LiFE (Lifestyle-integrated Functional Exercise) program

• Risk of falls https://icd.who.int/browse10/2019/en#/W00-W19.
• Decrease of 31 % of risk of falls (Clemson, 2012).
• ICD11: MB47.C

• Improvement of balance (Clemson, 2012).
• Improvement of autonomy (Clemson, 2012).
• Decrease of healthcare costs (Dams, 2024).

• Falls with minor consequences.
• Fatigue and minor pain.

• Neuroplasticity, the brain's ability to reorganize itself by forming new neuronal connections, leading to improved cognitive functions, notably memory, learning and executive functions.
• Cognitive reserve, brain resistance that can delay the onset of cognitive decline and reduce the risk of neurodegenerative diseases.
• Neurotrophic factors, increased levels of brain-derived neurotrophic factor (BDNF) through physical activity, a protein that helps protect existing neurons and encourages the growth of new neurons and synapses. 
• Mood regulation.

• Minimal improvement in balance and coordination through advances in proprioception (the body's ability to perceive its position in space), essential for maintaining balance and coordination.
• Minimal improvement in muscular strength through gains in muscle fibre and muscular efficiency. 
• Improved functional mobility, the ability to move more easily and safely in different environments (walking, climbing stairs, using the toilet, etc.).
• Minimal improvement in cardiovascular health by boosting blood circulation, reducing blood pressure and improving lipid profiles. This promotes overall heart health and reduces the risk of cardiovascular disease.
• Hormonal regulation through the release of various hormones such as endorphins (mood enhancement and stress reduction) and blood sugar management (insulin sensitivity).

• People over 65 at high risk of falling.
• People over 80 at moderate or high risk of falling.
• Program feasible for people with moderate cognitive impairment (Belala, 2019).

• People with severe cognitive impairment.
• Acute conditions (severe infection, recent surgery, uncontrolled chronic illness).
• Uncontrolled cardiovascular conditions (severe hypertension, heart failure).

• Easily acceptable program if the professional is trained (Reicherzer, 2021).
• Initial assessment at home with a health check-up by the healthcare professional to evaluate physical abilities and identify fall risks.
• Integrated functional exercises with the aim of integrating exercises into daily activities to improve strength, balance and coordination.
• Personalization and progression according to each individual's abilities.
• Incorporate exercises into daily routines such as housework, gardening or shopping.
• Exercises are performed several times a day, every day of the week.
• Follow-up and adjustments based on progress and feedback from the participant.
• Encouragement to progressively increase the difficulty of the exercises.
• Encouragement of regularity with continuous integration of exercises into daily routine to maintain long-term benefits.
• Regular follow-up to ensure that exercises are performed correctly and safely.

• Muscle mobilization using everyday activities such as carrying groceries or lifting household objects to develop muscle strength.
• Personalization of everyday movements to ensure that exercises are both stimulating and achievable, promoting adherence and effectiveness, and may involve small modifications to the home to facilitate physical activity in complete safety (tidying up, support bars, etc.).
• Mobilization of balance by strengthening the lower limbs, ankles (toe-lifting exercises, posture on heels, etc.) and trunk (leg lifts while sitting, posture on one leg while brushing teeth or washing dishes, etc.).
• Functional movements from real life, such as getting up from a chair without using your hands, or going up and down stairs.
• The use of behavior change techniques (strategies to encourage long-term adherence, such as setting realistic and achievable physical activity goals, self-monitoring and self-assessment of progress, problem-solving by identifying and overcoming barriers to exercise such as lack of motivation or physical limitations) (Mikolaizak, 2022).
• Support for the justification of daily physical activity and living arrangements, in particular for falls prevention (information on the benefits of exercise and advice on how to integrate it into daily life, regular follow-up).

• Comfortable clothes and shoes.
• Common household tools.
• Chairs.
• Stairs.

• A professional manual of the LiFE programme https://open.sydneyuniversitypress.com.au/9781743324004.html is available online (Clemson, 2014a).
• A free LiFE program guide for participants also available online (Clemson, 2014b).
• The success of the program lies in the willingness to integrate physical exercise into daily routines (Hezel, 2021).
• Provide information on the benefits of physical exercise and advice on how to integrate it into daily life (Dargent-Molina, 2017).
• Offer periodic check-ups to adjust the program if necessary and provide encouragement.
• The NPI can be prescribed as a first-line treatment in general practice (Gibbs, 2019).
• Participants who performed balance activities more frequently (≥4 days/week) scored better in the balance and physical activity domain (Nerz, 2022).

• The NPI prepares all participants to pursue pleasant, independent physical activity in their immediate environment, in line with public health recommendations on frequency, intensity and variety.
• Medication and dietary supplements should be regularly reviewed by the attending physician. 
• Alcohol consumption should be limited, particularly in cases of dizziness or drowsiness.
• Regular visits to an ophthalmologist are recommended, as reduced vision induced by advanced glaucoma or cataracts, for example, is a risk factor for falls.
• Shoes should be well-fitting, with good support both inside and out.

• Medical prescription.
• Free of charge, but the practitioner must systematically cite the LiFE program https://open.sydneyuniversitypress.com.au/9781743324004.html

• Occupational therapist trained at the NPI.
• Nurse trained at the LiFE program.

Prototypical study
Clemson L et al. LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Aust Occup Ther J. 2010 Feb;57(1):42-50. https://doi.org/10.1111/j.1440-1630.2009.00848.x


Pivotal mechanistic study
Endress C et al. Lifestyle-integrated functional exercise for fall prevention: How and why do walking characteristics change?. Z Gerontol Geriatr. 2023 Oct;56(6):464-469. German. https://doi.org/10.1007/s00391-023-02230-y


Pivotal intervention trials
Clemson L et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012 Aug 7;345:e4547. https://doi.org/10.1136/bmj.e4547 

Jansen CP et al. Comparison of falls and cost-effectiveness of the group versus individually delivered Lifestyle-integrated Functional Exercise (LiFE) program: final results from the LiFE-is-LiFE non-inferiority trial. Age Ageing. 2023 Jan 8;52(1):afac331. https://doi.org/10.1093/ageing/afac331


Intervention studies assessing the risks
Jansen CP et al. Comparison of a group-delivered and individually delivered lifestyle-integrated functional exercise (LiFE) program in older persons: a randomized noninferiority trial. BMC Geriatr 2018;18:267. https://doi.org/10.1186/s12877-018-0953-6 

Clemson L et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012 Aug 7;345:e4547. https://doi.org/10.1136/bmj.e4547


Implementation study in Europe
Nerz C et al. Group-based and individually delivered LiFE: Content Evaluation and Predictors of Training Response - A Dose-Response Analysis. Clin Interv Aging. 2022 Apr 27;17:637-652. https://doi.org/10.2147/CIA.S359150


Other
Belala N et al. Feasibility of the lifestyle integrated functional exercise concept in cognitively impaired geriatric rehabilitation patients. Z Gerontol Geriatr. 2019 Feb;52(1):61-67. https://doi.org/10.1007/s00391-018-1431-7 

Clemson L et al. Lifestyle-integrated functional exercise (LiFE) program to prevent falls: trainer’s manual. Sydney, University Press, 2014a. https://sydneyuniversitypress.com/products/78838 

Clemson L et al. Lifestyle-integrated functional exercise (LiFE) program to prevent falls. Participant’s manual. Sydney: University Press, 2014b. https://open.sydneyuniversitypress.com.au/files/9781743324004.pdf 

Dams J et al. Budget impact analysis of a Lifestyle-integrated Functional Exercise (LiFE) program for older people in Germany: a Markov model based on data from the LiFE-is-LiFE trial. BMC Geriatr. 2024 Feb 23;24(1):186. https://doi.org/10.1186/s12877-024-04802-y 

Dargent-Molina P et al. Prévention des chutes chez les personnes âgées de plus de 75 ans vivant à leur domicile: analyse des interventions efficaces et perspectives de santé publique. Bull Epidémiol Hebd. 2017;(16-17):336-43. https://beh.santepubliquefrance.fr/beh/2017/16-17/2017_16-17_6.html 

Gibbs JC et al. Measuring the implementation of Lifestyle-Integrated Functional Exercise in primary care for older adults: Results of a feasibility study. Can J Aging. 2019 Sep;38(3):350-366. https://doi.org/10.1017/S0714980818000739 

HAS. Personnes âgées à risque de chute : Prescription d’activité physique. HAS, La Plaine, 2024. https://www.has-sante.fr/upload/docs/application/pdf/2024-04/synthese_aps_personnes_agees_a_risque_de_chute.pdf 

Hezel N et al. The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications: a narrative review. Ger J Exerc Sport Res. 2012 51:416–429. https://doi.org/10.1007/s12662-021-00770-2

INSERM. Activité physique et prévention des chutes chez les personnes âgées. Paris, INSERM, 2014. https://www.inserm.fr/wp-content/uploads/media/entity_documents/inserm-ec-2015-chutespersonnesagees-synthese.pdf 

Mikolaizak AS et al. Impact of adherence to a lifestyle-integrated programme on physical function and behavioural complexity in young older adults at risk of functional decline: a multicentre RCT secondary analysis. BMJ Open. 2022 Oct 5;12(10):e054229. d https://doi.org/10.1136/bmjopen-2021-054229

Reicherzer L et al. Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability. BMC Geriatr. 2021 Feb 1;21(1):93. https://doi.org/10.1186/s12877-020-01991-0