Exploring balance challenge in fall prevention community exercise programs for older adults across Canada: A cross-sectional electronic survey of instructor perceptions.

Background: Exercise that challenges balance helps reduce falls in older people. Evaluating the intensity of balance challenge is difficult and no validated measures exist for group settings. Objective: To examine how instructors determine and perceive balance challenge at the program level, and explore relationships between estimates of program-level balance challenge. Design: Cross-sectional self-report study. Setting: Electronic survey questionnaire approach. Participants: Instructors of Canadian group exercise programs targeting community-dwelling older adults. Measurements: Instructors perceived program-level balance challenge and estimates of program-level balance challenge. Results: Most instructors (n = 108, 77%) perceived that their programs fully challenged balance among participants. However, no programs were identified as highly challenging. Most of the observed non-verbal balance challenge behaviours observed (n = 4, 80%) had no relationship to perception of balance challenge. Conclusions: Findings suggest a misalignment between instructor perception and estimates of balance challenge at the program level. Further investigations of methods to assess balance challenge are warranted.