Strength and balance programmes can help us live well – so why aren’t they available for all?

Over the past year, I have been involved in delivering a project focussed on increasing the availability, provision and uptake of community-based strength and balance exercise programmes. The OTAGO and Fitness and Mobility Exercise (FaME) programmes are both proven to reduce falls and risk of falls for older adults living in the community. OTAGO can be delivered at home or within a community setting, whilst FaME is mainly delivered in group  settings by highly-skilled exercise instructors. 

Both are offered either as part of a rehabilitation programme after a fall, or as part of a community programme of prevention. In our travels across England working with local areas and trying to further understand how these programmes were funded and delivered, we came across a great variety of practice. In some areas, both types of programme were on offer, providers had strong links with referral pathways (eg. GPs, Physiotherapist, Rehabilitation Services, Falls Services). Yet in other areas, things were not so joined-up.

As we delved deeper into local community provision, we met a number of individuals who really reaped the benefits that good, joined-up, person-centred pathways could deliver. We met Catherine (83) who was living with a number of long-term conditions, and as a result, was a frequent faller. Catherine had been referred to a community-based FaME programme by her GP. She had a local class – which was easy to get to on the bus – that was delivered by Lucy, a skilled exercise instructor. Catherine attended her weekly class, met new friends, always completed her home exercises, and over time became more confident.

She learnt how to get up from the floor so that when she did have a fall, she could get up herself and continue with her daily activities. Catherine was often out visiting friends, taking part in community activities and enjoying a happy later life. Where Catherine lived, services were well funded and organised, referral pathways were working well because all local healthcare professionals were well informed, knew about Lucy’s classes and referred into them.

In contrast to Catherine, we met Susan. Susan (62) was working part-time where she was paid the minimum wage and had no family or support nearby. Susan had experienced three falls in the 12 months before we met. The first fall resulted in a fractured wrist. She was immediately referred to her GP, where following some tests, she was diagnosed with borderline osteoarthritis. Advised to take a supplement, she was not referred onto any strength and balance programmes. Her second fall did not involve any physical injuries, but mentally, Susan started to be concerned about going out, and attending work became a challenge.

Her third fall was backwards down a series of concrete steps in the flats where she lived. She was told by the paramedic that there were no fractures, but three days later, and in a lot of pain, Susan made her way to the local accident and emergency department where she was told she had fractured her wrist again. At no point did anyone suggest Susan should attend a strength and balance exercise programme to help her build her strength, improve her balance, gain greater confidence and in the long run, reduce the risk of future falls.

This is an example of health inequalities: two people living in different areas, but each experiencing very different levels of support and access to evidence-based community exercise provision. These two stories still resonate with me today. When community-based services are person-centred, have co-created pathways that are shared, and skilled instructors who understand how to deliver evidence-based exercise programmes, people are able to live well in later life.

On the contrary, for those living in areas of high deprivation, where services are poor – often due to underfunding – are not joined up and lack good leadership, inequalities in health continue to impact on those living in our communities.