A New Adaptive Home-based Exercise Technology among Older Adults Living in Nursing Home: A Pilot Study on Feasibility, Acceptability and Physical Performance

Non-Immersive Virtual Reality Exercise Can Increase Exercise in Older Adults Living in the Community and in Long-Term Care: A Randomized Controlled Trial

Purpose

To assess the impact of an 8-week non-immersive virtual reality exercise program for older adults on 1) balance, physical function, community integration and quality of life; 2) falls, emergency room visits, hospital and long-term care admissions; 3) quantity of exercise performed; and 4) acceptance of non-immersive virtual reality.

Patients and Methods

This prospective, assessor-blinded, randomized controlled trial was carried out on two separate samples of older adults: those living in their own homes ("home-based") and those living in long-term care ("facility-based"). Participants were randomized to non-immersive virtual reality or usual activity. Non-immersive virtual reality consisted of 20-30 minutes of customized, gamified exercises for balance, stepping, strengthening, and aerobic conditioning, performed 3-5x/week for 8 weeks. Outcomes were measured before the intervention, immediately after, and 1 month later. Physical testing and questionnaires addressed objective 1). Counts for objectives 2) and 3) were reported by the participants and retrieved from the non-immersive virtual reality platform. Logbooks and a short interview addressed objective 4).

Results

Recruitment was substantially impacted by the COVID-19 pandemic. The facility-based sample had 31 participants; the home-based sample had 16. There were no statistically-significant benefits to non-immersive virtual reality in either sample for objective 1), although the facility-based non-immersive virtual reality group showed a clinically-significant improvement in functional walking. Effect sizes were small (≤ 0.16). No falls occurred during non-immersive virtual reality exercise. The facility-based non-immersive virtual reality group did an average of 14.1 sessions (average 20.1 minutes/session) and the home-based non-immersive virtual reality group did an average of 17.2 sessions (22.6 minutes/session). Participants enjoyed the non-immersive virtual reality, found it challenging and motivating and felt that it improved balance and walking. Most were interested to continue beyond the study.

Conclusion

Non-immersive virtual reality for home-based and facility-based older adults is safe, enjoyable and feasible and may increase users' weekly levels of physical activity leading to clinical benefits for functional walking in facility-based users.

Trial Registration

ClinicalTrials.gov (NCT04083885; registered 2019-09-06).

The "FitBrain" program: implementing exergaming & dual-task exercise programs in outpatient clinical settings

Dual-task training and exergaming interventions are increasingly recognized for their potential to enhance cognitive, physical, and mood outcomes among older adults and individuals with neurological conditions. Despite this, clinical and community programs that use these interventions are limited in availability. This paper presents the "FitBrain" program, an outpatient clinical model that combines dual-task and exergaming interventions to promote cognitive and physical health. We review the scientific rationale supporting these methods, detail the structure and methodology of the FitBrain program, and provide examples of session designs that integrate dual-tasking through exergaming. The paper also addresses implementation considerations, such as tailoring interventions to specific populations, ensuring user-centered design, and leveraging accessible technologies. We discuss key challenges, including limited research on programs utilizing multiple technologies and cost constraints, and propose directions for future research to refine best practices and evaluate the comparative effectiveness of multimodal vs. singular interventions. This paper aims to inform clinicians and program developers on implementing dual-task and exergaming interventions within diverse clinical and community settings by offering a structured model and practical guidelines.

State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review

INTRODUCTION

Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions.

METHODS

Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish.

RESULTS

The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators.

CONCLUSION

Remote exercise interventions using technology appear to be feasible and acceptable in OACA.

IMPLICATIONS FOR CANCER SURVIVORS

Some remote exercise interventions may be a viable way to increase PA for OACA.

Immersive virtual reality in the promotion of health and well-being for people in residential aged care without cognitive impairment: A scoping review

Objective

Sustaining the health and well-being of older people living in residential aged care (RAC) requires new means of providing safe and stimulating recreational and therapeutic programs such as using virtual reality (VR). The aim of the scoping review was to investigate the utility of immersive VR interventions using head-mounted display technology to promote the health and well-being of people without cognitive impairment living in RAC.

Method

The following databases were searched from inception until January 2024: PubMed, PsycINFO, Scopus, Cochrane and CINAHL. The eligibility criteria were quantitative, qualitative or mixed methods studies published in English, conducted in RAC, using VR with head-mounted display with people without cognitive impairment.

Results

Of the 274 articles identified, 9 articles with a total of 310 residents and 50 staff met the inclusion criteria. Seven factors to either impede or enable the use of VR with head-mounted displays in RAC were: residents' agency; the nature of the VR experience; the content of the experience; the ease of use and comfort of the technology; the role of RAC staff; and the role of residents' family members.

Conclusion

Immersive VR has potential as a tool to promote the health and well-being of people without cognitive impairment living in RAC. Small sample sizes, variations in study design, and selection bias mean that generalisability of the results is limited. Further research is recommended to inform the design and implementation of immersive VR programs tailored specifically for this population.

VR exergame interventions among older adults living in long-term care facilities: A systematic review with Meta-analysis

BACKGROUND

To improve the motivation toward exercise in older adults, exergames have shifted from entertainment to rehabilitation.

OBJECTIVES

To review the training focus of exergames and analyze the effectiveness of exergame training on physical, psychological, or cognitive outcomes among older adults in long-term care facilities (LTCFs).

METHODS

This review followed the PRISMA guidelines. By searching 7 electronic databases up to April 30, 2022, studies were included if they 1) involved adults ≥65 years old residing in LTCFs, 2) were randomized controlled trials (RCTs) with virtual reality-based exergames as the intervention, 3) compared the effects of exergames to usual care or conventional exercises, and 4) reported physical, psychological, or cognitive outcomes. The Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to evaluate the methodological quality of studies and levels of evidence for outcomes. The meta-analysis was conducted with Review Manager 5.4. Results are presented as standardized mean differences (SMDs) and 95% confidence intervals (CIs).

RESULTS

A total of 12 RCTs were included in the systematic review and meta-analysis. For overall methodological quality, 10 studies showed some concerns and 2 studies showed high risk. Levels of evidence for outcomes were assessed as low (n = 8) and very low (n = 4). The studies involved a total of 482 older adults. Most studies implemented balance exercise as the exergame intervention. Older adults who completed exergame interventions showed improvements in cognitive outcomes (SMD 0.90, 95%CI 0.61-1.19, p<0.001) and in balance self-efficacy (SMD 1.04, 95%CI 0.47-1.61, p<0.001) as compared with those in usual care. They also showed improvements in balance (SMD 0.49, 95%CI 0.20-0.78, p<0.001) as compared with those in conventional exercise programs. Overall, exergames had a positive effect on balance (SMD 0.62, 95%CI 0.29-0.95, p<0.001).

CONCLUSION

This review revealed that exergames can improve the balance ability of older adults in LTCFs.

Effects of Healthcare Technologies on the Promotion of Physical Activities in Older Persons: A Systematic Review

This study aimed to explore the effects of health technologies on the promotion of health through physical activities of older persons. Following PRISMA guidelines, a systematic review of relevant articles published prior to 2020 was conducted from selected indices such as COCHRANE, PubMed, Science Direct, Proquest, including the use of hand search procedure. Twenty-seven articles were analyzed with significant findings influential to older people nursing: types of health technologies used for promoting physical activity; effects of technology use in promoting physical activity of older person care; and aspects that need to be considered in technology use among older persons. Characteristics of technologies were accuracy, usefulness, reliability, comfort, safety, and relevancy. Most technologies promoting physical activities for older people were wearable technologies that use artificial intelligence. Altogether, these technologies influenced overall healthcare behaviors of older persons. With healthcare technology efficiencies, proficiencies, and dependencies, technology-based healthcare have served older people well. Most technologies for older people care, such as wearables, reliably produce characteristics enhancing dependency and accuracy of bio-behavioral information influencing physical activities of older persons. Health technologies foster the values of physical activities among older persons thereby promoting healthy living.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Feasibility and Acceptability of Remote Physical Exercise Programs to Prevent Mobility Loss in Pre-Disabled Older Adults during Isolation Periods Such as the COVID-19 Pandemic

This study aimed to assess the feasibility and acceptability of remote physical exercise (PE) to prevent mobility loss among pre-disabled older adults during the COVID-19 lockdowns. Participants followed a 12-week PE remote program in Zoom© supervised groups (Web-Ex group, n=11) or phone-supervised individual booklet-based home-program (Booklet group, n=33). The total rate of adherence was 82.5% in the Web-Ex group and 85.8% in the Booklet group. The level of satisfaction was « a lot » for 60% of the participants in the Web-ex group and for 37.9% of those included in the Booklet group. Respectively 10% and 31% of the participants rated the difficulty as « low » in the web-ex and Booklet groups. Remote physical exercise using a web technology or booklets at home with regular and personalized follow-up during the lockdown was feasible and acceptable among pre-disabled seniors.

Using Medical Device Standards for Design and Risk Management of Immersive Virtual Reality for At-Home Therapy and Remote Patient Monitoring

Numerous virtual reality (VR) systems have received regulatory clearance as therapeutic medical devices for in-clinic and at-home use. These systems enable remote patient monitoring of clinician-prescribed rehabilitation exercises, although most of these systems are nonimmersive. With the expanding availability of affordable and easy-to-use head-mounted display (HMD)-based VR, there is growing interest in immersive VR therapies. However, HMD-based VR presents unique risks. Following standards for medical device development, the objective of this paper is to demonstrate a risk management process for a generic immersive VR system for remote patient monitoring of at-home therapy. Regulations, standards, and guidance documents applicable to therapeutic VR design are reviewed to provide necessary background. Generic requirements for an immersive VR system for home use and remote patient monitoring are identified using predicate analysis and specified for both patients and clinicians using user stories. To analyze risk, failure modes and effects analysis, adapted for medical device risk management, is performed on the generic user stories and a set of risk control measures is proposed. Many therapeutic applications of VR would be regulated as a medical device if they were to be commercially marketed. Understanding relevant standards for design and risk management early in the development process can help expedite the availability of innovative VR therapies that are safe and effective.

Lifestyle and rehabilitation during the COVID-19 pandemic: guidance for health professionals and support for exercise and rehabilitation programs

Introduction: The coronavirus disease-2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and healthcare professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.Areas covered: In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.Expert opinion: We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.

Energy Expenditure and Muscular Recruitment Patterns of Riding a Novel Electrically Powered Skateboard

Analysis of metabolic gas exchange and muscular output measures have enabled researchers to index activity intensity and energy expenditure for a myriad of exercises. However, there is no current research that investigates the physiological demands of riding electrically powered skateboards. The aim of this study was to measure the energetic cost and muscular trends of riding a novel electrically powered skateboard engineered to emulate snowboarding on dry-land. While riding the skateboard, eight participants (aged 21-37 years, 1 female) donned a portable breath-by-breath gas analyzer to measure energy expenditure (mean = 12.5, SD = 2 kcal/min), maximum heart rate (mean = 158, SD = 27 bpm), and metabolic equivalent (mean = 10.5, SD = 2 kcal/kg/h). By comparison, snowboarding has a metabolic equivalent (MET) of 8.0. Per the Compendium of Physical Activities guidelines, the predicted MET values for riding an electrically powered skateboard qualifies as vigorous-intensity activity. Four participants additionally wore a surface EMG embedded garment to record the percentage of maximum voluntary contraction (%MVC) of lower limb muscle groups. The inner quadriceps had the most pronounced mean peak muscle activation of 145%MVC during frontside and 164%MVC during frontside turns. EMG recordings showed 11.7%MVC higher utilization during backside turns compared to frontside turns while riding the electrically powered skateboard, which is similar to trends observed in alpine snowboarders. Therefore, electrically powered skateboards may be a promising technology for snowboarders and non-snowboarders alike to burn calories and increase physical activity year-round.

Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial

Background

Cardiac rehabilitation (CR) is highly effective as secondary prevention for cardiovascular diseases (CVDs). Uptake of CR remains suboptimal (30% of eligible patients), and long-term adherence to a physically active lifestyle is even lower. Innovative strategies are needed to counteract this phenomenon.

Objective

The Physical Activity Toward Health (PATHway) system was developed to provide a comprehensive, remotely monitored, home-based CR program for CVD patients. The PATHway-I study aimed to investigate its feasibility and clinical efficacy during phase III CR.

Methods

Participants were randomized on a 1:1 basis to the PATHway (PW) intervention group or usual care (UC) control group in a single-blind, multicenter, randomized controlled pilot trial. Outcomes were assessed at completion of phase II CR and 6-month follow-up. The primary outcome was physical activity (PA; Actigraph GT9X link). Secondary outcomes included measures of physical fitness, modifiable cardiovascular risk factors, endothelial function, intima-media thickness of the common carotid artery, and quality of life. System usability and patients’ experiences were evaluated only in PW. A mixed-model analysis of variance with Bonferroni adjustment was used to analyze between-group effects over time. Missing values were handled by means of an intention-to-treat analysis. Statistical significance was set at a 2-sided alpha level of .05. Data are reported as mean (SD).

Results

A convenience sample of 120 CVD patients (mean 61.4 years, SD 13.5 years; 22 women) was included. The PATHway system was deployed in the homes of 60 participants. System use decreased over time and system usability was average with a score of 65.7 (SD 19.7; range 5-100). Moderate-to-vigorous intensity PA increased in PW (PW: 127 [SD 58] min to 141 [SD 69] min, UC: 146 [SD 66] min to 143 [SD 71] min; P_interaction=.04; effect size of 0.42), while diastolic blood pressure (PW: 79 [SD 11] mmHg to 79 [SD 10] mmHg, UC: 78 [SD 9] mmHg to 83 [SD 10] mmHg; P_interaction=.004; effect size of −0.49) and cardiovascular risk score (PW: 15.9% [SD 10.4%] to 15.5% [SD 10.5%], UC: 14.5 [SD 9.7%] to 15.7% [SD 10.9%]; P_interaction=.004; effect size of −0.36) remained constant, but deteriorated in UC.

Conclusions

This pilot study demonstrated the feasibility and acceptability of a technology-enabled, remotely monitored, home-based CR program. Although clinical effectiveness was demonstrated, several challenges were identified that could influence the adoption of PATHway.

Trial Registration

ClinicalTrials.gov NCT02717806; https://clinicaltrials.gov/ct2/show/NCT02717806

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2017-016781

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

BACKGROUND

Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life.

METHODS

A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only).

DISCUSSION

This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents.

TRIAL REGISTRATION

The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

A technical concept of a computer game for patients with Parkinson's disease - a new form of PC-based physiotherapy

Background: At present, there are no meaningful and sophisticated computer games that simultaneously allow the treatment of movement disorders such as Parkinson's syndrome. In particular, there are no systems to consider the severity of the disease and the physical skills of the patient. Methods: A computer game using the Microsoft Kinect as markerless sensor for the 3 D recognition of the patient's movement was developed to support the rehabilitation. The scenario of a basketball game was created after determining that the movement like throwing a ball and the correct posture of the body are important. A study based on system usability was performed with 15 patients to evaluate the system. Results: The technical feasibility of a computer-assisted training system for supporting patients with Parkinson's disease has been demonstrated. No markers on the patient are required for movement detection and allow a user-friendly handling. Regarding the usability study, the patients were accepting of such a system and its at-home use and symptoms like 'freezing' and the Pisa syndrome can be treated. Conclusions: The physiotherapist can be assisted by the developed rehabilitation system. An objective measurement of the patient's training progress delivers valuable information to adjust the training sessions for every patient individually. Due to its modular character, the system can also be applied to other diseases or sports injuries and offers the basis for further development.

Digital Therapeutics: An Integral Component of Digital Innovation in Drug Development

Digital therapeutics represent a new treatment modality in which digital systems such as smartphone apps are used as regulatory-approved, prescribed therapeutic interventions to treat medical conditions. In this article we provide a critical overview of the rationale for investing in such novel modalities, including the unmet medical needs addressed by digital therapeutics and the potential for reducing current costs of medical care. We also discuss emerging pathways to regulatory approval and how innovative business models are enabling further growth in the development of digital therapeutics. We conclude by providing some recent examples of digital therapeutics that have gained regulatory approval and highlight opportunities for the near future.

Use of an Exercise Technology in Post-Acute Care of a Skilled Nursing Facility: A Feasibility Study

OBJECTIVES

Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy.

DESIGN

Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews.

SETTING

SNF.

PARTICIPANTS

A sample of post-acute patients (n = 237).

MEASUREMENTS

Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES).

RESULTS

Average time spent using the technology varied greatly (range, 1-460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = -0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates.

CONCLUSION

Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects.