA programmes. Aim: This workshop aims to provide an overview of 5 studies with an emphasis on key recommendations for policy, research and discussion on implication for practice. Keywords: Health; Wellbeing; Physical Activity; Developed and Developing Countries. Older adults' uptake and adherence to exercise classes: The role of the instructor Hawley, Helen University of Manchester, UK. Background: Leadership behaviour and quality of instruction is important in influencing engagement of older adults in exercise classes.''^ Little is known about the relationship between attitudes and characteristics of instructors and their delivery in relation to uptake and adherence of older adults to classes. Methods: We present the findings and recommendations from three studies: A survey of 731 United Kingdom exercise instructors with Level 3 older adults exercise qualifications which investigates instructors' characteristics and attitudes towards older-adults' participation in exercise.' Interviews with 19 instructors to further explore their attitudes, experiences and beliefs in relation to their exercise classes for older adults and how these experiences and beliefs are influenced by training and characteristics. A longitudinal cohort study of 16 instructors and 193 class participants over 6 months to explore what characteristics of exercise instructors, the group and class participants influ- ence adherence. Findings: The first study establishes that there is a relationship between instructors' training, experience, characteristics and their attitudes. The second study sup- ports these findings and demonstrates how instructors' think that these factors and others not only influence how they deliver and promote their classes but also influence older adults' uptake and adherence to exercise classes. The final study enables us to look at the relation- ship between instructor variables and the participant within the exercise class setting. Class participants' mental well-being, education and housing were key factors related to their attendance. Having attended the class for more than six months at baseline was an important factor related to adherence. Individual factors such as participants' attitudes, beliefs about group cohesion and instructor variables such as personality traits and experience emerged in the final models both in relation to participant attendance and adherence. Conclusion: There are a series of complex interactions between the instructor, participant, the group and others which influence beliefs and attitudes and this needs to be acknowledge in future research, practice and policy. It is clear that the instructor can influence participants and they have an important role to play in creating an atmosphere and environment of which participants want to be a part of. References: 1. Dinan, S. (2001). Delivering an Exercise Prescription for Vulnerable Older Patients. In Young, A., Harries, M (Eds.), Physical Activity for Patients: An Exercise Prescription (pp.121-132). London: Royal College of Physicians; 2. Ecclestone, N.A., & Jones, J. (2004). International Curriculum Guidelines for Preparing Physical Activity Instructors of Older Adults, in collaboration with the Aging and Life Course. Wednesday 15th August S129 World Health Organization. Joumal of Aging and Physical Activity. 12, 467-79; 3. Hawley H., Skelton D, Campbell M & Todd C (2012) Are the Attitudes of Exercise Instructors Who Work With Older Adults Influenced by Training and Personal Charactedstics? Joumal of Aging and Physical Activity, 20: 47-63. Older adults' perceptions of the influence of exercise instructors in the uptake and adherence of exercise Home, Mada University of Manchester, UK. Background: A variety of physical activity (PA) interventions are readily available for older adults, but uptake and adherence to these activities remains problematic with drop-out rates from structured programs being high