Feasibility and preliminary efficacy of Ai Chi aquatic exercise training in Hong Kong's older adults with risk of falling: Design and methodology of a randomized controlled trial

Falls in older adults are a major global public health concern. Group exercise could mitigate fall risk but the traditional land-based group exercise may not be always suitable for older adults at risk of falling, especially for those with musculoskeletal problems. Ai Chi aquatic exercise program could provide a safe and low-impact exercise training for older adults. However, the feasibility and efficacy of the program has not been well-investigated. The objective of this study is to investigate the feasibility and efficacy of the Ai Chi aquatic exercise program, compared to the land-based exercise program for older adults with moderate to high risk of falling. Forty community-dwelling older adults aged 65 or above with moderate to high fall risk will be recruited. They will be randomly allocated in the Ai Chi Aquatic Exercise Group (intervention) or the Land-based Exercise Group (active control) receiving 16 sessions (8 weeks) of specific exercise training. Feasibility of both exercise groups will be examined by recruitment, adherence, retention, feedback, subjective exercise experiences and satisfaction. Preliminary efficacy will be determined by whether physical and psychological fall risk factors could be mitigated. Physical fall risk assessment will include tests for flexibility, muscle strength, gait and balance. Psychological fall risk will be evaluated by preliminary cognitive function, anxiety level, level of depression and fear of falling. The results could establish a solid foundation for worldwide development of a feasible, safe and effective Ai Chi aquatic exercise program for prevention of falls in older adults with risk of falling.