3 Protocol for the In Balance randomized controlled trial | 45 activity, the impact a fall can have on a person’s life and health, and the purpose of the In Balance intervention. In the second phase (week 2-4), there are three weekly educational meetings about increasing awareness of one’s fall risk and balance disturbance, increasing knowledge about how to implement effective fall prevention methods and getting acquainted with the upcoming training weeks. The third phase (week 5-14) consists of a physical exercise programme with two one-hour training sessions per week. Exercises are derived from principles of Tai Chi, with balance and strength elements and with emphasis on standing strong and shifting weight. Education and Tai Chi exercises are known to be effective in reducing the incidence of falls (152-154). After each session, the participants receive homework, consisting of conducting exercises learned during the training sessions and reading parts of the textbook belonging to the In Balance intervention. Participants are expected to spend about one hour per week on this homework, distributed over several days. The 3 phases of the intervention are summarized in Figure 3.1. Figure 3.1. Overview of the In Balance intervention Control group The control group will receive written general physical activity recommendations in the form of a flyer. This flyer contains advice on physical activity levels, strength and balance for older adults. For example, a minimal amount of 150 minutes of moderate to vigorous physical activity per week is recommended, distributed over several days. Also muscle and bone strengthening activities such as walking stairs and balance exercises at least twice per week are advised. Moreover, the health benefits associated with physical activity are explained. These recommendations follow the Dutch Guidelines for Physical Activity (155). To minimize study attrition, participants of both the intervention and control group will receive regular newsletters during the study and a personal advise on (changes in) physical performance after ending of the study.
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