摘要：Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls. Falls contribute significantly to morbidity among older adults (aged 65 years and older), 1 , 2 and balance problems are an important risk factor for falls. 3 Despite evidence showing that specific exercise programs can improve balancing ablility, little is known about the success of these programs when broadly delivered in a community context. Since the mid-1990s, randomized controlled trials have demonstrated that it is possible to reduce the incidence of falls among older adults with physical exercise interventions to improve balance. 4 – 6 Although initial studies focused mainly on intensive individual programs, more recent studies have examined group programs. 7 , 8 These studies were conducted in contexts where research method constraints prevailed over those related to result implementation (generalization). Unfortunately, interventions shown to be effective in tightly controlled efficacy studies do not necessarily yield similar effects when delivered on a large scale in clinical or community settings. 9 The pivotal issue is how to disseminate interventions, found to be effective, in real-life contexts without jeopardizing components essential to their efficacy. Given the demonstrated efficacy of exercise interventions in improving balance and reducing falls and the dearth of information on their effectiveness in real-life settings, the purpose of this study was to determine the effectiveness of a group-based exercise intervention designed to improve balance among older adults. Our hypothesis was that even when delivered in a natural setting by personnel and staff in local older-adult centers and community health organizations, a group-based exercise intervention may improve balance among older adults concerned about falls.
