Impact of multicomponent home-based exercise on fear of falling in older people with a history of falls: insights from the GAITCARE project.

Aims: To compare the effectiveness of an 8-week multicomponent exercise program delivered at home with digital support versus conventional in-person hospital exercise sessions in reducing FOF. Materials and methods: The GAITCARE project is a multicenter quasi-experimental trial in three hospitals. Participants were assigned by hospital to either: (1) VIVIFIL App group-individualized daily home exercise with remote supervision; or (2) In person group-face to face exercise at hospital day-care units. The primary outcome was FOF measured by the Short Falls Efficacy Scale-International (Short FES-I). Secondary outcomes included adherence and app satisfaction. Results: 127 participants were included (64 in App group, 63 in-person group), aged 70-93 (mean 82.36). FOF (SFES-I) was present in 68.3% of the in-person group and 54.7% of the App group. The 8-week intervention reduced FOF scores in both groups, reaching statistical significance only in the in-person group. However, the App group also showed a clinically relevant reduction (∼20%) despite starting with slightly lower baseline FOF, suggesting potential benefits of remote delivery. The in-person group showed higher adherence at weeks 4, 8, and 12 (follow-up). Baseline physical activity influenced adherence, with sedentary participants showing lower adherence. Digital delivery with remote supervision showed good feasibility and was generally well accepted by participants. Conclusion: FOF is prevalent in older adults with falls and can be significantly reduced by face-to-face group exercise, which also achieves higher adherence. Enhancements in telematic applications are necessary to improve adherence in digital interventions targeting FOF.