In this area , there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention .
Background Healthy ageing and health promotion ( HP ) actions for older people have become an important health sector priority .
At the same time , the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance .
The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and /or primary prevention ( PP ) programmes for older people whilst providing deeper insight into method ological aspects of such studies , their overall quality and issues related to practical implementation of results .
Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care.
BACKGROUND Regular physical activity ( PA ) reduces the risk of falls and hip fractures , and mortality from all causes . However , PA levels are low in the older population and previous intervention studies have demonstrated only modest , short-term improvements . OBJECTIVE To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years . DESIGN The ProAct65 + study was a pragmatic , three-arm parallel design , cluster r and omised controlled trial of class-based exercise [ Falls Management Exercise ( FaME ) programme ] , home-based exercise [ Otago Exercise Programme ( OEP ) ] and usual care among older people ( aged ≥ 65 years ) in primary care . SETTING Forty-three UK-based general practice s in London and Nottingham/Derby . PARTICIPANTS A total of 1256 people ≥ 65 years were recruited through their general practice s to take part in the trial . INTERVENTIONS The FaME programme and OEP . FaME included weekly classes plus home exercises for 24 weeks and encouraged walking . OEP included home exercises supported by peer mentors ( PMs ) for 24 weeks , and encouraged walking . MAIN OUTCOME MEASURES The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity ( MVPA ) per week , 12 months after cessation of the intervention . Secondary outcomes included functional assessment s of balance and falls risk , the incidence of falls , fear of falling , quality of life , social networks and self-efficacy . An economic evaluation including participant and NHS costs was embedded in the clinical trial . RESULTS In total , 20,507 patients from 43 general practice s were invited to participate . Expressions of interest were received from 2752 ( 13 % ) and 1256 ( 6 % ) consented to join the trial ; 387 were allocated to the FaME arm , 411 to the OEP arm and 458 to usual care . Primary outcome data were available at 12 months after the end of the intervention period for 830 ( 66 % ) of the study participants . The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40 % to 49 % in the FaME arm , from 41 % to 43 % in the OEP arm and from 37.5 % to 38.0 % in the usual-care arm . A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [ adjusted odds ratio ( AOR ) 1.78 , 95 % confidence interval ( CI ) 1.11 to 2.87 ; p = 0.02 ] . There was no significant difference in MVPA between OEP and usual care ( AOR 1.17 , 95 % CI 0.72 to 1.92 ; p = 0.52 ) . Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level . In the 12 months after the close of the intervention phase , there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm ( incidence rate ratio 0.74 , 95 % CI 0.55 to 0.99 ; p = 0.042 ) . Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care , as did perceptions of benefits from exercise . Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm . There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes , including quality -adjusted life-years  . FaME is more expensive than OEP delivered with PMs ( £ 269 vs. £ 88 per participant in London ; £ 218 vs. £ 117 in Nottingham ) . The cost per extra person exercising at , or above , target was £ 1919.64 in London and £ 1560.21 in Nottingham ( mean £ 1739.93 ) . CONCLUSION The FaME intervention increased self-reported PA levels  among community-dwelling older adults 12 months after the intervention , and significantly reduced falls . Both the FaME and OEP interventions appeared to be safe , with no significant differences in adverse reactions between study arms . TRIAL REGISTRATION This trial is registered as IS RCT N43453770 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 49 . See the NIHR Journals Library website for further project information
In this area , there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention .
Background Healthy ageing and health promotion ( HP ) actions for older people have become an important health sector priority .
At the same time , the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance .
The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and /or primary prevention ( PP ) programmes for older people whilst providing deeper insight into method ological aspects of such studies , their overall quality and issues related to practical implementation of results .