Falls among older adults are a major public health issue, accounting for approximately 2 million incidents annually in France, resulting in more than 10,000 deaths and 130,000 hospitalizations. Their cost is estimated at nearly 2 billion euros per year and is expected to rise as the population ages.
Falls result from multiple factors, including biological, behavioral, and environmental factors, with balance and gait disorders playing a central role. Their consequences include loss of independence, restricted activity, and fear of falling.
The ability to get back up from the ground after a fall is still largely overlooked. Yet up to two-thirds of older adults who have fallen are unable to get up on their own, exposing them to serious complications and an increased risk of further falls. This skill remains under-assessed and under-trained.
Physical activity-particularly programs combining balance, muscle strengthening, and functional training-can reduce the risk of falling by approximately 20 to 30 percent. Balance workshops are widely used for this purpose. However, these interventions primarily focus on fall prevention and rarely address fall management, particularly the ability to get up from the floor. Specific interventions targeting this skill are still underdeveloped, with mixed results.
The integration of structured training in getting up from the floor into balance workshops
People over the age of 65
Able to walk 100 m independently, with or without a walking aid (1 cane or 1 crutch)
Individuals who have fallen at least once in the past 12 months
Individuals who feel unsteady while standing or walking
Refusal to participate in the study
Individuals who walk with two canes or a walker, or who are unable to walk
Medical contraindications to physical activity (cardiac conditions, acute illness, uncompensated vestibular disorder).
Major cognitive impairment or dementia preventing active participation.
Parallel
Balance Workshops
Other interventionParticipants take part in the standard program, which includes one-hour group sessions designed to improve balance, mobility, coordination, muscle strength, confidence in moving around, and fall-prevention behaviors. The sessions include: * static and dynamic balance exercises; * muscle-strengthening exercises; * coordination and dual-task exercises; * joint mobility exercises; * educational sessions on physical activity, the environment, nutrition, and fall prevention; * discussion and wrap-up sessions to identify simple actions participants can take between sessions.
"getting up from the floor" module
Other interventionThis 20 minutes module includes a safe progression covering: * lower-body mobility, particularly the ankles, knees, and hips; * weight shifts; * gradual transitions to the floor; * exercises in intermediate positions: lunge, knight's stance, all fours; * strategies for turning and moving on the floor; * learning to transition from the floor to a standing position; * identifying secure points of support; * managing apprehension; * applying what has been learned to everyday situations. Progression is tailored to each participant's level. Moving to the floor is never required. In cases of apprehension, pain, functional limitations, or identified risks, the physical therapist suggests adaptations: exercises with support, use of a stable chair, partial exercises, movement simulation, or identifying possible steps without fully lowering oneself to the floor.
Feasibility of the intervention
The feasibility of the intervention will be assessed based on the fidelity of its implementation: adherence to the content. This aspect will be evaluated by the research team using a standardized monitoring form completed by the physical therapists.
Feasibility of the intervention
The feasibility of the intervention will be assessed based on the fidelity of its implementation: the pedagogical progression. This aspect will be evaluated by the research team using a standardized monitoring form completed by the physical therapists.
Feasibility of the intervention
The feasibility of the intervention will be assessed based on the fidelity of its implementation: the duration of the scheduled sessions. This aspect will be evaluated by the research team using a standardized monitoring form completed by the physical therapists.
Acceptability of the intervention
The acceptability of the intervention will be assessed based on the following factors: • Participants' satisfaction with the program, measured using a satisfaction questionnaire administered at the end of the intervention. The satisfaction survey for participants in the control group alternates between multiple-choice questions (to assess overall satisfaction, sense of safety, trust built, and organization) and open-ended questions (to gather their personal feedback on the benefits, challenges they faced, and areas for improvement). The satisfaction survey for participants in the intervention group alternates between multiple-choice questions (to assess overall satisfaction, organization, sense of safety, and confidence regarding falls) and open-ended questions (to gather personal impressions on benefits, challenges, and areas for improvement).
Ability to stand up from the floor
Ability to get up from the floor, assessed using a standardized floor-to-standing test, which allows for an evaluation of the level of assistance required (0: cannot get up, 1: with assistance, 2: without assistance) and the time required to get up. The floor-to-standing test will be used to assess the functional ability to get up after a fall. Participants will be asked to lie down on the floor in a standardized position and then get up as quickly as possible, without assistance, according to the instructions. The time taken to get up will be recorded, along with the strategy used (support, external aids). This test is considered a relevant indicator of impaired health, fall risk, and fall severity
Functional mobility
Functional mobility, assessed using the Timed Up and Go (TUG) test. The Timed Up and Go test measures basic functional mobility, including the ability to stand up, walk, turn around, and sit back down. The total time in seconds will be recorded.
Functional lower-limb strength
Functional strength of the lower limbs, assessed using the Five-Time Sit-to-Stand Test. The Five-Time Sit-to-Stand Test (FTSST) will be administered to assess lower-limb strength and functional mobility. Participants will be asked to stand up and sit down on a chair five times as quickly as possible, with their arms crossed over their chest. The total time required to complete the task will be recorded.
Postural balance
Postural balance: Static balance will be assessed using the Romberg test, the tandem stance test, and the single-leg stance test. For the Romberg test, participants stand with their feet together and arms at their sides, maintaining the position for up to 20 seconds-first with their eyes open, then with their eyes closed, and finally with their eyes open and their head tilted back. For the tandem stance test, participants stand with one foot directly in front of the other, heel to toe, for up to 20 seconds. Performance will be recorded separately for the right-foot-forward and left-foot-forward positions For the single-leg balance test, participants must stand on one leg without support, with the non-weight-bearing foot positioned at calf height without touching the leg. The time spent maintaining balance, up to 20 seconds, will be recorded for each leg.
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