Otago Exercise Programme

Original Editor - Lauren Lopez

Top Contributors - Lauren Lopez, Wendy Walker and Tony Lowe  

Description

The Otago Exercise Programme (OEP) is an evidenced-based, "home-based, individually tailored strength and balance retraining programme”[1]. The OEP is carried out by physiotherapists (and/or trained providers such as community nurses). It is designed to be carried out over 12 months (or more recently, six months). The physiotherapist makes approximately five home visits within that period and also makes monthly phone calls to the participant to encourage adherence[2]

The OEP was developed by Campbell and Robertson[1] for the New Zealand Accident Compensation Corporation (ACC) which provides treatment and rehabilitation under a universal, no–fault accidental injury scheme. See here for original report providing background, evidence for and instructions for use.  

Falls in older adults can cause significant physical[3] and psychological injury[4] to the individual. Falls also incur significant costs for health care providers[3][5][6]. Hence, ACC looked to find a proven way to reduce falls. 

Research shows the OEP is effective in reducing the risk of death and incidence rate of falls over a one year period in older adults[7]. One study reported falls in older adults were reduced by 35%[1]. The OEP has also been shown to be a cost effective intervention, particularly for adults over 80 years old[8].  It has been modified for other health systems in Australia[9] and the United States[10] although its effectiveness in modified formats is unclear[11]

The OEP comprises five strengthening exercises and 12 balance exercises. Participants are instructed to perform the exercises three times a week[12]. In addition, participants are instructed to walk twice a week for 30 minutes (can be broken into smaller periods e.g. three ten-minute blocks)[12]. Depending on the individual’s strength and mobility, the exercises can be progressed. For example, adding hand weights to squats and other weight-bearing exercises or increasing repetitions.      

Table 1: Exercises of the OEP[1].
Exercises *start at 10 repetitions 
Strength  Knee extensor 
Knee flexor 
Hip aductor 
Ankle plantarflexors (calf raises) 
Ankle dorsiflexors (toe raises) 
Balance  Knee bends 
Backwards walking 
Walking and turning around 
Sideways walking 
Tandem stance (heel toe stand) 
Tandem walk (heel toe walk) 
One leg stand 
Heel walking 
Toe walk 
Heel toe walking backwards 
Sit to stand 
Stair walking 


Indication

Older adults who are at risk of falling, particularly those who are over the age of 80. 

Clinical Presentation

The frail older adult: those who have had a fall already and those who have had not. 

Individuals with strength and balance deficits as defined by failure to complete either the chair stand test or four-test balance scale[12]

Resources

New Zealand Accident Compensation Corporation’s manual for the Otago Exercise Programme. The manual contains: background, evidence, instructions for training providers and prescribing exercises, record sheets and information for participants (exercise booklets). 

"How to do it:Practical implementation of an exercise-based falls prevention programme" by Gardner et al, 2001.

References

  1. 1.0 1.1 1.2 1.3 Campbell AJ, Robertson MC for the New Zealand Accident Compensation Corporation. Otago Exercise Programme to prevent falls in older adults. 2003. Accessed 2 October 2018.
  2. Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin. 2001,22;3–4: 78-83. Accessed 13 October 2018.
  3. 3.0 3.1 World Health Organisation. Falls. 2018. Accessed 16 October 2018.
  4. Parry SW, Deary V. How should we manage fear of falling in older adults living in the community?BMJ, 2013; 346. Accessed 16 October 2018.
  5. Morello RT, Barker A, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA Stoelwinder JU. The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust 2015; 203;9: 367e1-8. Accessed 16 October 2018.
  6. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc, 2018; 66:693–698. Accessed 16 October 2018.
  7. Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing, 2010; 39 (6): 681–687. Accessed 16 October 2018.
  8. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan Km, Marra CA. Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. Br J Sports Med 2010;44:80-89. Accessed 16 October.
  9. Queensland Government. Queensland Health: Otago Exercise Programme - Qld Stay On Your Feet. 2013. Accessed 16 October 2018.
  10. Shubert TE, Goto LS, Smith ML, Jiang L, Rudman H, Ory MG. The Otago Exercise Program: Innovative Delivery Models to Maximize Sustained Outcomes for High Risk, Homebound Older Adults. Front Public Health 2017; 5: 54. Accessed 16 October 2018.
  11. Martins AC, Santos C, Silva C, Baltazar D, Moreira J, Tavares N. Does modified Otago Exercise Program improves balance in older people? A systematic review. Prev Med Rep. 2018; 11: 231–239. Accessed 16 October 2018.
  12. 12.0 12.1 12.2 Gardner MM, Buchner DM, Robertson MC, Campbell AJ. How to do it: practical implementation of an exercise-based falls prevention programme. Age Ageing 2001; 30: 77-83. Accessed 16 October 2018.