Health in Motion is an app-based digital falls prevention program that helps older adults assess their falls risk, exercise, and learn how to avoid falls—all from the comfort and convenience of home. The program is an online adaptation of two established evidence-based programs: the Otago Exercise Program and A Matter of Balance (AMOB).

How did Health in Motion come to be?

NCOA launched the Administration for Community Living Evidence-Based Program Review Process in January 2025—the same month Sheryl Flynn and her family lost their home in the Eaton Fire in Altadena. Flynn is the founder and CEO of Blue Marble Health, a remote therapeutic monitoring platform for chronic disease and aging. Despite devastating personal loss, she moved forward and submitted Health in Motion for review. The program was ultimately approved for implementation with Older Americans Act Title III-D funding. 

Blue Marble Health partnered with the original program developers to create the digital adaptations. After several years of trials supported by National Institutes of Health (NIH) funding, Health in Motion now makes falls prevention programming more accessible for older adults who may be unable to attend in-person sessions. The platform also has the potential to bring other evidence-based programs online, further expanding their reach and impact.

NCOA talked with Flynn and Blue Marble Health’s Chief Operating Officer, Chris Ashford, to learn how Health in Motion works and what sets it apart.

1. How does your (i.e., Blue Marble Health) program reduce health care costs for your target population? 

The target population for Health in Motion is older adults at high risk of falling. The concept integrates fall risk assessments with both exercise and educational components, along with tools that allow people to track their progress. The broader goal is to reduce health care costs by increasing awareness of falls risk among older adults and enabling them to engage in falls prevention programming, ultimately reducing their likelihood of falling.

Implementation is highly cost-effective due to its fully digital nature. The platform is also highly scalable and can be used independently or with the support of a health coach. Access is typically provided through health systems, clinics, coaches, or community-based organizations. With access, older adults can take an active role in their health, monitoring improvements in their falls risk alongside their care team.

Another key feature is the optional collection of ZIP code data, which can help identify geographic areas in need of additional resources. Local Area Agencies on Aging (AAAs) and community-based organizations (CBOs) can use this data to better target their support and identify where to allocate funding most effectively. 

The digital format makes Health in Motion especially valuable for underserved older adults, such as those with limited transportation or income, by allowing them to participate from home using their own devices and internet connection. This not only empowers them to seek support from health care providers and community organizations but also enables those monitoring their data to proactively reach out with assistance. This is especially critical for older adults recently discharged from the hospital following a fall, as it helps bridge the gap between hospital-based physical therapy and local falls prevention programs provided by CBOs.

2. From your perspective, what part of your program intervention seems to have the greatest impact on participants’ health? Why do you think that is? 

There are concerns when something becomes purely digital that older adults will not use it or will find it too challenging. Blue Marble Health involved older adults in their focus groups throughout the development of Health in Motion. As a result, the client-facing side of the app was intentionally designed to look and function differently from most modern apps; it features a simplified interface with limited options and avoids sleek, high-tech visuals in favor of clarity and ease of use.

The app is displayed in landscape mode, like the layout of newspapers or books, making it more comfortable for older users who are accustomed to reading longer blocks of text. The design is very user-friendly and customizable; if the default display feels overwhelming, users can remove content and customize it to their preferences. As one study participant mentioned, “This is the first app that I’ve used that feels like it was developed with people my age in mind.”

3. What sets your intervention apart from others? 

What sets Health in Motion apart from similar programs is its high level of accessibility. A major challenge faced by community-based organizations offering falls prevention programming is enrolling enough participants to deliver the program as designed. While this is less disruptive for virtual sessions, it can be especially inconvenient for people who travel to attend in person, only to find the class canceled. 

Health in Motion addresses this by preserving program fidelity through close collaboration with program developers, who review and approve all adaptations. At the same time, the platform offers flexibility, allowing older adults to engage with the content on their own time and in manageable segments, such as 10-minute sessions instead of full-length, two-hour classes. To simulate the group experience, the app includes interactive “characters” who pose questions and offer quizzes to reinforce learning and maintain engagement.

Scalability is another key feature that sets this program apart. Rather than reaching just a few hundred or thousand people each year, Health in Motion has the potential to reach an exponentially higher number of people simply by allowing users to download the app from the App Store or access it with a code provided by their health care provider or community-based worker.

Health in Motion also offers a comprehensive set of standardized assessments that measure fall risk and functional ability. Older adults can perform these tests before and after participating in a falls prevention program, allowing them to print out the results and share them with their care team. The platform also provides a printable home safety checklist, enabling users to assess and improve safety room by room. To support ongoing monitoring, the system can automatically prompt users to complete assessments every three or six months. Even if a person decides not to participate in an evidence-based program, they can still track their progress and identify any signs of decline. This empowers them to make informed decisions about their health. 

Additionally, the organization that provides access to the app can monitor these trends using the Blue Marble Health web-based dashboard and proactively reach out to offer support and encourage participation in falls prevention programming.

4. What noticeable improvements are you seeing in participants’ health, confidence, or behavior because of this program?

One of the most striking outcomes among participants has been their strong adherence to the program. Sheryl noted that during their clinical trial, which included about 100 participants, they recorded nearly half a million repetitions of exercises, not including walking or timed activities like the sit-to-stand or balance exercises. She shared how exciting it was to witness the level of commitment and capability among many participants. Remarkably, even three years after the trial ended, many are still exercising three to six days a week. 

Sheryl also shared that during the trial, participants were reassessed every three months. At each check-in, people were given the option to discontinue if they no longer wished to participate—no pressure. She observed three distinct participant groups throughout the trial: those who dropped out within the first few weeks, those who followed the program as instructed, and a third group she called “super overachievers.” Health in Motion gave participants the flexibility to track more exercise than required, which provided deeper insights into behavior and helped identify who stood to benefit most from the program.

Sheryl believes there are many more people in that overachiever category and is eager to connect with them through this program. She also noted that some participants who initially considered leaving at the three-month mark decided to stay in the program after reviewing their fall risk scores, which sometimes hadn’t improved as much as they’d hoped. These check-ins proved to be powerful motivators. Participants received their results in a simple red, yellow, and green format. This, along with the thoughtful design of the program, supported strong adherence and empowered people to make informed, proactive decisions about their health.

Since the platform allows participants to self-assess their falls risk, some study participants indicated they would like to measure their risk as frequently as they check their blood pressure, while others indicated they’d prefer to check their fall risk every three months or annually. Regardless of how often a person completes the surveys or physical function tests, the results are stored in the app for participants to review. For some, the results of their tests motivate their continued exercise. In fact, several participants indicated that they would like to continue exercising until their scores moved from the red or yellow zone into the green zone.

5. Do you have any testimonials you can share?

The following participant testimonials were shared:

• “I had polio as a child, and I’ve been told to exercise my whole life. I have not found a program that I’ve wanted to participate in, until now. This is the first exercise program that allows me to exercise when I want, and I love how I can check in to see how I’m doing.”  —This participant has used the program consistently from October 2021 through to today, June 2025.
• “These tests are great. I’d like to do the sit-to-stand test every morning when I get up just to check in with myself”.
• “I thought I was going to drop out of the program this month, but now that I see my scores, I think I’ll stay in another three months; and this time, I’ll really dedicate myself to the program. I hope my scores improve from the yellow zone to the green zone by the time I do the tests again.”
• “I took the program on the cruise ship with me!”
• “I’m very concerned about COVID. I’m glad I don’t have to go anywhere to take these classes”. 
• “I just moved, now I have to redo all of the safety checklists again in my new home. I’m glad the app gives me the opportunity to do that.”
• “I identify with the character in the lessons who is very nervous. A lot of her comments sound like me talking to my friends. Another character is just like my friend, not afraid of anything. I think the program was designed very well, very informative.”

This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $10,000,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.