Effectiveness of an mHealth Exercise Program on Fall Incidence, Fall Risk, and Fear of Falling in Nursing Home Residents: The Cluster Randomized Controlled BeSt Age Trial

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluated the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Primary outcomes were fall incidence and fall risk (Berg Balance Scale [BBS], Timed Up and Go [TUG]); fear of falling was secondary. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1,190.81) = 8.25, p = .005), while changes in TUG performance, fear of falling, and fall incidence were nonsignificant. The intervention improved balance, a key component of fall risk, but did not reduce fall frequency within the study period. These findings demonstrate the feasibility and short-term functional benefits of a staff-mediated mHealth approach to fall prevention in NH residents.