Targeting concerns about falling to modulate biological stress systems: Effects of a multicomponent randomized controlled trial in older adults

Introduction

Concerns about falling (CaF) are common in older adults and may act as a chronic stressor affecting physical activity, psychological well-being and physiological regulation. This study examined the impact of a 16-week multimodal exercise intervention on CaF, stress pathways, and peripheral inflammation in older adults.

Methods

In the randomized, controlled FEARFALL study, 160 community-dwelling older adults (aged ≥70 years) were assigned to either an intervention group (IG) or a sham control group (SCG). The IG received a multimodal exercise program, while the SCG engaged in low-intensity activities. Three psychological questionnaires were used to assess CaF: Falls Efficacy Scale-International [FES-I] (fear of falling); Falls Efficacy Scale-International Avoidance Behavior [FES-IAB] (avoidance behavior); Updated Perceived Control of Falling Scale [UP-CoF] (perceived control). Hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) activity was determined using saliva samples (cortisol, alpha-amylase), inflammatory markers using blood samples (C-reactive protein [CRP], Interleukin 6 [IL-6]).

Results

There were significant improvements in CaF over time and perceived control in both groups (FES-I: β = −6.645, 95 %-CI [-10.56, −2.73], p = .001; UP-CoF: β = 3.911, 95 %-CI [1.24, 6.58], p = .004). Diurnal cortisol slope normalized after the intervention (β = −0.014, 95 %-CI [-0.03, 0.00], p = .014), while other neuroendocrine and inflammatory markers remained unchanged.

Conclusion

A multimodal short-term intervention reduced psychological aspects of CaF, while physiological stress and inflammatory parameters may require more intensive or longer-term interventions. Findings support CaF as a biopsychosocial stressor and highlight the efficacy of multimodal programs in enhancing coping in older adults.