90 | Chapter 5 our results. Last, this study included a wide range of outcome measures, including physical activity measures. A limitation of this study is that it was powered based on an anticipated 50% less falls in the intervention group compared to the control group, but the observed reduction was only 15%, making the study underpowered for the primary outcomes. Second, the primary outcomes—the number of falls and fall-related injuries—were collected through self-reported data. The combination of monthly phone calls and fall and injury diaries has been shown the most accurate method and helped mitigate recall bias (97). At the same time, intensive monitoring during the post-intervention follow-up period may have led to a high number of reported falls compared to retrospective questionnaires. Furthermore, a limitation of this study is that attendance was not distinguished between participation in the information/education sessions (weeks 1–4) and the exercise sessions (weeks 5–14), because this data was not available in most individuals. Last, a limitation of this study is that, although the In Balance intervention includes education for environmental modifications, we did not monitor whether participants implemented these changes in their own homes. As a result, we cannot assess the impact of environmental adjustments on fall prevention outcomes. There are some practical implications for fall prevention programs like In Balance based on the results of this study. First, it may be important to implement follow-up exercise programs after the initial intervention to achieve the desired health outcomes. A fall prevention program, such as In Balance, aims for long term benefits, e.g. to protect people from falls in the long term. To maintain these long-term benefits, it is essential that knowledge and skills are periodically refreshed, and that the training effects gained during the intervention are sustained. Follow-up activities, particularly those involving exercises targeting strength and balance, can play an important role in this. Moreover, in our study, we saw the largest effects directly after the intervention compared to the long-term effects. Further research should explore the impact of continuous fall prevention and exercise interventions, rather than a stand-alone program. Enhancing participant engagement through personalized support and regular check-ins could also improve adherence and effectiveness; and may possibly be boosted by telemedicine and technological solutions. Additionally, future research should include a larger sample size, as our power analysis was based on 50% less falls in the intervention group compared to the control group, and appeared to be 15%. Moreover, future studies could investigate tailoring interventions for both non-frail and pre-frail older adults to maximize benefits across a wider population. Last, although this study was conducted in the Netherlands, its findings are valuable for other countries with similar demographic
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