Summary
Falls and fall related injuries are a leading cause of death, disability, hospitalization, and institutionalization globally. Among Canadian seniors, 20-30% falls annually cause physical and psychological harm, costing the healthcare system an estimated 2 billion dollars. Physical activity and exercise have been shown to be the most effective way to reduce the risks of falls and fall-related injuries. The Zoomers on the Go program, funded by the Public Health Agency of Canada through the Healthy Seniors Pilot Project, is an evidence-informed, fall prevention exercise program, offered at no cost in English and French to adults aged 50 and above. Since its conception in 2012, more than 2500 individuals have participated, with many returning each cycle Currently, Zoomers on the Go is offered in-person and virtually, attracting about 800 people per 12 week cycle. All classes are peer-led by certified volunteers and offered 2-3 times a week for one hour. Each session consists of strength, balance, and flexibility training. Participants are also provided educational resources to reduce their risk of falls. Research findings show that participants benefit from increased balance, strength and well-being while decreasing their risk of falls. Zoomers on the Go was initiated in New Brunswick, a small Canadian province, but recently received funding to be implemented across Canada and abroad. The goal is now to learn how to increase accessibility, attract underrepresented groups, and grow the program. Zoomers on the Go is fulfilling its mission of offering accessible and effective fall prevention exercise programming for all!
Planning and Implementation
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What was the challenge you were trying to address?
Fall and fall-related injuries are a leading cause of hospitalization, disability, and death in Canada. The annual fall rate among Canadian seniors is 20-30%. Falls cause physical and psychological harm to individuals and create a burden for caregivers. Fall-related hospital stays last 9 days longer than the average, and 1/3 of fall-related hospitalizations among seniors results in long-term care institutionalization. More than 2 billion dollars is spent annually by the Canadian Health Care system to treat fall related injuries. Research has shown that the most effective way to prevent falls and fall-related injuries is exercise. However, many seniors either do not see themselves at risk of falls or do not have access to effective fall prevention programs. Many barriers exist preventing individuals from participating in exercise including lack of programming, finances, travel, time, self-efficacy, and ability levels. Zoomers on the Go is designed to both prevent falls using evidence-informed exercises and to mitigate barriers individuals may experience when attempting to exercise. For example, the program is free to all participants. It is peer-led which makes class more enjoyable and helps participants develop self-efficacy to exercise. The program is implementable in both urban and rural settings and is available online for those who cannot access a local class. Through research and collaboration, Zoomers on the Go has become a low barrier program that improves the lives of its participants and reduces hospital and caregiver burden through fall and fall injury prevention.
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Who were you trying to impact?
Older people in general, Older people with vulnerabilities
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What sectors were you targeting?
Education, Health
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Who else was involved?
Government, Academia, Health Care
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How did older people participate?
Older people were part of the process at multiple or all stages
Lessons learned
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Please describe how collaboration worked in your initiative.
Implementing Zoomers on the Go requires collaboration between various stakeholders. The University of New Brunswick Cardiometabolic Exercise and Lifestyles Laboratory (CELLAB) takes care of the day-to-day tasks of implementing Zoomers on the Go, including finding locations for classes, recruiting participants and leaders, and running everything smoothly. The CELLAB also performs research on the Zoomers on the Go program to demonstrate that the program is evidence-informed and effective. Collaborators are from different sectors: 1. Non-profit organizations: Fitness New Brunswick, oversees the training and certification of peer leaders. 2. Provincial Health Authorities: A major funding organization for staff administration, the program website host, and a participate in the advisory committee. Their community developers help with finding locations to host classes and participate in the advisory committee. 3. The communities: Classes are held in locations where spaces are offered for free (e.g., library, arena, church). They deserve a lot of the credit because without various community centers donating their space, we would be unable to afford to expand Zoomers on the Go. 4. Advisory committee: Many stakeholders (e.g., non-profit organizations, private sectors, older adults, government representation) sit on the provincial advisory committee to help staff with recruitment of participants/leaders, implementation, and motivation. 5. The program is funded by the the provincial government and Public Health agency of Canada. As a result, we have the expectations to have a strong knowledge transfer plan, and that lessons learned and findings are shared across Canada.
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What was the impact of your initiative on older people, their families, and/or their communities?
Our research has shown that participants in Zoomers on the Go, experience many health benefits including a reduced risk of falling, increased balance, increased functional ability, and better emotional health. These benefits also impact other aspects of their lives because they are less likely to experience fall related injury and disability and are more likely to stay healthy, happy and independent for longer. Seniors who are more independent are better able to care for themselves and less likely to be a burden on caregivers and the larger healthcare system. By preventing falls and fall-related injuries, we help free up valuable resources by reducing emergency room visits, hospitalizations and long-term institutionalization.
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What issues did you face, and how did you address them?
Balancing the various needs of Zoomers on the Go, is challenging, especially with a rapidly expanding program. The processes we use must be barrier-free for participants, convenient for leaders, and feasible for our team given our time, financial, and staff restraints. Processes that worked well when the program was smaller, are no longer viable for our staff. One example of this was our registration system. Previously, Zoomers on the Go was small enough that we could register individuals by driving to the individual class locations, but as the program has expanded, this was no longer feasible. Instead, we decided to switch to an online registration system. However, we failed to consider the lack of digital literacy among our participants and chose a system that was convenient for us, but difficult for our participants to use. This led to unnecessary headache for staff, participants and leaders, as participants stressed about guaranteeing their place in the program. After consulting with our leaders and participants we decided to use a much more user-friendly registration system that has saved everyone a lot of time and stress. Whenever we face challenges, we do our best to brainstorm solutions with our various stakeholders, that meet all of the needs above. Sometimes, we fail but through communication, experimenting and innovative change, we have adapted to the various challenges that have come our way.
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What lessons did you learn from implementing this initiative?
One thing that we have learned from the latest systematic reviews and the latest WHO guidelines for falls prevention, is what makes up an effective fall prevention exercise program. To meet this goal, a program is most effective if it focuses on balance-related exercises. While strength, aerobic, and flexibility training also contribute to fall prevention and have many other health benefits, balance needs to be the main component to reduce the risk of falls. Balance exercises train the neuromuscular system to respond quickly and effectively to events that challenge balance and may result in a fall. Our program is structured so that the first 10 minutes consist of dynamic flexibility exercises, the next 10-15 minutes are strength exercises, the next 25-35 minutes are balance training, and the final 10-15 minutes are stretching and cool down exercises. A second lesson that we have learned is that we need to make sure to identify and find solutions to the many barriers that individuals face when trying to access exercise programs. Anytime we make a change to the program, we fix some barriers, but can also build others. The best way to identify barriers is to talk directly with, and engage our participants and leaders. Common barriers include time, finances, transportation, digital literacy, self-efficacy, and a lack of knowledge of fall risks and mobility.
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Do you have any other reflections you would like to share?
Many exercise programs exist around the world to increase well-being and reduce the risk of falls of aging adults. This one is particular because it has elements (e.g., offered in multiple language, for free, by peers, in the community) that make it more accessible and sustainable. Any views and opinions expressed in this case study are solely those of the Recipient and may not reflect the views and opinions of the Government of Canada.