Skip to content
Main menu hidden.

Image: Mostphotos: https://www.mostphotos.com/10435624/elderly-woman-with-tablet-computer

Safe Step

Research project The overarching objective of this research initiative is to enable independent engagement in strength and balance exercises among older individuals prone to falls. Safe Step is a research project focused on evaluation of a digital fall prevention exercise program specifically designed for older adults through co-creation.

Engaging in regular strength and balance exercises has proven effective in reducing falls in the older population, but accessible evidence-based self-managed exercise programs are urgently needed. 'Safe Step,' a digital exercise program empowering seniors to start and maintain fall-preventive exercises. The programme is developed in co-creation with seniors and has indicated promise in trials as a primary preventive measure. The current phase involves implementing Safe Step in municipal fall prevention efforts and nationwide distribution for older adults in Sweden.

Head of project

Marlene Sandlund
Associate professor

Project overview

Project period:

Start date: 2019-09-01


  • The Swedish Research Council for Health, Working Life and Welfare (FORTE) Dnr 2020-00589.  2021-2023
  • Umeå University Faculty-funded Strategic Research Resources 2023-2025

Participating departments and units at Umeå University

Department of Community Medicine and Rehabilitation

Research area

Public health and health care science

Project description

Falls represent the most prevalent cause of injury in the older population, resulting in escalating societal costs and challenges. Regular engagement in strength and balance exercise has proven to substantially reduce the incidence of falls and associated injuries. However, it's crucial to improve access to exercises based on evidence and encourage older adults to manage their own exercise routines.

The Safe Step app is a digital exercise programme designed in co-creation with older individuals. The app offers a collection of exercise videos, guiding users in the autonomous creation of a personalized exercise programme. To enhance program adherence, the app incorporates a set of behaviour change techniques. Additionally, it provides video lectures on subjects related to falls prevention and healthy ageing. See sakrasteg.se  for more information.

The Safe Step research project aligns with the guidelines outlined by the Medical Research Council of the United Kingdom for the development and evaluation of complex interventions. The app has undergone comprehensive evaluation, encompassing a feasibility trial and a nationwide randomized controlled trial (RCT).  Participant interviews showed strong self-efficacy in managing exercise and the app was preferred over traditional methods for better adherence. The RCT was design to mimic the conditions of a real-world setting and the 1628 participants included were monitored over a year, with monthly fall reports and quarterly digital surveys. Preliminary results indicated a significant reduction in fall risk in the exercise group, positioning Safe Step as a primary preventive measure for reducing fall risk among seniors. Analyses of data is still ongoing.

In the next phase we are now proceeding with implementation studies to support decision-making in municipalities that wish to incorporate Safe Step into their fall prevention efforts. Furthermore, this involves the nationwide distribution of the app for free download to older adults across Sweden.


The aim of the current phase is to describe and evaluate the implementation of Safe Step into the fall prevention initiatives in three medium-sized municipalities situated in the northern region of Sweden. Additionally, it seeks to examine the usage patterns of the app among older individuals in Sweden, once it becomes freely available for download.


Our approach will encompass the comprehensive documentation and clarification of strategies adopted by each municipality, followed by a dedicated one year-long commitment to monitor and evaluate the progress of their implementation endeavours. The implementation studies have been structured in alignment with the implementation outcomes taxonomy proposed by Proctor et al. (2011) to address acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The results will describe factors that facilitate or hinders the use of Safe Step as an effective falls prevention approach in each municipality.

In parallel, we will launch the app for free download throughout Sweden. To understand how older individuals use the app outside of participating in a controlled study, we will use anonymized logs generated by the application to monitor its usage patterns over time.

Latest update: 2023-11-15