Development of intervention and implementation themes in the ICA
| Subtheme | Trials (n) | Examples of informal evidence | Correspondence between themes and trial outcome* |
| Theme 1: the right exercise | |||
| Balance and strength (21 codes) | 11 | ‘Multicomponent exercise program focusing primarily on strength and balance training found to be the most effective strategy in the management of falls in the elderly’. Dhargave et al,29 p57 | 6/8 trials with positive findings tested the effect of exercise interventions that combined progressive standing balance and strength. 4/9 trials with neutral or negative findings also involved balance and strength exercise. |
| Tailored to the individual (34 codes) | 12 | ‘This pattern (fluctuating adherence) of commitment to exercise interventions, suggests that exercise programs may need to be specially tailored for individual seniors’ changing needs, interests, physical, and cognitive capabilities’. Nowalk et al,23 p864 | 7/8 positive trials tailored their exercise programme to the individual and progressed it accordingly. 5/9 trials with neutral or negative findings tailored the programme. |
| Moderate intensity (21 codes) | 8 | ‘6 months of individualised and progressive multicomponent exercise at moderate intensity composed of strength, balance and walking recommendations in long term nursing home residents was effective to prevent falls’. Arrieta et al,28 p1149 | 6/8 trials with positive findings tested exercise interventions at a moderate intensity. The other two trials tested low intensity exercise. 0/9 trials with neutral or negative findings tested moderate intensity exercise. |
| Theme 2: exercise engagement support | |||
| Sufficiently resourced (17 codes) | 8 | ‘The study identified an overall reduction in the risk of falls in individuals who underwent structured exercise program, whereas we identified that those who were not provided with any of the supervised training had an increase in risk of falls after the study period’. Dhargave et al,
29 p57 ‘A dose of 30 or more hours of this type of exercise over a 25 week time frame may therefore produce outcomes similar to those with the higher doses previously recommended’. Hewitt et al, 27 p7 | 4/8 positive trials sufficiently resourced via funding the trials to deliver structured and supervised balance and strength exercise interventions>30 hours compared with 2/9 trials with neutral to negative findings. |
| Group exercise to allow for socialisation (6 codes)† | 3 | ‘Elderly people can reduce their risk of falling by participating in moderate intensity group-exercise programs. Another reason for preferring moderate intensity exercise is that a key element in sustaining exercise participation of older people is the opportunity to socialize. Faber et al, 38 p893 | 5/8 trials delivered their exercise interventions in a group that supported participant socialisation. 4/9 trials with neutral or negative findings also delivered group exercise. |
| Staff and resident education (6 codes)† | 4 | ‘Educating staff and residents on the potential benefits of progressive resistance training (PRT) and balance training may have resulted in higher participation rates’. Hewitt et al, 27 p7 | 3/8 trials with positive findings employed educational strategies to increase adherence – one trial highlighted staff education, one resident education and one both. 1/9 trials with neutral or negative findings provided staff and resident educational strategies. |
*Trial was included in the thematic table if they included 100% of the intervention component.
†Subtheme was unable to differentiate clearly between successful and neutral/negative trials and therefore did not proceed to the final ICA theory.
ICA, intervention component analysis.