8 General discussion and summary | 163 these barriers (230, 307). Nonetheless, if the duration or design of the program limits its impact on fall reduction, strategies to increase attendance may need to be accompanied by structural changes to the intervention itself. Online support offer further potential for improving adherence (308, 309). Tools like apps and online platforms can provide participants with greater flexibility, accommodating those who face logistical or health-related challenges (308). For example, the StandingTall program combined digital modules with home visits, boosting adherence and achieving long-term goals (310). Similarly, exergaming, interactive video games that require physical exertion, can improve both motor and cognitive functions while making exercise more engaging, and thus can improve adherence (311-313). Duration of and continuation after the In Balance intervention A second potential explanation for the lack of significant effects is the 14-week duration of the In Balance intervention, which may be too short to achieve significant health improvements such as reduced falls, injuries, and improved strength, balance, and mobility (305, 306). Research suggests that effective programs require at least 26 weeks, with 3 hours per week, to reduce falls (305, 306). The In Balance intervention was shortened from 20 to 14 weeks to improve feasibility of widespread implementation. Furthermore, in a previous study evaluating In Balance in a nursing home setting the impact on the number of falls did not increase anymore after 12 weeks. Finally, longer intervention programs may face difficulties in recruiting participants (314). Additionally, longer durations may not fit into therapists’ daily practices due to the time commitment required (315). However, both this study and existing literature highlight the importance of continued exercise post-intervention, as only minimal health benefits are observed during the short training period (46, 49, 136, 179, 305, 316). To maximize the impact of the program, follow-up exercise should be encouraged. Offering participants easy access to community-based programs, like Tai Chi or walking groups, or online platforms with virtual classes can help reinforce the skills developed (317, 318). For example, the Dutch ‘SeniorenFit’ program offers supervised strength, balance, and coordination exercises, and MBvO (Meer Bewegen voor Ouderen, translated as More Exercise for Older Adults) provides various activities, such as Tai Chi and dancing, tailored to older adults. These programs, often held in community centers, focus on maintaining mobility and independence, supporting long-term health benefits after the intervention. Follow-up sessions could also improve the long-term effectiveness of the In Balance program by reinforcing learned behaviours. Additionally, emphasizing the importance of continued physical activity and long-term behaviour change during the program, for example, through
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