PROJECT SUMMARY
Among persons aged 65 and older, falls are the leading cause of morbidity and mortality and impose
significant social and economic burdens on community health services and healthcare systems. Although
evidence shows that group-based, in-person exercise interventions improve strength, balance, and dual-task
abilities and consequently directly and indirectly reduce the incidence of falls effectively in older adults, such
approaches are problematic in practice because they can be costly, have limited reach, can be logistically
difficult to implement, and are often not scalable or generalizable. Therefore, timely identification of alternative
implementation strategies that can overcome these limitations to expand delivery of fall prevention
interventions to the aging population at greatest risk for falls is of high public health importance and clinical
relevance. In response to implementation challenges and community care needs in fall prevention, the primary
objective of this project is to evaluate a home-based virtual fall prevention exercise intervention that eliminates
common barriers to older adults participating in group-based in-person intervention programs. The proposed
intervention is founded on the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program,
which has been specifically reconfigured into a virtual format (V-TJQMBB) delivered through real-time
videoconferencing at home. Supported by promising data on feasibility, acceptability, and demand, we propose
a 6-month randomized controlled virtual trial to determine the comparative effectiveness of the V-TJQMBB
intervention, relative to a virtual multimodal exercise intervention, in lowering the incidence of falls (primary
outcome) and improving dual-task performance and physical and cognitive functioning (secondary outcomes)
among at-risk older adults living across the U.S. We will also (a) evaluate whether the benefits of the V-
TJQMBB intervention on falls can be sustained following formal training and (b) examine the mechanisms
(mediators of improved dual-task cost and executive function) through which the V-TJQMBB intervention
reduces fall rates. In addition, we will explore implementation potential by examining practical issues, including
intervention fidelity, compliance, acceptability, and perceived burdens and benefits of online exercise. The
proposed project is novel because it represents a paradigm shift in program delivery from in-person to virtual
and is significant because the clinical value of many home-based fall prevention interventions remains
inconclusive. If successful, the proposed study will extend the reach and impact of the evidence-based
TJQMBB intervention beyond locally situated community-facility settings to home settings where access is not
weather limited, transportation dependent, or geographically bounded. Thus, this proposal advances
dissemination and implementation research by providing a scalable, flexible, and fiscally responsible means for
sustainable fall prevention that potentially could be implemented across the country.
