Author(s): LIAO, Q., ZHENG, C., ZHANG, H., CHEN, J., CHENG, Y., QU, Y., ZHANG, B., SUN, F., Institution: THE EDUCATION UNIVERSITY OF HONGKONG, Country: HONG KONG, Abstract-ID: 1348

INTRODUCTION:
Falls are a leading cause of injury in older adults, particularly among those with obesity. Exercise snacks, brief bouts of activity spread across the day, offer a feasible alternative for older adults facing barriers to traditional exercise. To our knowledge, no trial has compared home-based exercise snacks with supervised exercise on fall risk in obese older adults. This study compared the effects of 14-week home-based exercise snacks (ES) versus coach-led supervised exercise (SUP) versus control on fall risk, body composition, and quality of life. The cost efficiencies of both intervention programs were also calculated.
METHODS:
Ninety community-dwelling obese older adults [body mass index (BMI) ≥ 25 kg/m2] were randomly assigned to one of three groups. Participants in ES group performed 3–4 bouts of 8-minute video-guided home exercise (aerobic, resistance, balance) for 5 days per week. Participants in SUP group attended three supervised 70-minute exercise sessions on alternate days per week. Participants in control group maintained their habitual activity. Primary outcomes were the performance of Sensory Organization Test (SOT), Activities-specific Balance Confidence (ABC), and Falls Efficacy Scale-International (FES-I). Secondary outcomes included body composition, EuroQol Five-Dimension Five-Level Visual Analogue Scale (EQ-5D-5L VAS), and fall incidence. A descriptive cost analysis calculated per-participant cost and cost per fall prevented. Data were analyzed using linear mixed models with group (ES, SUP, Control) and time (pre- and post-intervention) as fixed factors under an intention-to-treat framework (n = 86: ES = 30, SUP = 29, Control = 27).
RESULTS:
Significant group × time interactions were observed for all primary outcomes: FES-I (F(2,83) = 15.09, p < .001, η²p = .27), ABC (F(2,83) = 25.95, p < .001, η²p = .39), and SOT (F(2,83) = 28.39, p < .001, η²p = .41). Both ES and SUP improved significantly versus controls (all p < .001), with large effect sizes (Cohen’s d: 1.29–1.97). SUP showed greater SOT gains than ES (+9.72 vs +6.20, d = 0.56), whereas ES yielded greater EQ-5D-5L VAS improvement (+12.83 vs +7.93, d = 0.65). Both ES and SUP reported zero falls versus 0.1 falls per person in control group. Per-participant cost was HKD 353 for ES and HKD 4,243 for SUP (ratio 1:12). The incremental cost per fall prevented was USD 453 for ES and USD 5,440 for SUP.
CONCLUSION:
Both ES and SUP interventions significantly improved balance, fall related self-efficacy, and quality of life, with comparable fall prevention outcomes. ES demonstrated a significant cost advantage and a cost per fall prevented, when compared with SUP. These findings support home-based exercise snacks as an economically viable and scalable fall prevention strategy for obese older adults, particularly where access to supervised programme is limited.