Introduction

FaME Implementation Toolkit for Ireland  

We are delighted to present this Irish version of the FaME Implementation Toolkit with links to resources and information. This toolkit aims to guide and assist service managers and providers to successfully implement the Falls Management Exercise (FaME) programme in Ireland, ensuring better practice, better outcomes and return on investment. If delivered with fidelity (maintaining the essential components) the outcomes of FaME change lives.  

The case for investing in strength and balance exercises for adults at risk of falling is clear. Each year around a one in every three adults over 65 years have at least one fall, with one in every eight requiring medical attention from a fall, resulting in falls being the most frequent cause of admission to hospital in Ireland. (1).  The HSE Falls Prevention Framework prepared by the HSE CDLMS regional area recommends that older adults who are at risk of falling should undertake an evidence-based multicomponent exercise programme – such as FaME – to help address this growing issue of falls across Ireland. 

FaME (FAlls Management Exercise) is an evidence based effective and cost-effective tailored, individualised and progressive multi-component exercise programme that has been shown in clinical trials, and in ‘real-life’ delivery, to prevent falls and increase physical activity levels in older adults who are at high and lower risk of falls. Despite this, few areas of Ireland report having an evidence-based falls prevention exercise programme such as FaME. Therefore, by providing the necessary tools to set up FaME, and delivery resources in one place it is hoped that FaME can be made more widely available, meaning that more adults at risk of falling can benefit from it and live a long, healthy, independent and happy life. 

The toolkit is designed to be viewed online and the resources included within can be downloaded and adapted for your locality. There are many resources that can be used to make the case for FaME, successfully promote its uptake locally.

The original UK toolkit was developed by a multidisciplinary team of researchers, practitioners, service managers, and service users across the UK, as part of the PhISICAL study at the University of Nottingham, funded by the National Institute for Health and Care Research Collaboration for Leadership in Applied Health Research and Care, East Midlands (NIHR CLAHRC EM) (2, 3) This Irish adaptation has been developed through the Health Research Board (HRB)-funded FaME Ireland study (4), in collaboration with falls experts, patient and public involvement (PPI) representatives, service providers, and Postural Stability Instructors from across Ireland. As FaME provision expands nationally, we encourage those implementing the programme to share their experiences and any resources they are willing to make publicly available. 

The research 

This toolkit was originally produced for use in a UK context and is an output of two research studies funded by the National Institute of Health and Care Research (NIHR) Applied Research Collaborations (ARCs); the PhISICAL study (Physical activity Implementation Study In Community-dwelling AduLts) and the FLEXI (Falls EXercise Implementation) study) (2, 3).  

The UK toolkit was subsequently revised for Irish settings as part of the FaME Ireland study. FaME Ireland was a two-year research project funded through a Health Research Board (HRB) Applied Partnership grant with additional funding support from the HSE. Using the HSE Guide for Change (Define, Design, Deliver process). The main aims of this study were to: 

• Define current service provision and practice across Ireland, along with a deeper analysis of service provision in 3 early adopter sites (Dublin, Kerry and Leitrim) through observation, interviews and examining the outcomes of FaME.  
• Co-design adaptations and service improvement ideas with key stakeholders 
• Re-Deliver the service with the changes in place and re-evaluate service delivery. At this stage, Cork was added as a fourth site. 

As part of the FaME Ireland study, researchers met and interviewed service providers (PSIs and physiotherapists) working in all three sites. A series of focus groups were also conducted with participants in the FaME classes at both midway and towards the end of the programme.  

The findings from these visits, along with the results of a 2024 national online survey of Irish based PSI trained professionals, informed a series of 'co-design' events run for a range of local health care professionals and managers, and community-based exercise professionals and leaders working in each of the early adopter areas.  These events examined access, funding and links to local exercise initiatives, and explored strategies to improve and consolidate the service provision for healthy ageing, exercise and physical activity and falls prevention and management in each area.   

In addition, another 'co-design' event was held for the FaME leads and PSIs working in each of the early adopter areas to look at ways to improve the efficiency and effectiveness of the service that could be implemented by the current service providers. Changes were agreed, and implemented in the subsequent phase of the study, Deliver. This phase allowed us to evaluate the feasibility and effects of the agreed changes. We also disseminated outputs of the findings and began discussions across the Irish health community on falls management and prevention models and pathways at a 2024 symposium in Dublin and a 2026 conference in Cork.

Why is this toolkit needed? 

FaME is an evidence-based, effective, and cost-effective multicomponent exercise programme that is tailored, individualised, and progressive. It has been shown, both in clinical trials and in real‑world delivery, to reduce falls and increase physical activity levels among older adults at higher and lower risk of falling (2, 5, 6). Although strength and balance exercise is strongly recommended for older adults at risk of falls, relatively few areas in Ireland currently provide an evidence-based falls prevention exercise programme such as FaME or Otago. 

Establishing new programmes can be a lengthy and resource‑intensive process. Developing a business case, writing service specifications, tendering, and implementing and evaluating a programme can take months. To support and accelerate this process, we have developed an implementation toolkit that brings together all the key components required to establish and run FaME successfully. 

Implementation toolkits are a critical resource for service managers and providers. They support the delivery of evidence‑based programmes with fidelity, helping to ensure optimal outcomes for older adults and best return on investment. By reducing duplication of effort, guiding effective service delivery, and drawing on best practice across localities, this toolkit enables FaME to be planned and implemented more efficiently. 

How should the toolkit be used? 

This toolkit provides a suite of resources that service managers can use to plan, implement and monitor FaME. It is divided into the following sections: 

Section 1 - Building the Case for Investment in FaME: This section includes evidence summaries for service managers and elected members, a costing tool, a business case and real-life case studies from FaME class participants and service providers in Ireland. 

Section 2 - Planning for FaME Implementation: This section describes an implementation plan with Gantt chart, a service specification, example delivery models, logic model and key learning from the FaME Ireland study. 

Section 3 - FaME Delivery: This section includes sample promotional materials, template clinical letters, briefings for referrers and participants, home exercise diaries and other guidance on programmes and classes.  

Section 4 - Monitoring and Evaluation: This section includes quality assurance guidance and suggested monitoring tools and schedule.  

Section 5 - A Resource Library of additional documents: This section includes additional documents, templates and presentations that provide further information about the FaME programme and can be used to support the case for adoption.  

 REFERENCES:

1. Briggs R, Ward M, Scarlett S, van der Velde N, Hernandez B, Romero-Ortuno R, et al. Determining the burden of falls amongst community-dwelling older people in Ireland to inform falls care delivery: secondary data analysis from the Irish longitudinal study on ageing – the defined study. BMJ open. 2026;16(1):e107647.
2. Orton E, Audsley S, Coupland C, Gladman JRF, Iliffe S, Lafond N, et al. 'Real world' effectiveness of the Falls Management Exercise (FaME) programme: an implementation study. Age Ageing. 2021;50(4):1290-7.
3. Carpenter H, Audsley S, Coupland C, Gladman J, Kendrick D, Lafond N, et al.PHysicalactivity Implementation Study In Community-dwelling AduLts (PHISICAL): study protocol. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2019;25(5):453-8. 
4. McCullagh R, Horgan N, Eldridge C, Thackeray K, Cahalane E, Cummins V, et al. Falls Management Exercise programme: Improving reach, effectiveness, value and sustainability in Ireland. Case studies for learning (acronym: FaME Ireland): protocol of an observational evaluation study [version 1; peer review: awaiting peer review]. HRB Open Research. 2025;8(56). 
5. Iliffe S, Kendrick D, Morris R, Masud T, Gage H, Skelton D, et al. Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care. HealthTechnolAssess. 2014;18(49). 
6. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise — FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age and Ageing. 2005;34(6):636-9.