Smallest worthwhile effect of exercise programs to prevent falls among older people: estimates from benefit-harm trade-off and discrete choice methods

Age Ageing. 2016 Nov;45(6):806-812. doi: 10.1093/ageing/afw110. Epub 2016 Jun 27.


Background: the smallest worthwhile effect (SWE) of an intervention is the smallest treatment effect that justifies the costs, risks and inconveniences associated with that health intervention.

Objective: to estimate the SWE of exercise programs designed to prevent falls among older people and to compare estimates derived by two methodological approaches.

Study design and setting: discrete choice experiment (n = 220) and benefit-harm trade-off (subsample n = 66) methods were used.

Participants: community-dwelling older people who reported a past fall or a mobility limitation answered online or face-to-face questionnaires.

Results: a substantial proportion of participants (82% in the discrete choice experiment and 50% in the benefit-harm trade-off study) did not consider that participation in the proposed exercise programs would be worthwhile, even if it reduced their risk of falling to 0%. Among remaining participants, the average SWE of participation in an exercise program was an absolute reduction in the risk of falling of 35% (standard deviation [SD] = 13) in the discrete choice experiment and 16% (SD = 11) in the benefit-harm trade-off study.

Conclusions: many participants did not consider the hypothetical falls' risk reduction of the proposed exercise programs to be worth the associated costs and inconveniences. Greater community awareness of the fall prevention effects of exercise for older people is required.

Keywords: benefit–harm trade-off; discrete choice experiment; exercise; falls; older people; smallest worthwhile effect.

Publication types

  • Comparative Study

MeSH terms

  • Accidental Falls / economics
  • Accidental Falls / prevention & control*
  • Aged
  • Aged, 80 and over
  • Choice Behavior*
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Exercise Therapy / adverse effects
  • Exercise Therapy / economics
  • Exercise Therapy / methods*
  • Female
  • Health Care Costs
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Patient Participation
  • Process Assessment, Health Care* / economics
  • Risk Assessment
  • Risk Factors
  • Surveys and Questionnaires
  • Treatment Outcome