Fear of Falling May Be Linked to Lower Physical Activity for People with Physical Disabilities
A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
A growing number of people are aging with physical disabilities acquired earlier in life, such as muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI). People with these long-term physical disabilities may have fears about falling while performing everyday activities. Regular physical activity or exercise that builds strength, endurance, and balance can help to prevent falls as well as promoting health more generally. However, people aging with physical disabilities may be reluctant to exercise regularly if they are worried about falling. In a recent NIDILRR-funded study, researchers looked at physical activity level, fear of falling, actual fall history, and disability type in a sample of adults with either MD, MS, PPS, or SCI. They wanted to find out whether levels of physical activity differed by disability type and whether fear of falling or a history of falls were related to physical activity levels in this sample.
Researchers at the Rehabilitation Research and Training Center on Promoting Healthy Aging for Individuals with Long-Term Physical Disabilities looked at surveys from 1,591 adults with MD, MS, PPS, or SCI. The respondents reported their weekly physical activity level by indicating how many days in the previous week they had performed strenuous, moderate, or mild physical activity. They also answered 7 questions asking to what extent they felt fearful about falling while performing daily activities and reported whether or not they had fallen down at all in the past 6 months. Finally, the respondents reported their age, sex, disability type, and the extent of mobility limitations they experienced, ranging from 0 (no limitations) to 5 (limited ability to get around even with assistive devices).
The researchers first compared the levels of reported physical activity, fear regarding falling, fall history, and extent of mobility limitations among the 4 disability types. They found that:
- The respondents with SCI reported the highest average level of physical activity, followed by respondents with MS, MD, and then PPS.
- The respondents with PPS reported the highest level of fear about falling, followed by respondents with MD, SCI, and MS.
- Regarding actual falls, the highest percentage of the respondents with MD reported falling in the past 6 months, followed by the respondents with PPS, MS, and SCI.
- On average, the respondents with SCI reported the most severe mobility limitations followed by respondents with PPS, MD, and then MS.
When the researchers looked at the relationships between physical activity, actual fall history, and fear about falling, they found that the respondents who had actually fallen in the past 6 months reported similar levels of physical activity as the respondents who had not fallen. However, the respondents reporting greater fear about falling were less physically active than the respondents reporting less fear about falling. This association held up even after accounting for age, sex, disability type, and severity of mobility limitations.
The authors noted that fear of falling may be related to lowered physical activity and less participation in daily activities for people with physical disabilities. In this study, the respondents with PPS reported the lowest average activity levels as well as the highest levels of fear about falling. From this study, it is not clear whether fear of falling might have led the respondents to be less physically active, or if people who are less physically active are less confident in their ability to prevent or recover from falls. Future research may be useful to determine whether there is a causal connection between fear of falling and reduced physical activity.
The authors noted that fall prevention programs may help people with physical disabilities to develop strategies for safe physical activity. These programs may be especially beneficial for people with PPS, who reported relatively high fear about falling and lower physical activity in this study. In addition, rehabilitation providers may wish to ask their clients with physical disabilities if they are concerned about falling as part of their regular intake and referral process.
To Learn More
Falls prevention research includes understanding the causes of falls, whether medical or environmental, and developing interventions to mitigate these causes and build confidence in one’s ability to avoid or recover from a fall. Learn more about falls prevention research and programs from the NIDILRR community and elsewhere in Celebrate Fall, not Falls – Resources for Falls Prevention Awareness Week from NARIC’s Spotlight blog.
To Learn More About this Study
Matsuda, P.N., Egan, T., Hreha, K.P., Finlayson, M.L., and Molton, I.R. (2020) Relationship between fear of falling and physical activity in people aging with a disability. PM&R, 12, 454-461. This article is available from the NARIC collection under Accession Number J84744.