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Background: Falls among community-dwelling older adults can be significantly reduced through exercises for balance and strength. Digital solutions show promise in increasing the reach and promote adherence to fall prevention exercises among older adults. However, research on long-term engagement in self-managed fall prevention programs is lacking. The Safe Step application is designed, in collaboration with older adults, to motivate and support them in independently engaging in balance and strength exercises. The aim of this study was to explore longitudinal patterns of older adults’ engagement in self-managed fall prevention exercise supported by the Safe Step digital application.

Methods: A qualitative longitudinal study was nested within a randomized controlled trial that evaluated the effectiveness of the Safe Step application in reducing falls among community-living older adults. A selection of participants who maintained an exercise dose of ≥ 60 min each week was invited to the study. Fifteen participants were included. Each participant was interviewed twice, first at the end of a twelve-month trial period and then after an additional six months. The analysis followed the Pattern-Oriented Longitudinal Analysis approach, analyzing patterns of change over time.

Results: Four engagement patterns were identified that began to emerge during the first year and were consolidated over time: (i) Coherent and sustained pattern, (ii) Coherent and episodic pattern, (iii) Integrated and sustained pattern, and (iv) Integrated and episodic pattern. The long-term engagement in self-managed digital fall prevention was characterized by the degree of cohesion and regularity in training. Initially, all participants followed the exercise recommendations provided by the application. With time they developed different strategies to maintain the exercises that resonated with their own preferences and daily activities. Conclusions: The digital program played a meaningful role in initiating and establishing exercise routines, while other determinants also influenced long-term engagement strategies. Support for self-management of fall preventive exercise needs to evolve over time to meet the changing needs of individuals and their different patterns of exercise engagement. Further research is needed to inform digital interventions aimed at supporting long-term engagement in fall prevention programs.