Stepping On is an evidence-based fall prevention program designed for community-dwelling older adults. The program was developed in the late 1990s by a team of researchers and clinicians at the University of Wisconsin Madison. It aims to empower participants to reduce fall risks in their homes and improve their strength and balance through low-impact exercise.
The Stepping On program takes place once a week for 2 hours over 7 weeks. Each session features an educational presentation on a fall risk topic as well as exercise to improve strength and balance. Common topics covered include home hazard assessment, vision and falls, safe footwear, medication management, and safety when out in the community. Exercise is led by a certified fitness instructor and focuses on movements like hip strengthening, steps, and body movements that translate to daily tasks.
Several research studies have found Stepping On to be highly effective at reducing falls among older adult participants. A randomized controlled trial published in 2002 evaluated 224 community-dwelling older adults who were at risk for falling. The study found a 30% reduction in falls for those who took part in Stepping On compared to a control group over a 12-month period. Another clinical trial in Melbourne, Australia involving 360 older adults replicated this finding, with participants experiencing a 31% reduction in falls post-intervention.
Subsequent cost-analysis studies have explored the financial benefits of Stepping On as well. A 2017 study published in the Journal of the American Geriatrics Society compared fall-related healthcare costs over 12 months for Stepping On participants versus a control group. It found the program generated a cost savings of $672 per participant through reductions in fall-related medical expenditures like emergency department visits and hospitalizations. With hospital costs for fall-related injuries totaling over $50 billion annually in the United States, effective community-based programs like Stepping On can help curb rising healthcare spending on fall-related care for older adults.
The Stepping On program has been widely disseminated across the United States and internationally since its inception. As of 2022, over 30 states in the US have trained leaders and regularly offer Stepping On workshops in communities. Fidelity to the original curriculum developed at the University of Wisconsin is emphasized in training new leaders to deliver the program. Standardized training involves a 3-day class for potential leaders, which prepares them to implement all educational and exercise elements of Stepping On.
Fidelity is considered important to Stepping On’s effectiveness given the consistency of positive results demonstrated across multiple research studies. Several implementation studies have confirmed trained leaders adhere closely to the prescribed curriculum and can achieve significant reductions in falls comparable to the initial clinical trials. Participant satisfaction is also quite high. Standard evaluation forms reveal the vast majority believe Stepping On helped improve their balance, strength, and awareness of fall risks.
The low cost and infrastructure needed to implement Stepping On has enabled wide adoption globally as well. Translated curricula and leader trainings exist for populations in countries spanning Australia, Canada, Japan, New Zealand, Brazil, and beyond. The World Health Organization has endorsed Stepping On worldwide due to its success at scale. An analysis published in Age and Ageing estimated that if participation was expanded to just 10% of appropriate older adults, over 18,000 fall-related hospitalizations could be prevented annually in the United States alone.
Over two decades of research supports Stepping On as a highly effective, evidence-based fall prevention program. Its multi-component approach combining education and exercise has demonstrated reliable 30% reductions in falls for older adult participants. The program proves cost-saving for healthcare systems and has experienced broad dissemination nationally and globally. With falls posing a major public health threat, low-cost community interventions like Stepping On can play an important role in improving health and independence for growing aging populations worldwide.