Use of Tele-Exercise for Translating an Evidence-Based Fall-Prevention Program for Older Adults in West Virginia

West Virginia (WV) has a critical need for resources to reach more of its older adults with
fall-prevention programming. The Tai Ji Quan: Moving for Better Balance® (TJQMBB) program is
an evidence-based, CDC-approved, community-delivered, physical activity fall-prevention
intervention for older adults. The program is efficacious and effective in reducing falls in
older adults, and has been translated into clinical and community settings. Programs
delivered in one setting; however, may not automatically translate to others. We recently
completed a CDC-funded study which successfully translated a 16-week TJQMBB intervention into
20 faith-based organizations in 7 rural WV counties. In the maintenance phase of the study
(i.e., post intervention), only 38% of classes continued despite the fact that 87% of
participants expressed a desire to continue. The rate limiting factor for continuing classes
in these rural areas was lack of instructors. Thus, there is a vital need to further
translate TJQMBB into practice using alternative delivery channels to increase the reach and
maintenance of the program, especially in rural areas where instructors are less available.

Using telehealth technology to deliver exercise classes (i.e. tele-exercise) is one
alternative to the traditional, face-to-face, group exercise classes where the instructor and
participants are in the same room. We propose delivering tele-TJQMBB to older adults using a
computer, television, and the internet. This delivery mode will allow us to recruit
instructors from any location (e.g., urban areas), and with possibly more experience, yet
still reach older adults in communities without instructors.

The purpose of this translational study is to work with our injury control, technology, and
wellness partners to: 1) implement a 16-week intervention of the tele-TJQMBB classes in 120
older adults at 12 community sites in 4 WV counties; 2) describe functional, self-reported,
and fall/injury outcomes; and 3) evaluate the translation of tele-TJQMBB with respect to its
Reach into the target population (number of participants), Effectiveness (participant
outcomes), Adoption (number of sites, instructors, classes), Implementation (fidelity
ratings), and Maintenance (satisfaction, continued participation) using the Re-aim Framework.
Demonstrating that tele-TJQMBB is effective would provide an additional delivery channel for
the program, help overcome the barrier of identifying instructors in rural areas, and in the
future, allow for the number of classes to be expanded to reach more older adults, provide
more community-based programs in which to refer older adults to, and enhance overall
maintenance of the program. To our knowledge, this is the first study to translate an
evidence-based, group, fall-prevention exercise program using an alternative delivery method
in a priority population, and thus, may serve as a model for reaching other underserved older
adults.

Inclusion Criteria:

- Adults age 55 and older

- Community-dwelling

- Able to attend 2, 1-hour Tai Ji Quan: Moving for Better Balance classes a week for 16
weeks

- Able to attend 2 testing sessions for data collection (Testing sessions will be
scheduled the week before classes begin and the week after the classes end)

- Able to walk at least 2 city blocks with or without an assistive device

Exclusion Criteria:

- Lack reliable transportation

- Unable to speak English