Active Ageing Project: Training materials for train-the-trainer workshops

Ref. Ares(2025)11608556 - 28/12/2025

WORKSHOP LEARNING MATERIALS

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.

INTRODUCTION 1) Ageing of the population: what’s changing and why trainers matter Population ageing is accelerating worldwide. WHO highlights that: By 2030, 1 in 6 people globally will be aged 60+.

The number of people aged 60+ is expected to increase from 1.0 billion (2020) to 1.4 billion (2030) and double to 2.1 billion by 2050.

People aged 80+ are projected to triple between 2020 and 2050 (to 426 million).

What this means for trainers: You will see larger numbers of older adults in community programmes.

Participants will be more diverse: from highly active “young-old” adults to people living with frailty, multimorbidity, pain, sensory loss, cognitive changes, or disability.

Demand will grow for programmes that support independence, confidence, and safe mobility —not only “fitness”.

Healthy ageing in trainer language WHO frames healthy ageing as maintaining functional ability—the ability to do what a person values (move around, participate socially, manage daily tasks).

For trainers, this translates into three priorities: Strength and power for daily tasks (stairs, carrying, getting up from a chair).

Balance and gait for safe mobility and fall prevention.

Confidence and participation to keep people active long term.

Ageing commonly involves: Sarcopenia: loss of muscle mass/strength (especially fast-twitch fibres) → slower reactions, weaker legs.

Reduced balance control: slower sensory integration (vision/vestibular/proprioception), less ankle/hip strategy efficiency.

Lower bone density → higher fracture risk if a fall happens.

Chronic conditions (arthritis, diabetes, cardiovascular disease) and polypharmacy can add dizziness, fatigue, pain or instability.

The critical teaching point: many of these changes are modifiable through the right kind of physical activity and progressive training.

2) Benefits of physical activity for older adults Across all ages, WHO emphasises that any physical activity is better than none, and starting small is beneficial—especially for people who have been inactive.

Physical benefits: Better muscle strength, balance, coordination, mobility, and functional capacity (daily living).

Better cardiometabolic health (blood pressure, glucose control, weight management).

Improved bone health when loading and strength training are included (important for fracture prevention).

Mental and cognitive benefits: Reduced symptoms of anxiety and depression, improved sleep and wellbeing.

Stronger cognitive functioning is commonly associated with regular activity (especially when activities include coordination, learning, or social engagement).

Social benefits: Group sessions reduce isolation and increase adherence—people show up for community, not just exercise.

Trainer teaching line: “We’re not training for sport performance. We’re training for life performance: walking, turning, stepping, carrying, rising, recovering.”

3) Falls among older people: the issue, the impact, and why prevention is urgent WHO’s Global Report on Falls Prevention in Older Age states: Approximately 28–35% of people aged 65+ fall each year.

This increases to 32–42% for those aged 70+.

A large 2022 systematic review and meta-analysis (104 studies; >36 million participants) estimated a global prevalence of falls of ~26.5% in older people, reinforcing how common falls are worldwide.

Falls are not only bruises. WHO’s falls fact sheet notes: Falls are the second leading cause of unintentional injury deaths globally.

An estimated 684,000 deaths occur from falls each year (with >80% in low- and middleincome countries).

37.3 million falls require medical attention annually.

Adults older than 60 experience the greatest number of fatal falls.

Beyond injury, falls commonly lead to: Fear of falling → reduced activity → deconditioning → higher future risk.

Loss of independence, reduced social participation, and increased caregiver burden.

Higher health system costs (emergency care, imaging, hospitalisation, rehabilitation).

Falls typically result from an interaction of: Intrinsic factors: strength loss, balance impairment, vision problems, foot pain, dizziness, chronic disease, cognitive impairment.

Behaviour: rushing, unsafe footwear, low activity levels, alcohol, not using aids.

Environment: poor lighting, clutter, uneven surfaces, stairs without rails, slippery bathrooms.

Trainer role in a multifactorial problem: You are not expected to “solve” every factor—but you can deliver the most powerful modifiable component for many people: exercise that improves balance, strength, and function, and builds confidence to stay active.

4) Impact of physical activity on falls prevention: what the global guidelines say The World Guidelines for Falls Prevention and Management for Older Adults (Global Falls Guidelines Task Force) underline that many falls can be prevented and that prevention is strengthened by multidisciplinary, person-centred management.

For trainers, the key take-home is the exercise specification—not just “be active”.

The World Falls Guidelines recommend exercise programmes that include: Balance-challenging and functional exercises (e.g., stepping, sit-to-stand, turning, reaching, controlled transfers), Delivered 3+ times per week, individualised and progressed, With a minimum duration of 12 weeks (and continued longer for sustained effect).

WHO’s PA guidance reinforces the same pattern for older adults—especially those with reduced mobility: Do activity to enhance balance and prevent falls on 3 or more days per week, Plus muscle-strengthening activities on 2 or more days per week.

Why “walking only” is not enough: Walking is excellent for health, but on its own it may not sufficiently train: Rapid stepping reactions, Single-leg stance control, Turning stability, Lower-body strength and power needed for trip recovery.

Trainer message: “Walking is the base. Falls prevention needs balance challenge + leg strength + functional practice.”

A recent review summarises that programmes combining strength and balance training can substantially reduce falls in community-dwelling older adults (some studies report reductions approaching 50%, depending on programme and population).

(Use this as motivational evidence, while keeping expectations realistic and person-specific.)

5) Practical training guidance: delivering falls-prevention PA sessions 5.1 Safety first: screening and red flags Even when trainers follow a structured programme such as ABC+ Movement, safety screening remains essential. Before starting a cycle, and before progressing intensity, briefly check for: Recent falls: when/why, any injury, head hit, dizziness, blackout/loss of consciousness.

New or worsening symptoms: chest pain, severe breathlessness, fainting, acute infection/fever, severe uncontrolled blood pressure.

New neurological symptoms: sudden weakness/numbness, slurred speech, sudden severe headache, new confusion.

Red flags for referral (pause training and advise medical review): Falls with suspected loss of consciousness or unexplained repeated falls New severe dizziness/near-fainting, chest pain, or acute neurological symptoms This aligns with the World Falls Guidelines emphasis that some falls may be related to syncope/cardiovascular causes and need medical assessment, not only exercise-based management.

5.2 The trainer’s “dose” checklist While ABC+ provides the exercise content, trainers should still ensure the programme exposure (“dose”) matches what global recommendations describe as effective for falls prevention.

Frequency Balance/functional components: 3+ sessions per week (where feasible across supervised + home practice) Muscle-strengthening: 2+ days per week Timeframe Minimum 12 weeks, with encouragement to continue afterwards (maintenance is essential for sustained benefit).

Intensity / challenge “Balance-challenging” means the activity requires real postural control without compromising safety (appropriate support options, safe environment, and progressions).

Use simple monitoring tools: the talk test and RPE 0–10. Moderate aerobic effort often feels ~5– 6/10, but balance “challenge” is primarily about task difficulty, not breathlessness.

5.3 Individualisation in group delivery Even with a fixed programme structure, participants differ widely in mobility, confidence, cognition, pain, and fatigue. Trainers should individualise delivery through: Level options: offering easier/standard/harder versions within the ABC+ exercise choices (e.g., hand support, base of support, speed, range of motion).

One-variable progression: change only one aspect at a time (e.g., reduce support or increase speed, not both simultaneously).

Self-efficacy and confidence: normalise caution, address fear of falling, and reinforce progress (“steady improvement beats perfection”).

Adaptations for common issues: knee/hip pain → reduce range, slow tempo, more rests dizziness/orthostatic symptoms → slower transitions, seated options, hydration reminder cognitive impairment → shorter instructions, visual cues, consistent routine, caregiver support when appropriate 5.4 Environment and session-risk management essentials Falls prevention training must be delivered in an environment that reduces unnecessary hazards while still allowing safe challenge: Space setup: clear floor, good lighting, stable chairs, access to wall/bar support points.

Footwear: encourage closed-heel, non-slip footwear; avoid loose slippers.

Clutter control: remove loose mats/cables, keep pathways wide, mark steps/thresholds.

Equipment checks: chairs stable, bands/props intact, no tripping hazards.

Emergency readiness: trainers know local emergency procedures; participants know how to signal dizziness or pain; keep a phone available.

5.5 Communication and follow-up: making prevention “stick” Because falls risk is influenced by behaviour, health status, and environment, trainer communication is a key implementation tool: Encourage participants to report falls and near-falls (no shame; this improves safety and tailoring).

Reinforce the message “some activity is better than none,” and support gradual progression for inactive participants.

Signpost to health professionals when needed (vision changes, medication changes, persistent dizziness, new neurological symptoms).

Promote continuity: attendance and home practice determine results as much as programme quality.

6) Teaching content: explaining falls prevention to participants Explain the “why” in plain language: “Falls happen when the body can’t react fast enough to a trip, turn, or slip.”

“Balance isn’t one thing—it’s strength, reaction speed, and how the brain uses vision and body awareness.”

“The best way to reduce risk is practise: stepping, turning, standing from a chair, and strengthening the legs.”

Address fear of falling: Fear is common and can reduce activity, which increases risk. Normalise it: “Being careful is good; avoiding movement completely makes the body less steady.”

Set small wins: “Let’s improve your confidence one step at a time.”

7) Monitoring progress: simple measures trainers can use You don’t need a lab. Use functional checks every 8–12 weeks - the tests are explained in the learning materials Also monitor: Attendance (dose is crucial), Participant-reported confidence, Any falls or near-falls (encourage honest reporting).

8) Key messages to close the module Population ageing means falls prevention and functional fitness will become a core community need.

Falls are common and can be severe, but many are preventable.

The most effective exercise for falls prevention is not generic activity: it must be balancechallenging, functional, progressive, and done 3+ times per week over 12+ weeks, with ongoing maintenance.

Trainers make prevention real by turning guidelines into safe, motivating, scalable sessions that older adults actually attend and continue.

MONITORING TOOLS FOR TRAINERS ONE-LEG STAND Purpose: To measure postural control while the area of support is reduced.

Health relation: Falls, caused by poor postural control and leading to osteoporotic fractures, are a major health problem among older persons. The middle-aged persons with back pain often have impaired postural control.

Exclusion criteria: Contraindications include dizziness, severe spinal symptoms and problems of lower extremities that might be aggravated by the test Equipment: Stopwatch Performance: The participant can choose a preferred leg to stand on. The heel of the opposite foot is placed at knee against the inner side of the supporting leg (heel at the level of the knee joint so that thigh is rotated outwards. Arms hang relaxed at the participant's sides and eyes are open.

Instructions: "Stand on one leg as long as possible with the free leg against the inner side of the supporting leg, heel in the middle of the knee joint. Use your arms for balance only when necessary. Sixty seconds is the upper limit for the task."

Practice and number of test trials: The tester shows the right performance. For practise the participant tries to stand on each leg and chooses the better one for test performance. Two trials are performed unless the result of the first trial is 60 seconds.

Measurement: The maximal duration of the test is 60 seconds. Tester starts timing when the participant has reached the correct test position. Timing stops when the participant looses the balance (ie. foot of the free leg looses contact from the supporting leg, supporting leg moves) or 60 seconds is reached.

Scoring: Test result is the longest time in seconds the participant maintains the correct test position (0-60 s).

6 MINUTE WALK TEST (modified from the ATS Statement: Guidelines for the Six-Minute Walk Test. Am. Respir Crit Care Med 2002;166:111-117) Purpose: To measure submaximal aerobic capacity. On the basis of the test result it is possible to estimate also maximal aerobic capacity (VOmax).

Health relation: Poor aerobic capacity is a risk factor for cardiorespiratory symptoms and diseases.

Slow walking speed increases a risk for mobility limitations.

Exclusion criteria: Absolute contraindications for the test are unstable angina and myocardial infarction during the previous month. Relative contraindications include a resting heart rate > 120, a systolic blood pressure > 180 mmHg and a diastolic blood pressure >100 mmHg. Equipment: Milometer, Таре, Small cones to mark the turnaround points, Stopwatch, Heart rate monitor Criteria for test interruption: Chest pain, Intolerable dyspnea, Leg cramps, Staggering, Diaphoresis and pale or ashen appearance Location: The test should be performed indoors, along at least 18-m long, flat, straight, enclosed corridor with a hard surface. The walking course must be 15-m in length. A starting line, which marks the beginning and end of each 30-m lap, should be marked on the floor using bright colour tape. The turnaround points should be marked with cones at least 1.5 m away from the wall. The length of the course should be marked every 3 m in order to assist the calculation of the test result.

Instructions: "The object of the test is to walk as fast as possible for 6 minutes. Six minutes is a long time to walk. You will probably get out of breath or become exhausted during the test. Walk back and forth around the cones. You should pivot briskly around the cones and continue back the other way as quickly as possible. Now I'm going to show you. Please watch the way I turn.

Remember that the object is to walk AS FAR AS POSSIBLE for 6 minutes, but don't run or jog. Are you ready? Start NOW!" Tester gives the test instructions (above) and shows one pivot turn around the cone. During the test the tester stands by the starting line, does not walk with the participant. The tester uses even tone of voice when using the standard phrases of encouragement. Additional talk should be avoided. The tester starts timing when the participant starts to walk and stops it when six minutes has passed. Each time the participant returns to the starting line, the tester marks one line on the worksheet. Thus, one marked line corresponds 30 meters of walk. ·After the first minute the tester says: "You are doing well. You have 5 minutes to go" ·After two minutes the tester asks/watches the participant's heart rate and says:" Keep up the good work. You have 4 minutes to go". ·After three minutes the tester says: "You are doing well. You are halfway ·After four minutes the tester asks/watches the participant's heart rate and says: "Keep up the good work. You have only 2 minutes left." ·After five minutes the tester says: "You are doing well. You have only 1 minute to go"

·When there are 15 seconds left, the tester says: "In a moment I'm going to tell you to stop. When I do, just stop right where you are and I will come to you." ·When the time is up, the tester says: "Stop!", walks to the participant, asks/watches the heart rate and records it on the table of measurement.

If the participant stops walking during the test and needs a rest, the tester says: "You can lean against the wall if you like; then continue walking whenever you feel able."

If the patient stops before the 6 minutes are up and refuses to continue (or the tester decides that the test should be interrupted), the tester stops the timing, and notes on the worksheet the distance, the time stopped, and the reason for stopping prematurely.

Practise and number of test trials: Brisk walk is practiced for 2 laps (60m). Usual walking aids (cane, walker etc.) are allowed.

Score: The test score is the walked distance in meters. The tester counts the number of lines on the worksheet (completed laps) and multiplies it by 30. Additional distance covered (the number of meters in the final partial lap) is calculated with the help of the markers on the wall as distance guides. For example: If the participant completes 24 laps and additional 18 m, the test score is (24 × 30)+18=738 m.

SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) The SPPB is an objective battery that assesses lower-extremity function (balance, gait speed, and leg strength) in older adults, originally developed at the US National Institute on Aging (NIA). It is widely used in research and clinical practice, and NIA notes it is available to use without royalty fees.

Structure and scoring - 3 subtests: standing balance, 4 m gait speed, 5x chair stands. Each subtest is scored 0–4 points; total score 0–12, where higher scores indicate better performance.

Materials needed: Stopwatch, chair with backrest, tape measure, recording sheet.

Standard order: Balance → Gait speed → Chair stand (recommended to keep results comparable).

1) 5 times sit-to-stand from the chair (Chair Stand Test) Purpose: Measures lower-limb strength and power needed for daily tasks (rising from a chair, stair climbing) and is strongly related to mobility limitation.

Safety question (before starting): The protocol explicitly asks whether it feels safe to stand from a chair without using arms, and again whether it feels safe to repeat the stand five times.

How to perform (key protocol points): Participant sits with feet on the floor and arms folded across the chest.

Instruction: stand up straight as quickly as possible 5 times, without stopping; sit fully between repetitions; keep arms folded.

Start timing when you cue “Ready? Stand” (or “Go”), stop timing when fully upright on the 5th stand.

Stop the test if the participant uses arms, becomes unsafe/tired/short of breath, or if they cannot complete within 1 minute.

Scoring (0–4) Unable / >60 sec = 0 ≥16.70 sec = 1 13.70–16.69 sec = 2 11.20–13.69 sec = 3 ≤11.19 sec = 4 2) 4 m walking time (Gait Speed Test) Purpose: Measures usual gait speed, a strong indicator of functional capacity and future adverse outcomes.

How to perform (key protocol points): Use a 4-meter course.

Instruction: walk at usual pace, like walking to the store, and walk past the end line before stopping.

If the participant normally uses a cane/aid and feels they need it for a short distance, they may use it.

Do two trials and record the faster (shorter) time.

Stop timing when one foot is completely across the end line.

Scoring for 4 m (0–4) Unable to do the walk = 0 8.70 sec = 1 6.21–8.70 sec = 2 4.82–6.20 sec = 3 <4.82 sec = 4 3) Static balance test (Standing Balance) Purpose: Assesses postural stability in progressively harder foot positions.

Important eligibility note: In one commonly used protocol, the participant must be able to stand unassisted without a cane or walker for the balance stances (you may help them get into position).

The three stances (each up to 10 seconds) Side-by-side stand: feet together. Aim to hold ~10 seconds.

Semi-tandem stand: heel of one foot beside the big toe of the other (either foot in front). Hold ~10 seconds.

Tandem stand: heel of one foot directly in front of and touching the toes of the other (either foot in front). Hold ~10 seconds.

How to time: Stand close enough to prevent a fall; provide minimal support to help position; start timing when the person is ready and you let go; stop at 10 seconds or if they step out of position or grab you.

Scoring approach used in a “stance-by-stance” method (total 0–4) Side-by-side held 10 sec = 1 point (otherwise 0) Semi-tandem held 10 sec = 1 point (otherwise 0) Tandem held: 10 sec = 2 points 3–9.99 sec = 1 point <3 sec = 0 points

TANDEM BACKWALKING TEST Purpose: Measures postural control while walking with a narrow base of support (heel-to-toe) and reduced visual control (walking backwards → higher reliance on proprioception).

Safety: Exclude / stop if the participant has: Dizziness/vertigo Severe spinal symptoms Lower-limb musculoskeletal pain/injury that may be aggravated During the test: stop immediately if the participant looks unsafe, becomes unwell, or requests to stop.

Equipment: Stopwatch, Tape measure, Masking tape 2–4 cm width Set-up (preparations): Tape a straight 6-meter line on the floor. Mark START and FINISH with clear cross-lines. Add cross-marks every 1 meter (helps distance recording if an error occurs).

Instructions: Participant wears sport shoes. Stand with heels on the start line. Face away from the walking direction (back towards where they will walk).

Tester position: walk beside the participant, ready to support if balance is lost.

Standard instructions to participant: “Walk backwards as fast as possible along the 6-meter line by placing one foot directly behind the other so that the toe of the back foot touches the heel of the front foot (toe-to-heel).

Avoid mistakes like side-steps or not touching the heel with the toe.

Step so your whole foot touches the floor.

You may use your arms for balance, but do not raise them above shoulder level.”

Test: 3 trials (always complete 3).

Start the stopwatch at the first toe-to-heel touch.

Stop timing when the participant crosses the 6 m finish line (any part of the foot crossing counts).

If a mistake occurs: Record the distance from the start to the place of the first mistake (accuracy 0.5 m).

Common mistakes: Side-step off the line No toe-to-heel contact Scoring: Final score = best (fastest successful) time of the 3 trials.

If none of the 3 trials is successful: score = 0.

If no successful trial: record best distance achieved before the first mistake as a useful follow-up measure over time.

Fall Risk Assessment (questionnaire): what it is and how to use it This Fall Risk Assessment form is a short screening tool designed to give a rough estimate of an older adult’s risk of falling. The person completes it by marking one option per question, then summing points across all questions to obtain a total risk score.

How to administer: Ask the participant to answer the 6 questions honestly (or support them if needed).

Ensure only one option is selected per question.

Add up points from all questions to get the total score.

Interpret the score using the risk bands provided (see below).

The assessment questions Q1. Age group “What age group do you belong to?” under 75 years (0 points) 75–84 years (1 point) 85 years of age or older (2 points) Why it matters: fall risk and fall consequences generally rise with age, so age contributes to the overall estimate.

Q2. Falls in the past 12 months “Have you fallen in the past 12 months? (Falling means slipping, stumbling, tumbling)” No (0 points) Yes, 1 time (2 points) Yes, 2 or more times (4 points) Why it matters: a previous fall—especially repeated falls—is one of the strongest warning signs for future falls.

Q3. Balance confidence and safety when moving “Do you think your balance is good and do you feel safe when moving?”

Yes, I feel safe moving without any aids inside and outside (0 points) Yes, with aids (1 point) No, I feel unsafe about my balance and/or movement (2 points) Why it matters: self-perceived unsteadiness and reliance on aids can indicate functional balance limitations and/or fear of falling.

Q4. Need for help with daily chores and activities “Do you need help in coping with daily chores and activities? (dressing, washing, household chores such as cooking and cleaning, going to the shop, and managing your affairs)” No, I can handle everything myself (0 points) Yes, I need some help with some chores (1 point) Yes, I need a lot of help (2 points)

Why it matters: needing help with daily activities can reflect reduced strength, endurance, balance, cognition, or overall functional capacity.

Q5. Health conditions that increase falls risk “Do you have any of the above conditions?”

No (0 points) Yes, one (1 point) Yes, two or more (2 points) The form lists examples of conditions that increase risk, including heart disease, diabetes, Parkinson’s disease, vertigo, osteoporosis, impaired vision, memory disorder, stroke, respiratory disease, sensory loss in the lower limbs, and musculoskeletal disorders (e.g., osteoarthritis, joint replacement in lower limbs).

Why it matters: many chronic conditions affect gait, balance, reaction time, sensation, strength, or bone health—raising either fall likelihood or injury severity.

Q6. Physical activity frequency “How often do you engage in physical activity?”

3 times a week or more for at least 30 minutes at a time (0 points) 1–2 times a week for at least 30 minutes at a time (1 point) Occasionally, or not at all (2 points) Why it matters: lower activity levels are associated with deconditioning (strength/balance losses), which can increase falls risk.

Scoring and interpretation After adding all points, interpret the score as: 0 points: fall risk is not elevated 1–5 points: fall risk is elevated 6–8 points: fall risk is clearly elevated → professional assessment recommended 9–14 points: fall risk is great → professional assessment required

Dear ABC+ exercise group participant!

Active Ageing project is collecting information with these questionnaires to evaluate the effects and suitability of the ABC+ exercise program. Participation in the evaluation of the project's effects and suitability is completely voluntary.

With the following questions, we ask you to assess your quality of life, health, and other aspects of your daily life. Please answer all questions. If you are unsure which answer option to choose, select the one that seems most appropriate. Often, the most suitable answer is the one that first comes to mind.

Personal identifier: ___/___/___/___/___/___/ (letter from first and last name, year of birth)

1. How satisfied are you with your health? ☐ very poor ☐ poor

☐ neither poor nor good ☐ good

☐ very good 2. How would you rate your quality of life at the moment? ☐ very poor ☐ poor

☐ neither poor nor good ☐ good

☐ very good 3. Do you have enough energy for everyday life?

Think about your experiences over the past two weeks. ☐ not at all ☐ a little

☐ moderately ☐ mostly

☐ completely

4. How unsteady do you feel when walking indoors and/or outdoors? If you use a walking aid (a cane or a walker) while walking indoors or outdoors, please assess your walking balance with it.

Indoors my walking balance is Outdoors my walking balance is

very poor

poor

good

very good

5. Do you worry about falling when walking indoors and/or outdoors?

Select one option from each row.

I’m worried about falling indoors I’m worried about falling outdoors

yes

no

6. How much do you worry about falling when walking indoors and/or outdoors?

Select one option from each row.

I’m worried about falling indoors I’m worried about falling outdoors

Not much

A little

Somewhat

Much

7. How many times have you fallen during the last 12 months?

Indoors:_________times Outdoors: ________times

8. How much do you do balance training or exercises? For example, do exercises on one leg, move on an uneven surface, dance, do tai chi, play different ball and/or racquet games.

Please consider the last 12 months and the time before joining the ABC+ exercise group. ________ times a week

9. Under each heading, please tick the one box that best describes your health today.

Pain / discomfort I have no pain or discomfort I have slight pain or discomfort I have moderate pain or discomfort I have severe pain or discomfort I have extreme pain or discomfort Anxiety / depression I am not anxious or depressed I am slightly anxious or depressed I am moderately anxious or depressed I am severely anxious or depressed I am extremely anxious or depressed

Ref. Ares(2025)760631 - 31/01/2025

ABC+ MOVEMENT PROGRAM FOR ACTIVE AGEING AND VITAL LIVING

What is Healthy Exercise ABC Plus Program?

Content and Structure of the Healthy Exercise ABC Plus Program

Healthy Exercise ABC Plus is a movement

Each exercise unit consists of a preparatory, main, and

program that promotes an active lifestyle

concluding part. The prepratory part includes dynamic warm-up

and aims toimprove physical and functional

exercises, the main part contains strength and balance exercises

abilities in adults. It is an upgrade of the

in maximum of six difficulty levels, and the concluding part

existing Healthy Exercise A B C program, which

includes static stretching exercises. The program is planned for 12

was the first systematic multi-month program

weeks, with 2-3 exercise units per week. Each difficulty level of the

for improving physical fitness for adults in

exercise is expected to be performed in 4-6 exercise units.

Slovenia. The Healthy Exercise A B C Plus program includes exercises to increase strength (stability), balance, coordination, flexibility, and aerobic capacity. It adheres to recent global guidelines for planning healthy exercise.

The program consists of three exercise periods (EP), named Exercise Periods A, B, and C. Each exercise period is divided into the first two exercise units and the second two units. Thus, within Exercise Period A, the first part is called A1 and the second part is called A2.

Similarly, Exercise Periods B (B1 and B2) and Exercise periods C (C1 and C2) are represented. EP A includes content of the lowest volume and intensity of loads, which appropriately increase up to the conclusion of EP C. In the introductory part of the program, exercises on a coordination ladder and dynamic exercises without equipment are presented. The main part includes pelvic floor muscle exercises, strengthening exercises for the whole body using various exercise equipment, and exercises for static and dynamic balance on hard, soft, and elevated surfaces. The concluding part involves static stretchingexercises.

Instructions for Performing Progressive Strength Exercises in the Healthy Exercise ABC Plus Program Perform 10-12 repetitions of the exercise. You should feel the exercise as moderately strenuous. On the Borg

R P E SCALE Rate of Perceived Exertion 1

VERY LIGHT ACTIVITY Hardly any exertion, but more than sleeping, watching TV, etc.

2-3

LIGHT ACTIVITY Feels like you can maintain for hours, easy to breathe and carry on a conversation.

4-6

MODERATE ACTIVITY Breathing heavily but you can still hold a short conversation. Still somewhat comfortable, but becoming noticeably more challenging.

7-8

VIGOROUS ACTIVITY Borderline uncomfortable, short of breath, can speak asentence.

9

VERY HARD ACTIVITY Very difficult to maintain exercise intensity, can barely breathe, and can speak only a few words.

10

MAXIMAL E F F O R T Feels almost impossible to keep going, completely out of breath, unable to talk, cannot maintain for more than a very short amount of time.

scale, for example, moderate effort is rated at level 14.

If you feel less effort (e.g., 10), choose a more difficult version of the exercise. If you feel more effort (e.g., 16), choose an easier version of the exercise.

• Movement should be smooth, with each repetition of the exercise lasting approximately two seconds.

• Breathe evenly and do not hold your breath.

• Maintain an upright and tense torso and keep your head in line with your spine during exercises.

• For exercises performed standing, keep your knees slightly bent.

• Exercises performed with only one limb or to one side should be completed with all repetitions on one limb or side first, and then on the other limb or side.

• Certain exercises can also be performed in an isometric contraction mode (the exercise position is held for for at least 3 seconds). Particular care should be taken with exercisers with associated medical conditions, such as cardiovascular disease, as isometric contractions place a greater strain on the cardiovascular system than dynamic performance of the same exercise.

PREPARATORY PART - WARM-UP Aerobic and Coordination Tasks on the Ladder: 12 tasks, repeat 30 seconds each task.

1.

2.

3.

Walking forward, one foot in each

Walking forward, both feet in each

Walking sideways, both feet in each

square.

square.

square.

PREPARATORY PART - WARM-UP / Aerobic and Coordination Tasks on the Ladder

4.

5.

6.

Walking backwards, both feet in each

Walking forward three squares, then

Walking sideways, one foot in each

square.

one backwards.

square (legcrossing).

PREPARATORY PART - WARM-UP / Aerobic and Coordination Tasks on the Ladder

7.

8.

9.

Walking forward, in the square and

Walking backwards, in the square and

Walking forward over the obstacles.

apart over the next.

apart over the next.

PREPARATORY PART - WARM-UP / Aerobic and Coordination Tasks on the Ladder

10.

11.

12.

Walking sideways over the obstacles,

Walking sideways over the obstacles

Walking backwardsover

both feet in each square.

(leg crossing).

the obstacles.

Free Gymnastic Warm-Up Exercises: 8 exercises, 10 repetitions each.

1.

2.

3.

4.

Swings with arms diagonally

Circulararm movements

Torso twists with hands on

Lifts of opposite limbs while

back.

backwards.

the back of the neck.

supported with the forearm against thewall.

PREPARATORY PART - WARM-UP / Free Gymnastic Warm-Up Exercises

5.

6.

7.

8.

Turning thumbsbackwards

Leg raises while supported

Trunk raises while

Squats.

in a half-squat with a

with the back against the

supported with the coccyx

forward bend.

wall.

against thewall.

Exercise 1

A1

PELVIC FLOOR MUSCLE CONTRACTIONS W H I L E LYING ON YOUR BACK

Lie on your back on a mat, legs bent, arms alongside your body.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 1

A2

PELVIC FLOOR MUSCLES CONTRACTIONS W H I L E LYING ON YOUR STOMACH

Lie on your stomach, one leg is bent to the side, with your forehead resting on your hands.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 1

B1

PELVIC FLOOR MUSCLES CONTRACTIONS W H I L E SEATED ON A CHAIR

Sit on a chair bent forward, resting your elbows on your thighs.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 1

B2

PELVIC FLOOR MUSCLES CONTRACTIONS W H I L E KNEELING

Kneel on a mat and lean on your forearms, with your forehead resting on your arms.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 1

C1

PELVIC FLOOR MUSCLES CONTRACTIONS W H I L E BENDING OVER

Stand astride slightly bent forward, and your legs slightly bent. Rest your hands on your knees with your palms facing inwards.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 1

C2

PELVIC FLOOR MUSCLES CONTRACTIONS W H I L E STANDING Stand with your knees slightly bent.

With your hands on your buttocks, make sure you don’t squeeze your gluteal muscles during the exercise.

Contract the pelvic floor muscles.

Hold the contracted muscles for 6-8 seconds, then do 3 strong squeezes. Repeat five times (there is a 5-second break between repetitions).

Exercise 2

A1

LIFTING D U M B B EL L S

Lie on your back on a mat with your knees bent. Hold the dumbbells in your hands with your arms extended.

Raise and lower the dumbbells, stopping the motion before your arms touch the ground.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 2

A2

PUSHING A RESISTANCE BAND FORWARD W H I L E SEATED

Sit on a chair, holding a taut resistance band in your hands.

Push the resistance band forward.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 2

B1

WA LL PUSH- U PS

Lean against a wall with your hands shoulder-widthapart.

Perform push-ups.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 2

B2

PUS H- U PS ON YOUR K NEES

Kneel on a mat with your arms extended. The angle at the hip and knee should be greater than 90°.

Perform push-ups.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 2 BENCH PUSH- U PS

Place your hands on a bench, shoulder-width apart.

Perform push-ups.

Do 10-12 repetitions.

Repeat threetimes.

C1

Exercise 2

C2

LIFTING INTO A PLANK POSITION

Forearm plank position on a mat with your toes on the ground.

Alternate lifting into a plank position on extended arms, first with your right arm and then with your left.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 3

A1

SEATED TORSO L I F T S W I T H A STICK

Sit bending forward on a chair, holding a stick behind you, touching your head, your back between the shoulder blades, and your sacrum.

Raise your torso to an upright position.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 3

A2

SEATED TORSO L I F T S W I T H A RESISTANCE BAND

Sit bending forward on a chair, cross your arms holding a resistance band.

Lift your torso to an upright position.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 3

B1

SEATED TORSO L I F T S W I T H A HEAVIER RESISTANCE BAND

Sit bending forward on a chair, cross your arms holding a heavier resistance band.

Lift your torso to an upright position.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 3

B2

TORSO L I F T S WITH A RESISTANCE BAND W H I L E LEANING ON A W ALL

Lean against a wall with your sacrum, your knees slightly bent, holding a resistance band in crossed arms.

Lift your torso to an upright position.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 3

C1

OPPOSITE LIMB L I F T S AGAINST A WAL L W I T H A RESISTANCE BAND

Lean against a wall with your forearms, with a resistance band looped around them.

Simultaneously liftopposite limbs.

Do 10-12 repetitions.

Repeat three times with each pair of limbs.

Exercise 3

C2

OPPOSITE LIMB L I F T S AGAINST A WAL L W I T H A HEAVIER RESISTANCE BAND

Lean against a wall with your forearms, with a heavier resistance band looped around them.

Simultaneously liftopposite limbs.

Do 10-12 repetitions.

Repeat three times with each pair of limbs.

Exercise 4

A1

ELBOW PUSH -OF FS FROM A WAL L

Stand with slightly bent knees against a wall. Your head, shoulder blades, elbows, and sacrum are touching thewall.

Push off the wall with your elbows, allowing your head and torso to move away from thewall.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 4

A2

SEATED RESISTANCE BAND ROWS

Seated rows with a taut resistance band.

Pull the band backward.

Begin the movement by retracting your shoulder blades, then bend your arms.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 4

B1

STANDING RESISTANCE BAND PULLS

Stand with your legs apart and your knees slightly bent, holding a taut resistance band in front of you.

Pull the band backward.

Begin the movement by retracting your shoulder blades, then bend your arms.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 4

B2

R O PE P U L L S

Holding a taut rope in front of you, lean back slightly.

Pull up to a more upright position. Begin the movement by retracting your shoulder blades, then bend your arms.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 4

C1

BENT-OVER ROWING W I T H T H E D U M BB EL L S

In a bent-over half-squat position, hold the dumbbells.

Lift the dumbbells. Begin the movement by retracting your shoulder blades, then bend your arms.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 4

C2

SINGLE-ARM D U M B B EL L ROW IN A BENT-OVER LUNGE POSITION

In a bent-over lunge position, hold a dumbbell.

Lift the dumbbell. Begin the movement by retracting your shoulder blade, then bend your arm.

Do 10-12 repetitions.

Repeat three times with each arm.

Exercise 5

A1

LEG RAISES W H I L E LYING ON YOUR BACK

Lie on your back on a mat with one leg bent, and your arms by your sides.

Lift the extended leg.

Do 10-12 repetitions.

Repeat three times with each leg.

Exercise 5

A2

CRUNCHES

Lie on your back on a mat with one leg bent, and your palms under the lumbar region of your trunk.

Raise the upper part of your trunk and head, supporting yourself with your elbows on the floor.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 5

B1

CRUNCHES W I T H L I F T E D EL B O W S

Lie on your back on a mat with one leg bent, your palms under the lumbar region of your trunk, and your elbows lifted.

Raise the upper part of your trunk and head.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 5

B2

CRUNCHES W I T H YOUR HANDS ON YOUR CHIN

Lie on your back on a mat with one leg bent. Cross your arms with your hands on your chin.

Raise the upper part of your torso and head.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 5

C1

CRUNCHES W I T H YOUR HANDS ON YOUR FOREHEAD

Lie on your back on a mat with one leg bent. Cross your arms with your hands on your forehead.

Raise the upper part of your torso and head.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 5

C2

CRUNCHES W I T H AN ELASTIC BAND

Lie on your back on a mat with one leg bent, holding a resistance band in your hands.

Raise the upper part of your torso and head.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 6

A1

SQUATS W I T H S U PPO R T

Hold onto support (rope or bar) at shoulder height.

Perform squats to a 90° angle at your knees, keeping your heels on the ground.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 6

A2

WA LL SQUATS W I T H A BALL BEHIND YOUR BACK

Stand with your legs apart, facing away from a wall, with a large ball supporting your lower back against the wall.

Hands are on your hips.

Perform squats to a 90° angle at the knees.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 6

B1

K N E E ROCKS IN A SQUAT POSITION

Stand in front of a chair with your arms crossed over your chest.

Squat down and rock up and down on your knees.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 6

B2

SQUATS W I T H A RESISTANCE BAND

Stand with your feet shoulder-width aparton a resistance band. Hold the ends of the band in your hands, which are positioned against your upper arms.

Perform squats to a 90° degree angle at the knees.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 6

C1

ROCKING IN A LUNGE POSITION W I T H ONE LEG IN F R O N T

Stand in front of a chair with one leg in front and your knees bent, and your arms crossed over your chest.

Squat down and rock up and down on your knees.

Do 10-12 repetitions.

Repeat three times with each leg in front.

Exercise 6

C2

SINGLE LEG SQUATS

Stand in front of a chair on one leg, with your arms crossed over your chest.

Perform single-leg squats.

Do 10-12 repetitions.

Repeat three times on eachleg.

Exercise 7 SEATED D U M B B EL L OVERHEAD PR E SSE S

Sit on a chair, holding the dumbbells in your hands.

Raise thedumbbells overhead.

Do 10-12 repetitions.

Repeat threetimes.

A1

Exercise 7

A2

STANDING D U M B B EL L OVERHEAD PR E SSE S

Stand with your feet shoulder-width apart, your knees slightly bent, holding the dumbbells in your bent hands.

Raise thedumbbells overhead.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 7

B1

STANDING D U M B B EL L OVERHEAD PR E SSE S

Stand with your feet shoulder-width apart, your knees slightly bent, holding the dumbbells in your hands.

Raise thedumbbells overhead.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 7

B2

RESISTANCE BAND P U L L S

Stand with your feet apart on a resistance band, your knees slightly bent, holding the ends of the band in your hands.

Pull the band alternately across the front and alongside the body.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 7

C1

BICEP CURLS AND OVERHEAD D U M B B EL L PR E SSE S Stand with your feet shoulder-width apart, your knees slightly bent, holding the dumbbells in your hands.

1.

Begin with elbow flexion, then raise the dumbbells overhead. Next, abduct your elbows to the sides and extend your arms overhead.

2.

3.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 7

C2

BICEP CURLS AND OVERHEAD D U M B B EL L PR E SSE S Stand with your feet shoulder-width apart, your knees slightly bent, holding a dumbbell in your hand.

1.

Begin with elbow flexion, then raise the dumbbell overhead. Next, abduct your elbow to the sides and extend your arm overhead.

2.

3.

Do 10-12 repetitions.

Repeat three times with each arm.

Exercise 8

A1

ALTERNATING SEATED TORSO ROTATIONS W I T H A BALL

1.

Sit on a chair, holding a ball in your hands, with your shoulders pushed back and down.

Alternate rotating your torso and head to each side.

2.

3.

Do 10-12 repetitions.

Repeat three times on eachside.

Exercise 8

A2

SEATED TORSO ROTATIONS W I T H A STICK

Sit on a chair next to a wall, holding a stick in your bent arms and pressing it against the wall.

Push the stick into the wall with torso rotations.

Do 10-12 repetitions.

Repeat three times on each side.

Exercise 8

B1

TORSO ROTATIONS W H I L E KNEELING

In a kneeling position with one hand on the ground, place your other hand behind your neck and lift your elbow.

Rotate your torso and head towards yourarm.

Do 10-12 repetitions.

Repeat three times on each side.

Exercise 8

B2

HIP RAISES IN A SIDE PLANK

Perform a side plank position on your forearm and your knee.

Raise your hips.

Do 10-12 repetitions.

Repeat three times on each side.

Exercise 8

C1

SEATED TORSO ROTATIONS W I T H A RESISTANCE BAND

Sit on a chair, holding a resistance band with your arms extended.

Rotate away from the anchor point of the band.

Do 10-12 repetitions. Repeat three times on each side.

Exercise 8

C2

SIMULTANEOUS RAISES OF YOUR U P P E R LIMBS IN A SIDE PLANK

Perform a side plank position on your forearm and knee.

Simultaneously raise your upper leg andarm.

Do 10-12 repetitions.

Repeat three times on each side.

Exercise 9

A1

RESISTANCE BAND P U L L S W H I L E LYING ON YOUR BACK

Lie on your back with your knees bent, holding a taut resistance band overhead with your arms extended.

Pull the band down, starting by pushing your shoulders down, then bending your elbows.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 9

A2

RESISTANCE BAND P U L L S W I T H YOUR HIPS LIFTED

Lie on your back with your knees bent and your hips raised, holding a taut resistance band overhead with your armsextended.

Pull the band down, starting by pushing your shoulders down, then bending your elbows.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 9

B1

SEATED RESISTANCE BAND PULLS

Sit on a chair, holding a taut resistance band overhead with your arms extended.

Pull the band down, starting by pushing your shoulders down, then bending your elbows.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 9

B2

SEATED H E AVIER RESISTANCE BAND PULLS

Sit on a chair, holding a heavier taut resistance band overhead with your arms extended.

Pull the band down, starting by pushing your shoulders down, then bending your elbows.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 9

C1

SINGLE ARM RESISTANCE BAND P U L L S IN A SIDE PLANK

Perform a side plank position on your forearm and your knee.

Pull the resistance band downwards, starting by pushing your shoulder down, then bending your elbow.

Do 10-12 repetitions.

Repeat three times on each side.

Exercise 9

C2

P U L L - U PS FROM SQUAT POSITION

Hold a taut rope with your hands overhead in squat position, lean back slightly.

Pull yourself up to upright position. During the pulls, assist yourself by extending both legs.

Do 10-12 repetitions.

Repeat threetimes.

Exercise 10

A1

TANDEM STANCE ON A FI RM SURFACE

Stand with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, add head disturbances (alternate nods and tilts, twists, bends, and maintain position with your eyesclosed).

Exercise 10

A2

TANDEM STANCE ON A FI RM SURFACE

Stand with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, add head disturbances (alternate nods and tilts, twists, bends, and maintain position with your eyesclosed).

Exercise 10

B1

TANDEM STANCE ON A SO F T SURFACE

Stand barefoot with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 10

B2

TANDEM STANCE ON A SO F T SURFACE

Stand barefoot with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 10

C1

TANDEM STANCE ON A NARROW ELEVATED SURFACE

Stand with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 10

C2

TANDEM STANCE ON A NARROW ELEVATED SURFACE

Stand with one foot in front of the other, and your arms crossed over your chest.

Maintain a balance position for 20 seconds with each foot in front.

Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

A1

SINGLE LEG STANCE ON A FI RM SURFACE

Stand on one leg on a firm surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

A2

SINGLE LEG STANCE ON A FI RM SURFACE

Stand on one leg on a firm surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

B1

SINGLE LEG STANCE ON A SO F T SURFACE

Stand barefoot on one leg on a firm surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

B2

SINGLE LEG STANCE ON A SO F T SURFACE

Stand barefoot on one leg on a firm surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

C1

SINGLE LEG STANCE ON A NARROW ELEVATED SURFACE

Stand on one leg on a narrow elevated surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 11

C2

SINGLE LEG STANCE ON A NARROW ELEVATED SURFACE

Stand on one leg on a narrow elevated surface with your arms crossed over your chest.

Maintain this balance position for 20 seconds on each leg. Repeat twice.

In the next set, pass a small ball between your hands. In the final set, include head disturbances (alternate nods and tilts, twists, and bends).

Exercise 12

A -C

WALKING ALONG A BALANCE COURSE

1.

2.

Walk along the course. Change the order of different surfaces (hard, soft, elevated, etc.) in each training session.

Select two ways of walking the course, with one always being forward (regular walking or tandem walking). You can also choose to walk backwards or sideways.

3.

4.

Repeat each movement twice.

Then, in the third round, include head disturbances (alternate nods and tilts, twists, and bends).

CONCLUDING PART OF T H E EXERCISE – STRETCHING Static Stretching Exercises for the Whole Body: 5 exercises, hold 30 seconds each exercise, repeat twice.

1.

2.

Twist from the wall.

Leaning on the chair.

CONCLUDING PART OF T H E EXERCISE – STRETCHING / Static Stretching Exercises for the Whole Body

3.

4.

5.

Side bend in the lunge position.

Knee bend while supported against

Heal trust down while supported

the wall.

against thewall.

Regular physical activity helps maintain functional ability, bone density, and proper joint function, reducing the risk of injury from falls.

Overall, staying active is one of the most effective strategies for preventing falls and maintaining independence as we age.

+ BALANCE ABC+ MOVEMENT PROGRAM

Balance Exercises Part +BALANCE presents an exercise program to improve

Balance 1:

balance, which can be performed in pairs or in small groups. The

Object Handling-

basic instructions for performing the exercises in this section is:

BALL EXERCISES

Maintain balance position for 20 seconds on each leg or with

Balance 2:

each foot in front. Repeat twice.

Dual Task Activities -

If the exercise contains different roles, change the role after two repetitions.

COUNTINGAND SPELLING Balance 3: Pair/Group ExerciseBALL PASSING BY NAME OR N U M BER Balance 4: Balance ForwardPREDICTABLE DISTURBANCE Balance 5: Balance ForwardUNPREDICTABLE DISTURBANCE

Balance 1

1.

1.

1.

Maintain a balance position and hold the ball, while practising different grips.

2.

2.

Object Handling BALL EXERCISES IN BALANCE POSITIONS

3.

2.

3.

Pass the ball in different directions (front, back, top, bottom).

Try juggling the ball between hands while maintaingvarious balance positions.

Balance 2 Dual Task Activities COUNTING AND SPELLING

Maintain various balance positions.

Perform an activity while counting backwards, counting, spelling words aloud.

Balance 3 Pair/Group Exercise BALL PASSING BY NAME OR N U M B ER

Stand in a circle or pair up.

Pass the ball to someone when you call their name or number while maintaing various balancepositions.

Balance 4 Balance forwardPREDICTABLE DISTURBANCE

Stand in a pair while holding elastic band.

Pull the elastic band in different sides to create predictable disturbance.

Take turns and try to get your partner off balance.

Balance 5 Balance forward UNPREDICT ABLE DISTURBANCE

Stand in a pair on a soft or hard surface in different positions.

Alternately pull an elastic band each to their own side, to create unpredictable balance challenges while maintaining balance position.

Practice keeping balance after unexpected pulls also.

Progressive BalancePlan 1. STATIC BALANCE PROGRESSION Two-Leg Stance: 1. Stand on a firm surface with your eyes open.

2. Stand on a firm surface with your eyes closed.

3. Stand on a soft surface with your eyes open.

4. Stand on a soft surface with your eyes closed.

2. SENSORY ORGANIZATION (Surface andVision) • Change surface type (firm/soft) and vision (open/closed) as per above progression.

• Add variations with changing head positions to altervisual inputs.

Tandem Stance: 1. Stand heel-to-toe on a firm surface with your eyes open.

3. EXTERNAL/INTERNAL DISTURBANCE

2. Stand heel-to-toe on a firm surface with your eyes closed.

External Disturbance:

3. Stand heel-to-toe on a soft surface with your eyes open.

4. Stand heel-to-toe on a soft surface with your eyes closed.

Single-Leg Stance: 1. Stand on one leg on a firm surface with your eyes open.

2. Stand on one leg on a firm surface with your eyes closed.

3. Stand on one leg on a soft surface with your eyes open.

4. Stand on one leg on a soft surface with your eyes closed.

• Apply gentle pushes from different directions while standing in a specific position (e.g., singleleg stance) to challenge balance.

Internal Disturbance: • Partner exercises, such as elastic band pulls, to introduce predictable balance challenges.

4. COGNITIVE CHALLENGE

6. WALKING EXERCISES

• Introduce a dual-task component while

Basic Walking Progression:

performing any of the static balance exercises.

• Examples: - Count backward by threes.

- Spell simple words aloud.

- Recite months of the year in reverse.

5. UNPREDICTABLE DISTURBANCE • Use a rope tied around your waist, with a partner giving sudden tugs to create unexpected balance challenges.

1. Walk in a straight line on a firm surface.

2. Walk with your eyes closed.

3. Walk on a soft surface.

4. Walk heel-to-toe (tandem walking).

5. Add cognitive challenges (e.g., counting backward while walking).

Variations with Disturbances: • Use an elastic band attached to the waist while walking, with a partner adding resistance or sudden pulls.

• Walk while carrying an object to add complexity.

• Perform on both, hard and soft, surfaces.

This progressive approach allows for gradual development of balance skills, from simple static positions to dynamic, complex tasks, addressing both physical and cognitive components of balance.

No matter the age, stay active

+ BASIC MOBILITY ABC+ MOVEMENT PROGRAM

Learning basic mobilityand movement for olderadults

Older adults often fall at home or in the vicinity of their home.

1. Sitting to standing.

Falls are caused by a combination of several factors related to the

2. Transition from standing to fourlegged

environment and the effects of physical ageing. Reduced muscle capacity and joint mobility, poorer balance and coordination, and reduced reaction time can increase the risk of falls.

Getting up from the ground after a fall requires a certain amount of mobility and strength. As with movement in general, there is no one and only rule for getting up from the floor, but you can help yourself using a pictorial description of the movements, to make getting up from the floor easier and to improve mobility in everyday life.

position.

3. Transition from fourlegged position to sidelying.

4. Transition from side-lying to lying on a back.

5. Transition from lying on a back to lying on your stomach.

6. Getting up from lying on your back via side support.

7. Getting up from lying on your stomach.

8. Safe lifting of loads – active position (slightly bent knees, co-contraction of core stabilizers).

9. Sitting-rising test.

1. Sitting to standing

1.

2.

3.

4.

5.

6.

Sit toward the front edge of a sturdy chair.

Your knees should be bent and your feet should be flat on the floor, shloulder-width apart, and underneath your hips. Breathe continuously and slowly.

Activate your deep abdominal muscles by gently pulling your navel toward your spine.

Place your hands lightly on each side of the seat.

Keep your back and neck as straight as possible, with your chest slightly forward.

Lean forward and slightly shift your weight to the front of your feet. Try not to support any weight with your hands.

Stand and pause for a full breath in and out.

Sit down slowly. Tighten your core and abdominal muscles to control your lowering as much as possible. You should lower yourself back to the chair slowly, not just drop back into the seat.

Breathe out slowly as you sit on the chair.

Do 10-12 repetitions.

Additional instructions:

• If the exercise is too difficult, use a chair with sturdy armrests, and push off the armrests to help you rise to the standing position. You can also use the armrests to help slowly lower yourself back to sitting. As this gets easier, try to use your arms less. You can also place a firm cushion or pillow on the chair to make the surface higher.

Repeat 3times.

• If this exercise is too easy, do not use your arms to help raise or lower yourself. You can also wear a weighted vest, use hand weights, increase your repetitions, or try a lower chair.

2. Transition from standing to fourlegged position

1.

2.

3.

4.

5.

6.

Activate your deep abdominal muscles by gently pulling your navel toward your spine.

Place one foot forward and kneel. You can lean on your front leg with your hand.

Bring your legs together into a kneeling postion (in case of knee pain, perform the exercise on an exercise mat or cover your knees with a roll of towel).

If necessary, lean on a chair / wall while moving into a kneeling position.

Lean on your hands and lower yourself to fourlegged postion.

Knees and. Knees are hip-width apart and below them, palms are shoulder-width apart and below them.

Stand up in the reverse order.

Do 10-12 repetitions.

Repeat 3 times on each side (kneel with your right then with your left leg).

Additional instructions:

• If this exercise is too hard, you can lean on a chair, railing or wall when lowering down.

• If this exercise is too easy, do not lean on your front leg when standing or lowering down.

3. Transition from fourlegged position to side-lying

1.

2.

3.

In a fourlegged position on the floor, activate the deep abdominal muscles by gently drawing the belly button towards the spine.

Lower yourself into a side-sitting position.

Maintain a side-sitting position. The legs are slightly bent.

4.

5.

6.

Lean on the elbow on the side you will lie down on and use the other hand to slowly lower yourself.

Slowly lower yourself into a side-lying position, lower arm outstretched.

Return to the starting position in the reverse order.

Do 10-12 repetitions. Repeat 3 times on each side.

4. Transition from side-lying to lying on aback

1.

2.

3.

Lying on your side, activate your deep abdominal muscles by gently pulling your navel toward your spine.

Push off the ground with the hand on the side you will be facing.

Extend your lower leg and bend your upper leg slightly.

Begin the transition with your lower body by pushing your knees from the floor towards the ceiling. Then move the upper part of your body by pushing yourself onto your back with both hands.

Return to the starting position in the reverse order.

Do 10-12 repetitions.

Repeat 3 times on each side.

5. Transition from lying on your back to lying on your stomach

1.

2.

3.

Lying on your back, activate your deep abdominal muscles by gently pulling your belly button towards your spine.

Fold your arms over your chest.

Bend one leg. Start the transition to the side with the legs (push off the floor with the foot of the bent leg), followed by the upper body.

Additional instructions:

• Try the movement with each leg separately to find your dominant side where turning will be easier for you.

• Practice turning on both sides.

4.

5.

Once on your side, extend your lower leg and slowly turn onto your stomach. Then fully extend your other leg aswell.

Return to the starting position in the reverse order.

Do 10-12 repetitions. Repeat 3 times on each side.

6. Getting up from lying on afloor via side support

1.

2.

3.

4.

5.

Lying on your side, activate your deep abdominal muscles by gently pulling your navel toward your spine.

Push off the ground with your upper arm, so you can place the elbow of your other arm into support.

Lean on the elbow of your lower arm. Raise yourself to a semi-sitting position with the help of your hands.

By supporting yourself on your palms, lift your torso off the floor and stand on the floor (resting on your knees and palms).

Hold the four-legged position.

Knees are hip-width apart, palms shoulder-width apart.

6.

7.

8.

9.

In an all-fours position move to the nearest chair or another stable object nearby.

Straighten your spine and place one foot forward for support. Rest your hands on a nearby chair/furniture.

Stand up with support if needed.

Return to the starting position in the reverse order.

Do 10-12 repetitions. Repeat 3 times on each side.

Additional instructions:

• If the exercise is too hard, you can help yourself when standing up by leaning on a stable chair/furniture.

• If the exercise is too easy, stand up without resting your hands on the support.

• Practise getting up from the floor in parts of the movement pattern, and as you get better at it, do the whole pattern at once.

7. Getting up from lying on your stomach

1.

2.

3.

4.

Lying on your stomach, activate your deep abdominal muscles by gently pulling your belly button towards your spine.

Raise yourself up on your forearms and push your elbows back so they are under your shoulders.

Leaning on your forearms, lift your torso off the floor and get into a low, fourlegged position (supporting yourself on your knees and forearms).

Raise yourself on your palms. Hold the fourlegged position. Knees are hipwidth apart and palms shoulder-width apart.

5.

6.

7.

Straighten your spine and place one foot forward for support.

Lean on the leg with your hands in support and try to stand up slowly in support and stand up.

Return to the starting position in the reverse order.

Do 10-12 repetitions. Repeat 3 times on each side.

Additional instructions:

• If the exercise is too hard, you can help yourself stand up by leaning on a stable chair that is securely placed against a wall.

If the exercise is still too hard, turn from the prone position to the side into the lateral position (see exercise 6 - Getting up via the side support from the supine position).

• If the exercise is too easy, stand up without hands on the leg in support.

8. Safe lifting of loads

1.

2.

3.

Stand with your legs apart. Before lifting the load, activate the abdominal muscles deeply by gently pulling the belly button towards the spine. At the same time, activate the muscles of the pelvic floor (as if trying to hold back the leakage of urine and wind).

Bend your knees into a slight squat, keeping your spine straight. Keep the load close to your body.

Use your leg muscles to lift the load. While lifting, maintain a straight spine and active deep abdominal and pelvic floor muscles.

Lower the load slowly to the ground, following the lifting rules.

9. Sitting-rising test

1.

2.

3.

4.

Stand upright and ensure you have enough space around you (clear away any potential hazards!).

Carefully lower yourself into a crosslegged sitting position. Try not to use your arms or hands as leverage or support.

Once stably seated, attempt to stand back up, trying not to use your hands or knees for support.

You can achieve a total of 10 points: each additional support used (e.g. hand or knee) means a deduction of one point, and half a point for any loss of balance during the movement (see scorecard on the following page).

Hand support:

Knee support:

Support on the forearm:

Support with palm on knee:

Side support:

-1 point

-1 point

-1 point

-1 point

-1 point

GOOD: 8-10 points

FAIR: 3,5-7,5points

POOR: 0-3 points

Scoring: The maximum possible score on the test is 10 points: a possible total of 5 points for sitting down, and 5 points for rising from the floor to a standing position.

Using your hand, forearm, knee, or the side of your leg to press up from the ground—or bracing your hand on your knee—results in a deduction of one point.

An additional 0.5 points is deducted if the evaluator perceives an unsteady execution or partial loss of balance in any of the movement.

Authors

Prof. Dr. Maja Dolenc is a full professor at the Faculty of Sport, where she teaches in the field of sports recreation and fitness. She is the author of ten university textbooks and more than 130 scientific and 160 professional articles. Her research focuses on physical activity as a key component of a healthy lifestyle, particularly in the context of aging, fall prevention, and health promotion. Prof. Dolenc has supervised over 125 bachelor’s and master’s theses and has conducted more than 5 0 training courses, attended by 3,700 participants. In addition to her teaching and research work, she is actively engaged in various professional bodies and committees at the Faculty of Sport, the Olympic Committee of Slovenia, and the Slovenian Sports Union. She has participated in numerous national and international projects aimed at promoting physical activity, health, and active lifestyles.

Her achievements have significantly contributed to the development of sports recreation in Slovenia and beyond.

Tjaša Knific has a Master’s degree in physiotherapy and is a former elite athlete. She is employed as a developmental associate at the National Institute of Public Health (NIJZ) in the Centre for Preventive and Health Promotion Programs, where she leads the expert group on physical activity, sedentary behavior, and sleep. Her work includes research, management, and implementation of strategies in clinical practice, as well as lecturing in the fields of public health, physiotherapy, health promotion and prevention, daily physical behavior in adults, and active and healthy ageing. She actively participates in the training of healthcare professionals, the development and implementation of health programs, and the preparation of public health policies. Additionally, she is a lecturer at several Slovenian health faculties and the author or co-author of numerous articles, master’s and bachelor’s theses, manuals, and teaching materials on physical activity for health, physical fitness, and reducing sedentary behavior.

ABC+ movement program for active ageing and vital living Authors: Maja Dolenc* and Tjaša Knific** Publisher: National Institute of Public Health of the Republic of Slovenia, Trubarjeva 2, Ljubljana Lector: Mihaela Tornar

Partners

Photography: Marja Bizjak Ažman and Domen Bizjak Design: HercogMartini Ljubljana, 2025 Electornic edition Published on:https://nijz.si

*Faculty of Sport, University of Ljubljana, Slovenia **National Institute of Public Health, Ljubljana, Slovenia

All rights reserved. Reproduction in part or in full on any manner or in any medium is not permitted without written permission of the authors. Violations shall be sanctioned in accordance with copyright and criminal law.

Supporters

Cataloguing in publication (CIP) prepared by National and University Library in Ljubljana COBISS.SI-ID 221095939 ISBN 978-961-7211-55-9(PDF)

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.

Posting ABC+ exercise videos on the project landing page Introduction Healthy Exercise ABC Plus is a movement program that promotes an active lifestyle and aims to improve physical and functional abilities in adults. It is an upgrade of the existing Healthy Exercise ABC program, which was the first systematic multi-month program for improving physical fitness for adults in Slovenia. The Healthy Exercise ABC Plus program includes exercises to increase strength (stability), balance, coordination, flexibility, and aerobic capacity. It adheres to recent global guidelines for planning healthy exercise.

Content and Structure of the Healthy Exercise ABC Plus Program Each exercise unit consists of a preparatory, main, and concluding part. The preparatory part includes dynamic warm-up exercises, the main part contains strength and balance exercises in maximum of six difficulty levels, and the concluding part includes static stretching exercises. The program is planned for 12 weeks, with 2-3 exercise units per week. Each difficulty level of the exercise is expected to be performed in 4-6 exercise units.

The program consists of three exercise periods (EP), named Exercise Periods A, B, and C. Each exercise period is divided into the first two exercise units and the second two units. Thus, within Exercise Period A, the first part is called A1 and the second part is called A2. Similarly, Exercise Periods B (B1 and B2) and Exercise periods C (C1 and C2) are represented. EP A includes content of the lowest volume and intensity of loads, which appropriately increase up to the conclusion of EP C. In the preparatory part of the program, exercises on a coordination ladder and dynamic exercises without equipment are presented. The main part includes pelvic floor muscle exercises, strengthening exercises for the whole body using various exercise equipment, and exercises for static and dynamic balance on hard, soft, and elevated surfaces. The concluding part involves static stretching exercises.

Below are videos demonstrating the exercises to help you better understand and master the correct execution technique.

Videos on Youtube links TITLE

YOUTUBE LINK

2A1 LIFTING DUMBBELLS

https://youtu.be/bC2O9GGD7ls

2A2 PUSHING A RESISTANCE BAND FORWARD WHILE SEATED

https://youtu.be/Idvmp0ExzYY,

2B1 WALL PUSH-UPS

https://youtu.be/grhBZeD9FC8,

2B2 PUSH-UPS ON YOUR KNEES

https://youtu.be/1E1nxzHYzaU,

2C1 BENCH PUSH-UPS

https://youtu.be/cuh8-wpfTsA,

2C2 LIFTING INTO A PLANK POSITION

https://youtu.be/aYtv9g3Z5EU

3A1 SEATED TORSO LIFTS WITH A STICK

https://youtu.be/HX4jmYG6ch0,

3A2 SEATED TORSO LIFTS WITH A RESISTANCE BAND

https://youtu.be/Oqh7ODJAOvo,

3B1 SEATED TORSO LIFTS WITH A HEAVIER RESISTANCE BAND

https://youtu.be/LoXBSlgGhXA,

3B2 TORSO LIFTS WITH A RESISTANCE BAND WHILE LEANING ON A WALL

https://youtu.be/SRtPkyhNWLw,

3C1 OPPOSITE LIMB LIFTS AGAINST A WALL WITH A RESISTANCE BAND

https://youtu.be/4xO5X7cfUBg,

3C2 OPPOSITE LIMB LIFTS AGAINST A WALL WITH A HEAVIER RESISTANCE BAND

https://youtu.be/rsHBK41fJVU,

4A1 ELBOW PUSH-OFFS FROM A WALL

https://youtu.be/OlM26ILHfKM,

4A2 SEATED RESISTANCE BAND ROWS

https://youtu.be/gvlTUgQtBnI,

4B1 STANDING RESISTANCE BAND PULLS

https://youtu.be/rrOkIYd8Fnk,

4B2 ROPE PULLS

https://youtu.be/uYBcZbwkCCw,

4C1 BENT-OVER ROWING WITH THE DUMBBELLS

https://youtu.be/niJG9YEGh2c,

4C2 SINGLE-ARM DUMBBELL ROW IN A BENT-OVER LUNGE POSITION

https://youtu.be/4CwZPCF9bTI,

5A1 LEG RAISES WHILE LYING ON YOUR BACK

https://youtu.be/CadValyuN_M,

5A2 CRUNCHES

https://youtu.be/jHmWgiYkGk4,

5B1 CRUNCHES WITH LIFTED ELBOWS

https://youtu.be/ZtcrHP9L0do,

5B2 CRUNCHES WITH YOUR HANDS ON YOUR CHIN

https://youtu.be/42q7Eco_Op4,

5C1 CRUNCHES WITH YOUR HANDS ON YOUR FOREHEAD

https://youtu.be/NSONf2zoV0k,

5C2 CRUNCHES WITH AN ELASTIC BAND

https://youtu.be/EqURajW8v7I,

6A1 SQUATS WITH SUPPORT

https://youtu.be/nvvalj4YsGU,

6A2 WALL SQUATS WITH A BALL BEHIND YOUR BACK

https://youtu.be/Js137ciQMGg,

6B1 KNEE ROCKS IN A SQUAT POSITION

https://youtu.be/mIjdE7bAFd0,

6B2 SQUATS WITH A RESISTANCE BAND

https://youtu.be/pvoV7ezQVwc,

6C1 ROCKING IN A LUNGE POSITION WITH ONE LEG IN FRONT

https://youtu.be/BjPcWGV5m48,

6C2 SINGLE LEG SQUATS

https://youtu.be/Db6jVq5q7ck,

7A1 SEATED DUMBBELL OVERHEAD PRESSES

https://youtu.be/V0nOLrv6H0,

7A2 STANDING DUMBBELL OVERHEAD PRESSES

https://youtu.be/0FLf34MHDe4,

7B1 STANDING DUMBBELL OVERHEAD PRESSES

https://youtu.be/Bkp3Lp7bUro,

7B2 RESISTANCE BAND PULLS

https://youtu.be/WcRlMQURB0g,

7C1 BICEP CURLS AND OVERHEAD DUMBBELL PRESSES

https://youtu.be/uqOyqYsPOCw,

7C2 BICEP CURLS AND OVERHEAD DUMBBELL PRESSES

https://youtu.be/x0N9F7Lx7pE,

8A1 ALTERNATING SEATED TORSO ROTATIONS WITH A BALL

https://youtu.be/n4OEOWezniw,

8A2 SEATED TORSO ROTATIONS WITH A STICK

https://youtu.be/3n2e-61CYwc,

8B1 TORSO ROTATIONS WHILE KNEELING

https://youtu.be/1op_kpz9Kgo,

8B2 HIP RAISES IN A SIDE PLANK

https://youtu.be/eoZiSHIlpuM,

8C1 SEATED TORSO ROTATIONS WITH A RESISTANCE BAND

https://youtu.be/Yd41bjXCHGg,

8C2 SIMULTANEOUS RAISES OF YOUR UPPER LIMBS IN A SIDE PLANK

https://youtu.be/C3SkAvmmQc8,

9A1 RESISTANCE BAND PULLS WHILE LYING ON YOUR BACK

https://youtu.be/ptWV-2aURKo,

9A2 RESISTANCE BAND PULLS WITH YOUR HIPS LIFTED

https://youtu.be/GIe68hSqa5A,

9B1 SEATED RESISTANCE BAND PULLS

https://youtu.be/pqDfv_jtBLM,

9B2 SEATED HEAVIER RESISTANCE BAND PULLS

https://youtu.be/LUpTnsGmL78

9C1 SINGLE ARM RESISTANCE BAND PULLS IN A SIDE PLANK

https://youtu.be/h1froET1HvM,

9C2 PULL-UPS FROM SQUAT POSITION

https://youtu.be/FwNljP02XXs.

ABOUT THE PROJECT The Active Ageing for Falls Prevention project, coordinated by the Sports Union of Slovenia, is a Europe-wide initiative addressing one of the most significant public health challenges faced by ageing societies: the high incidence of falls among older adults. Falls are a leading cause of injury, disability, and loss of independence in older populations, yet research shows that many falls can be prevented through targeted physical activity focused on balance, strength, coordination, and functional fitness. The project brings together a broad partnership of organizations from several European countries, including national sport federations, local sport clubs, public health organizations, research institutions, and community-based service providers. The consortium works collaboratively to design, test, and implement effective, evidence-based exercise programmes that help older adults maintain mobility, improve balance, and build strength — thereby significantly reducing their risk of falling.

At the core of the project is the ABC+ Movement Program, a structured exercise methodology specifically tailored to meet the needs of seniors. The programme includes carefully designed group training sessions that combine: Balance training to improve stability and prevent loss of balance; Strength exercises to maintain muscle mass, joint stability, and postural control; Functional mobility exercises to support daily activities and independence; Coordination drills to support movement control and confidence.

The project emphasizes not only the delivery of exercise sessions but also the training of trainers and local instructors, who are equipped with scientifically validated methodologies and practical tools to safely work with older populations. To support this, the partnership has developed a comprehensive set of resources, including: Exercise programme for older adults, focused on falls prevention Guidelines for organisations Training materials for trainers with videos Pilot programmes will be implemented in Slovenia, Italy, France, and Finland. These pilots will engage local sport clubs, municipalities, and senior organizations, in the roll-out of the ABC+ Movement Program. Regular assessments, participant feedback, and functional tests have demonstrated not only improved physical function among participants but also enhanced psychological well-being, greater social engagement, and improved quality of life.

Beyond the direct health benefits, the project also aims to build sustainable local and national capacities for fall prevention through: Awareness-raising activities, Knowledge exchange between sectors, Policy recommendations for integrating fall prevention into community sport and health promotion strategies.

Active Ageing for Falls Prevention demonstrates the powerful role that community sport organizations can play in public health promotion and ageing policies. The project offers a scalable, replicable model that can be implemented by local sport clubs, municipalities, and health organizations across Europe.

The initiative is co-funded by the European Union under the Erasmus+ programme and is part of consortium’s broader effort to promote physical activity as a key component of healthy, active, and independent ageing.

Project landing page: https://active-ageing.isca.org/

WHO WEEKLY PHYSICAL ACTIVITY RECOMMENDATION FOR ADULTS 65+ WHO’s page stresses two simple ideas: physical activity benefits everyone at every age, and some activity is always better than none—small increases across the day can help people meet recommended levels.

WHO’s current physical activity (PA) recommendations for older adults (65+) focus on aerobic activity, strength, balance/functional training, and sitting less.

1) Aerobic activity (heart & lung fitness) Older adults should do, each week: 150–300 minutes of moderate-intensity aerobic activity, or 75–150 minutes of vigorous-intensity aerobic activity, or an equivalent mix of moderate + vigorous activity.

WHO notes that “doing some physical activity is better than none”, and people should start small and build up gradually.

2) Muscle-strengthening (to maintain function and independence) On 2 or more days per week, older adults should do muscle-strengthening activities (moderate or greater intensity) that work all major muscle groups.

3) Balance + functional strength for falls prevention As part of weekly activity, older adults should do varied “multicomponent” activity emphasising functional balance and strength training at moderate or greater intensity, on 3 or more days per week, to enhance functional capacity and prevent falls.

Important update: Older WHO materials often stated balance training especially for those with poor mobility. The 2020 WHO guideline update explains this recommendation now applies to all older adults, not only those with poor mobility.

4) Sedentary behaviour (sitting time) WHO advises adults/older adults to limit sedentary time and that, to offset high sitting time, they should aim for more moderate-to-vigorous activity.

5) If health or function limits activity If an older adult cannot meet the targets, WHO recommends being as physically active as abilities allow, and adjusting effort to fitness/functional capacity.

WHO GLOBAL REPORT ON FALLS PREVENTION IN OLDER AGE - KEY FINDINGS Falls in older age are a major and growing public health issue because they are common, costly, and frequently life-changing. The WHO publication summary highlights that around 28–35% of people aged 65+ fall each year, rising to 32–42% in those aged 70+, and stresses the substantial personal and financial consequences.

1) Falls are frequent events with serious health consequences Falls are not “minor accidents” in later life. They are a leading cause of injury, pain, disability, and loss of independence in older adults, and they can trigger a downward spiral of reduced mobility, reduced participation, and worsening health. The report emphasises that fall injuries often require hospital care, and the duration of hospital stay after a fall is typically longer than for many other injuries. In examples cited, lengths of stay vary across settings (e.g., several days to two weeks), while hip fracture admissions can extend to about 20 days. With increasing age and frailty, some older people may remain in hospital or require long-term care after a serious fall.

A critical finding is that falls are closely linked to severe injury patterns—particularly hip fractures and traumatic brain injuries—which carry high morbidity and mortality. In the case of hip fracture, the report notes that around 20% may die within a year of the fracture, illustrating how a single fall can mark the start of significant functional decline or premature death.

2) Mortality and severe outcomes rise steeply with age—and differ by sex The burden of fatal falls increases markedly with age. The report states that falls account for about 40% of all injury deaths, and that fatal fall rates increase exponentially with age, reaching the highest levels among those aged 85+. A nuanced point is the sex pattern: women often experience more falls and more hip fractures, but men have higher fatal fall rates across age groups, which the report links to higher levels of comorbidity among men who fall and poorer baseline health status in some studies. This distinction matters for prevention planning: programmes need to be sensitive both to the high incidence of falls and fractures among women and to the disproportionately severe outcomes seen among men.

3) Falls are multifactorial—risk emerges from the interaction of health, behaviour, and environment A central message is that falls rarely have a single cause. They arise from an interaction between intrinsic factors (e.g., strength, balance, chronic disease), behavioural factors (e.g., medication use, alcohol, risk-taking), and environmental/societal factors (e.g., housing hazards, transport design, poverty). Because risks cluster and interact, prevention works best when it targets multiple modifiable risks rather than focusing only on one element.

Several modifiable behaviours are explicitly linked to higher fall risk: Nutrition and bone health: low intake of calcium/vitamin D is described as a concern because it increases the likelihood that a fall results in fracture and may also be associated with fall risk.

Alcohol: heavier use (example threshold noted as 14+ drinks/week) is associated with increased fall risk in older adults.

Medication use and polypharmacy: age-related changes in drug metabolism and the use of multiple medicines can increase dizziness, impaired judgement, balance problems, or weakness—especially when medicines are not taken as prescribed or when interactions are not properly managed. The report stresses careful prescribing and checking all medicines, including self-prescribed products.

Risk-taking behaviours: climbing ladders, standing on unstable chairs, rushing, or not using prescribed mobility aids are examples of everyday actions that raise fall risk. Footwear choices also matter (e.g., ill-fitting shoes, slippery slippers).

The report underlines that the built environment can either protect older adults or place them at heightened risk. One example is public transport design: lack of rails, high steps, and insufficient seating can directly increase falls risk during boarding and travel—especially in settings where vehicles and stops are not age-friendly.

Socioeconomic factors are also important. The report associates lower income with increased risk of falling, emphasising pathways such as poorer living environments, poorer diet, and reduced access to health and social services. These determinants create inequities in who is most exposed and who benefits from prevention.

4) Fear of falling is both a consequence and a driver of further risk Fear of falling is common after an initial fall, but the key finding is that fear is not only an emotional outcome—it can become a mechanism that increases future risk. The report explains that fear may lead some older adults to restrict activity; over time, reduced activity can erode strength, balance, and confidence, thereby increasing fall risk again. Fear can also cause maladaptive gait and balance changes. Conversely, in some people it can motivate precaution and stability-enhancing adaptations. The implication is that prevention should address physical risk factors and confidence, self-efficacy, and safe participation.

5) Effective prevention exists, but “what works” depends on the setting The report distinguishes between community, residential (long-term care), and acute care settings. Across settings, the strongest theme is: multifactorial approaches are usually most effective, because they match the multifactorial nature of falls. extranet.who.int For community-dwelling older adults, the report identifies multifactorial approaches (typically involving assessment and tailored intervention packages) as the most effective overall. Alongside this, it highlights several single interventions with strong evidence in community settings, including: Exercise (especially programmes that target strength and balance) Home hazard assessment and modification Withdrawal of psychotropic medications where appropriate Cardiac pacing for recurrent fallers with carotid sinus hypersensitivity

A specific finding on exercise design is especially practical: individually tailored strength and balance retraining prescribed by a trained health professional is the most effective exercise approach. Group exercise is generally less effective than individually prescribed programmes, with an exception noted for Tai Chi, which shows effectiveness as a group-based programme. Home hazard work is also presented concretely: effective programmes commonly address risks such as loose rugs, clutter, unstable furniture, poor lighting, and lack of bathroom grab bars or stair handrails. Importantly, the report warns that “information only” approaches that do not support actual change are not effective in community settings—highlighting that implementation support matters as much as education.

In residential care, multifactorial approaches again perform best, but the successful components differ in emphasis because the environment is shared and care routines shape risk. The report lists common elements of effective multifactorial interventions such as staff training and guidance, medication changes, resident education, environmental assessment/modification, provision/repair of aids, exercise, and hip protectors. As single interventions in residential settings, the report notes evidence that vitamin D and calcium supplementation can be effective. It also lists several strategies that show promise (e.g., gait training, assistive device advice, medication review especially psychotropics, nutritional support, staff education, exercise, environmental modification, and post-fall problem solving). A key caution is that the report notes limited evidence for interventions to reduce falls among residents with cognitive impairment, signalling an important evidence gap and the need for adapted approaches and better research.

In hospitals, the report finds no evidence supporting multifactorial interventions as a category in acute care in the way they work in community/residential contexts, and it makes a strong point about restraints: physical or pharmaceutical restraints are not effective for fall reduction and there is moderate evidence they may increase injury risk when falls occur. The report points instead to alternatives (e.g., low beds, floor mats, training for safe transfers) with moderate evidence of effectiveness.

6) Falls prevention should be embedded in an “active ageing” and multisectoral policy model The report frames falls prevention as a multisectoral agenda, not just a clinical programme. It positions a WHO Falls Prevention model within the WHO Active Ageing framework, emphasising coordinated action that supports older adults’ health, participation, and security.

A practical “way forward” described in the report is structured around three pillars: Building awareness of the importance of falls prevention and treatment Improving assessment of individual, environmental, and societal risk factors Designing and implementing culturally appropriate, evidence-based interventions at scale This framing matters because it pushes systems to integrate falls prevention into mainstream health and social care agendas, with clear roles for primary care, community organisations, housing, transport, and social support networks.

7) Physical activity is foundational—but intensity and tailoring should match risk level The report strongly reinforces physical activity as a core preventive strategy, while differentiating what is “enough” depending on an older person’s risk profile. For healthier older adults at low risk, regular participation in a broad range of physical activities may be sufficient to meaningfully reduce risk. For those at higher risk, the report emphasises structured programmes targeting modifiable risk factors, progressed according to individual capability and experience, and—at the highest risk—exercise embedded within a wider multifactorial plan. It cites strength and balance exercises (including Tai Chi) as effective in reducing both injurious and non-injurious falls, while noting that further research is needed on optimal dose (type, frequency, duration, intensity). extranet.who.int 8) Workforce capability and practical coping skills are under-addressed Beyond “what works”, the report highlights implementation weaknesses: falls can be difficult to manage in primary health care settings because professionals may lack specific skills and knowledge. It gives a concrete example: teaching at-risk patients how to get up from the floor is recommended but “rarely done” in practice, despite its potential to reduce fear, complications, and time spent on the ground after a fall. This shows that prevention must include training, routines, and competencies—not just written guidance.

WORLD GUIDELINES FOR FALLS PREVENTION AND MANAGEMENT FOR OLDER ADULTS: A GLOBAL INITIATIVE KEY FINDINGS 1) Why these global guidelines matter The World Falls Guidelines were developed to provide a practical, evidence-informed framework that can be used internationally—across health and social care systems with very different capacities and resources. They place strong emphasis on (1) a person-centred approach that incorporates the perspectives of older adults and caregivers, (2) implementation feasibility across diverse contexts (including low-resource settings), and (3) newer opportunities such as ehealth/telehealth. They also adopt the World Health Organization definition of a fall and explicitly recognise that the definition includes syncopal events (important because unexplained falls may require syncope/cardiovascular work-up, not only “balance training”).

A central message running throughout the guidelines is that falls are both common and often preventable, and that prevention typically requires multidisciplinary management (clinical, functional, environmental and behavioural). The guidelines highlight that addressing falls risk factors (e.g., gait and balance problems) can yield wider benefits beyond falls prevention—such as improved function, intrinsic capacity and quality of life.

2) A proactive, person-centred framework: Predictive–Preventive–Personalised–Participatory The guidelines organise falls prevention around a clear framework: identifying risk (predictive), acting early to prevent harm (preventive), tailoring plans to the individual (personalised), and cocreating goals and actions with older adults (participatory). A particularly important shift is the emphasis on engagement: clinicians should explore older adults’ beliefs, attitudes and priorities about falls, because these strongly influence uptake and adherence to prevention plans. As part of a comprehensive assessment, clinicians should ask about the older adult’s perceptions of falls, what they believe causes them, their perceived future risk, and what they think might help—then incorporate the person’s goals and preferences into the care plan.

3) Opportunistic case-finding: finding risk before injuries happen A major practical finding is that older adults often do not spontaneously report falls, and many do not present to services after a fall. Therefore, opportunistic case-finding is recommended: clinicians should routinely ask about falls as a standard part of contacts with older adults.

Key points include: Ask at least once yearly whether a person has fallen in the last 12 months, and explore frequency, circumstances and consequences.

The simplest entry question (“Have you fallen in the last 12 months?”) is specific but can miss people with emerging risk. Therefore, tools covering multiple risk signals (e.g., the “three key questions”: falls, unsteadiness, worry about falling) can improve sensitivity when resources allow.

Falls history recall can be unreliable; the “past year” reference is presented as a pragmatic balance between recall accuracy and changes in risk over time.

4) Risk stratification in the community: low, intermediate and high risk—then match intensity of response The guidelines propose a simple three-tier risk stratification approach for community-dwelling older adults, intended to ensure the response is proportional and feasible: Low risk No falls, or a single non-severe fall without gait/balance problems.

Low risk is not “no risk”: these older adults should receive primary prevention advice and be reassessed annually.

Intermediate risk A single non-severe fall with gait and/or balance problems.

The recommended response is targeted strength and balance exercise (or referral to physiotherapy/exercise services), because this type of exercise is effective at reducing falls risk.

High risk Falls with features that predict recurrence and harm, including: fall-related injury requiring medical care, recurrent falls (≥2 in 12 months), frailty, inability to get up for ≥1 hour (“long lie”), or suspected transient loss of consciousness.

These individuals should be offered a comprehensive multifactorial falls risk assessment leading to tailored multidomain interventions.

Simple, usable tests for stratification The guidelines recommend including gait speed (e.g., a cut-off of <0.8 m/s) for falls risk prediction; Timed Up and Go can be used as an alternative (evidence less consistent).

5) What “multifactorial assessment” should cover: multiple domains, not a single checklist For high-risk older adults (and for many residents in care homes/hospitals), the recommended approach is a multifactorial assessment across domains commonly driving falls. The guidelines position this within or alongside comprehensive geriatric assessment, and provide examples of recommended tools for several areas. Key domains repeatedly highlighted include: Gait and balance (including objective measures such as gait speed).

Medication review with attention to fall-risk-increasing drugs (FRIDs), including psychotropics and some cardiovascular agents, using structured approaches (e.g., deprescribing tools).

Cardiovascular and autonomic factors, particularly orthostatic hypotension; the assessment should include lying/standing BP and ECG, and if syncope is suspected, management should follow syncope pathways.

Cognition and delirium (because cognitive impairment is a falls risk factor in multiple settings); the plan should incorporate older adult and caregiver perspectives to support adherence.

Vision and hearing, foot problems and footwear, continence, and underlying acute/chronic diseases that may present atypically (e.g., infection presenting as a fall).

Nutrition including vitamin D considerations (assess intake/status when appropriate; do not assume universal benefit).

Environment and home hazards (assessment of hazards plus the person’s capacity and behaviour in that environment).

Concerns about falling (fear/worry), using standardised tools such as FES-I/Short FES-I, including in hospitals and long-term care.

6) Interventions: exercise as the cornerstone, with tailored multidomain packages for high risk 6.1 Exercise and physical activity: the strongest, most consistent intervention The guidelines provide a very clear “minimum effective dose” style message for falls prevention exercise in community-dwelling older adults: Programmes should include balance-challenging and functional exercises (e.g., sit-to-stand, stepping).

Sessions three times per week or more, individualised and progressed in intensity, delivered for at least 12 weeks and continued longer for greater effect.

Where feasible, include Tai Chi and/or additional progressive resistance strength training.

This aligns tightly with WHO’s physical activity recommendation that adults aged 65+ should be regularly active, and that those with poor mobility should do activity to enhance balance and prevent falls on 3+ days/week, alongside strength work on 2+ days/week.

6.2 Multidomain interventions for high-risk older adults: “tailored packages”, not one-size-fits-all For community-dwelling older adults at high risk, the guidelines strongly recommend offering multidomain interventions informed by a multiprofessional multifactorial assessment. Importantly, these are defined as two or more individually targeted components—not a fixed bundle given to everyone.

A multidomain intervention “at minimum” should consider components such as: strength/balance exercise; medication review and deprescribing; management of orthostatic hypotension/cardiovascular disease; optimisation of vision/hearing; foot/footwear; vitamin D where indicated; nutrition; continence; addressing concerns about falling; education; and environmental modification (including assistive devices/technology).

6.3 Medication optimisation: deprescribing FRIDs is part of falls prevention Medication review and appropriate deprescribing of FRIDs is presented as a core element of multidomain falls prevention, including in long-term care residents.

6.4 Vision, vitamin D, and technology: targeted, evidence-aware use Vision: effective strategies include cataract surgery (where needed) and counselling active older adults about possible increased risk when adapting to new prescriptions; in some contexts, avoiding multifocal glasses outdoors is mentioned.

Vitamin D: the guidelines explicitly state evidence does not support universal vitamin D supplementation for preventing falls; supplementation should be targeted to those at risk of deficiency (with care home residents/frail/homebound older adults often prioritised).

Technology: telehealth and/or smart home systems may be used in combination with exercise where available, but current evidence does not support wearables as a standalone falls prevention strategy (though they may help participation in exercise programmes).

7) Setting-specific findings: hospitals and care homes need a different logic than the community 7.1 Hospitals: stop relying on scored screening tools; focus on multifactorial assessment and tailored actions For hospitalised older adults (>65), the guidelines recommend: Performing multifactorial falls risk assessment (and specifically recommend against using scored falls risk screening tools as a substitute for multifactorial assessment).

Delivering tailored education on falls prevention to all hospitalised older adults (≥65) and other high-risk groups.

Implementing personalised single or multidomain prevention strategies based on identified risks, behaviours or situations.

After a fall in hospital, conducting a post-fall assessment to identify mechanism, injury, precipitating factors (e.g., delirium, intercurrent illness), reassess risks and update the plan.

They also highlight what not to over-rely on: there is no robust evidence to recommend bed/chair alarms, grip/non-slip socks, or physical restraints when the sole purpose is falls prevention in hospitals.

7.2 Care homes: assume high risk for all residents; avoid restraints; prioritise multifaceted implementation In care homes, the guidelines recommend: Do not use falls risk screening to identify “who is at risk”—all residents should be considered at high risk.

Perform a multifactorial assessment at admission, repeat at least annually or when the condition changes (as feasible), and complete post-fall assessments to adjust strategies and avoid unnecessary hospital transfers.

Use a multifaceted approach including staff training, systematic decision support and implementation of multiple falls prevention actions.

Avoid physical restraints as a falls prevention measure.

Include nutritional optimisation (protein/calcium) and vitamin D supplementation as part of multidomain intervention, and promote exercise/physical activity when feasible and safe.

8) Special populations: adapt delivery and supervision, but keep exercise central The guidelines provide additional recommendations where falls risk is particularly high and standard delivery may need adaptation: Post-stroke: offer individualised exercise aimed at balance/strength/walking, integrated into broader rehabilitation, with higher supervision when impairments are greater.

Cognitive impairment (mild cognitive impairment to mild–moderate dementia): communitydwelling older adults should be offered exercise programmes; caregiver involvement can improve adherence through environmental modification, routine support and incident recording.

Post-hip fracture: offer progressive exercise focused on mobility (standing, balance, walking, stairs), ideally started in hospital and continued in the community.

Parkinson’s disease: recommendations include risk assessment and (depending on stage/cognition) individualised exercise with balance/resistance components, often requiring appropriate supervision.

9) Low- and middle-income countries: local context, cultural tailoring, and prioritised risk factors A distinct contribution of these guidelines is explicit attention to implementation in low- and middle-income countries (LMIC), recognising that the majority of older adults globally live in LMIC and that risk factors and feasible interventions may differ.

Key LMIC findings include: Implementation must consider local context, including workforce, access to equipment/services, and cultural practices.

Opportunistic screening is advised for community-dwelling adults aged 60+, at least annually, during any clinical encounter.

Assessment priority may shift toward risk factors highlighted as prominent in LMIC evidence: cognitive impairment, obesity/sarcopenic obesity, diabetes, lack of appropriate footwear, and environmental hazards.

Falls prevention should be included in policy using culturally sensitive strategies tailored to local expertise and resources, and—where possible—validated, freely available assessment tools should be used.

Overall takeaway Across settings, the World Falls Guidelines converge on a consistent core: exercise (especially balance-challenging, functional and progressive programmes) is the most robust single strategy, while high-risk older adults benefit most from tailored multidomain interventions based on a multifactorial assessment. The guidelines strongly promote proactive case-finding, a personcentred co-designed plan, and setting-specific approaches—including reducing low-value practices (e.g., relying on scored inpatient screening tools, or using restraints for prevention).

WORKING WITH OLDER ADULTS IN PHYSICAL ACTIVITY PROGRAMMES Working with older adults is one of the most rewarding roles in physical activity delivery, but it requires a slightly different mindset than coaching younger groups. The goal is not only fitness; it is function, confidence, and quality of life. Older adults join programmes with varied health conditions, life experiences, motivation patterns, and fears (especially fear of falling). This chapter provides practical guidance on the key specifics: communication, motivation, engagement, inclusion, and safety.

1) Understand the diversity of “older adults” Older adults are not one group. You may work with: Active, confident participants who want challenge and progression.

Previously active but deconditioned participants returning after illness or life events.

People living with chronic conditions (arthritis, diabetes, cardiovascular disease, osteoporosis, respiratory disease).

People with mobility limitations, balance problems, or use of aids.

People with mild cognitive impairment, hearing/vision issues, or high anxiety about movement.

A good trainer avoids assumptions based on age and instead focuses on the person’s current function, confidence, and goals. Two people of the same age can differ dramatically in strength, balance, and health literacy.

2) Key specifics of ageing that affect training delivery Several age-related changes influence how older adults experience exercise sessions: Older adults may need more time to recover between sets or sessions, and energy levels can vary day-to-day. Build in flexible pacing and encourage participants to self-regulate.

Trips and slips become harder to recover from as stepping reactions slow and strength decreases. This is why structured programmes (like ABC+) focus on balance and functional movements. Trainers should use clear cues, stable set-ups, and safe progressions.

Joint stiffness, osteoarthritis, and low back discomfort are frequent. The trainer’s job is to help people distinguish between “safe discomfort” (effort, mild muscle soreness) and “warning pain” (sharp, increasing, joint pain, nerve symptoms).

Vision and hearing loss can affect instruction understanding and movement safety. Use clear demonstrations, face the group when speaking, reduce background noise, and ensure good lighting.

Some medicines can increase dizziness, fatigue, and balance problems. Be alert to signs of orthostatic symptoms (light-headedness when standing) and adapt transitions.

3) Build trust first: communication that works Trust is the foundation of adherence. Many older adults will not fully engage until they feel safe, respected, and understood.

Use respectful adult-to-adult communication. Avoid “baby talk” or overly simplistic tone. Use clear, calm language and check understanding without embarrassment: “Let me show it once, then we’ll do it together.”

“If something doesn’t feel right today, we’ll adjust it.”

Give short instructions, then demonstrate. Older adults often learn best with: one short verbal cue, a visual demonstration, guided practice, feedback.

Use positive, specific feedback Replace “Good job!” with: “Great control on the turn.”

“Nice steady sit-to-stand—your knees stayed aligned.”

This builds confidence and teaches quality.

Normalise modifications. Say out loud that adaptations are expected: “There are levels for every exercise—choose the one that feels safe but still challenging.”

4) Motivation: what matters most to older adults Older adults are rarely motivated by “abs” or performance metrics. The strongest motivators are usually: staying independent (stairs, shopping, getting out of a chair), preventing falls and staying safe outdoors, reducing pain or stiffness, being able to play with grandchildren, social connection and routine, maintaining confidence and a sense of control.

Practical motivational strategies: Connect each activity to a life benefit: “This helps you get up from a chair more easily.” & “This improves your ability to recover when you trip.”

Use short-term wins: “By week 4 you’ll notice stairs feel easier.”

Encourage identity: “You are building your strength for everyday life.”

Celebrate consistency more than intensity: “Showing up is your superpower.”

5) Keeping people engaged long-term Engagement is not only about exercise content; it’s about experience.

Create a predictable session rhythm. Older adults feel safer when the structure is familiar: welcome + check-in warm-up main work cool-down closing message / home tip

Use social glue. Simple actions create belonging: learn names quickly, pair work or small group tasks (when safe), acknowledge milestones (attendance streaks, personal progress), create a supportive “we” culture.

Offer choice and autonomy. Autonomy increases adherence: offer two intensity options (“Option A / Option B”), let participants choose support level (chair/wall/no support), ask preferences (“Would you like more walking drills or more chair-based work today?”).

Keep challenge progressive—but achievable. Boredom reduces adherence, but fear reduces participation. The sweet spot is “I can do this, and it’s a little hard.” Progress one variable at a time (speed OR range OR support OR complexity).

Manage fear of falling. Fear is common and can lead to avoidance. Trainers should: validate the feeling (“It’s normal to feel cautious after a fall.”), keep early successes safe and controlled, use steady progressions, reinforce confidence: “Your balance improves through practice.”

6) Safety: your non-negotiables Safety is not about removing all challenge; it is about safe challenge.

6.1 Pre-session safety checks (trainer routine) Room: clear floor, no loose mats/cables, good lighting.

Equipment: stable chairs, intact bands, enough space between participants.

Participant readiness: quick check-in (“Any dizziness, chest pain, new injury, or recent fall since last session?”).

6.2 Red flags: stop and refer Stop participation and advise medical review if there is: chest pain, severe shortness of breath at rest, fainting/near-fainting, sudden neurological symptoms (weakness, slurred speech, severe new headache), repeated unexplained falls or suspected loss of consciousness, acute severe pain, swelling, or inability to weight-bear.

6.3 Safe delivery practices during sessions Position yourself to supervise those with higher risk.

Use stable support options (chair/wall) for balance tasks.

Avoid crowded layouts; give turning space.

Cue safe transitions (sit-to-stand, floor-to-stand) slowly and deliberately.

Encourage hydration and controlled breathing.

Use “quality first”: stop sloppy repetitions before they become risky.

6.4 Pain rules trainers can teach A simple approach: Green: mild muscle effort, manageable discomfort → continue.

Amber: pain increasing, joint pain, sharp discomfort → reduce range/support/tempo.

Red: sharp pain, dizziness, chest symptoms, nerve symptoms → stop.

7) Inclusion: adapting for common needs You can include most older adults in group training by adjusting delivery rather than excluding.

If someone uses a cane/walker outdoors, allow them to use it to enter and exit safely. During exercises, provide a stable support option and ensure enough space.

Face participants when speaking, reduce background noise, and demonstrate more. Use gestures and a consistent set of cue words.

Improve contrast and lighting; avoid clutter; use tactile/physical reference points (chair position, taped lines) if appropriate.

Keep instructions short, repeat routine, use visual cues, avoid rapid complex changes, and consider caregiver support.

Offer predictable progressions, reassure, and prioritise confidence-building. Anxiety often decreases after a few successful sessions.

8) Professional mindset Excellent older-adult trainers: are calm, patient, and consistent, treat every participant with dignity, create a culture where modifications are normal, focus on function and confidence, monitor safety without creating fear, use encouragement and clear feedback, track attendance and celebrate progress, communicate with programme coordinators/health professionals when needed.

9) Keep in mind For many older adults, the trainer is the difference between “I’m afraid to move” and “I can do this.” By combining safe structure, respectful communication, meaningful motivation, and inclusive practice, trainers can help older adults stay active, independent, and confident—while reducing falls risk and improving daily life.

Authors of the Active Ageing Workshop Learning Materials: Maja Dolenc, PhD (external coworker of Sports Union of Slovenia) Tjaša Knific (National Institute of Public Health) Maarit Pirtola (UKK Institute) Julia Ben Khalifa (UKK Institute) Mojca Markovič (UKK Institute)

Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.