The effectiveness of synchronous tele-exercise to maintain the physical fitness, quality of life, and mood of older people - a randomized and controlled study

e-Health Interventions for Promoting Physical Activity in Aging Adults: A Scoping Review

Background: The use of e-health interventions to promote physical activity (PA) among older adults has significantly increased in recent years. This review aims to comprehensively summarize the various e-health modalities and strategies used to encourage PA in aging adults. Methods: A systematic search of Medline, Embase, CINAHL, AMED, and PubMed databases was conducted to identify studies on e-health interventions targeting PA promotion in individuals aged 50 and older, published between 2012 and 2023. Information pertaining to study characteristics and e-health intervention specificities was extracted using a standardized data collection form. A narrative synthesis approach was employed to synthesize the data collected from the included studies. Results: Of 4,915 studies initially retrieved, 81 met the eligibility criteria. The findings reveal a diverse array of methods and interaction modes utilized to stimulate PA in aging adults, regardless of their medical conditions. Asynchronous methods such as web-based programs, mobile apps, and activity monitors were used in 71.6% of the studies and were most frequently employed for initiating behavior change components. Synchronous interaction modes mainly included videoconferencing and were predominantly featured in studies where real-time supervision and demonstration of exercises were integral to PA programs. There was a lack of information to guide the selection of the most effective e-health intervention format for motivating older adults to engage in regular exercise. Conclusion: This review underscores the versatility of e-health interventions, showcasing a wide spectrum of methods and interaction modalities. Future studies should compare these different modalities and methods while also identifying their barriers and facilitators. This will help in selecting the most suitable interventions for older adults.

Tele-Exercise for Fitness: Physical and Psychological Outcomes in Athletes and Non-Athletes' Trainees

Background: This research explored how tele-exercise influenced physical fitness and mental well-being in individuals with and without disabilities and with different training habits. Methods: One hundred and ninety-three participants were categorized into two groups: athletes and non-athletes. Participants were involved in either synchronous or asynchronous tele-exercise programs of two or three sessions of workouts per week, lasting eight weeks. Psychological well-being was evaluated pre- vs. post-intervention by the WHO-Five Well-Being Index (WHO-5), Psychological General Well-Being Index (PGWBI), and Perceived Stress Scale (PSS-10). Fitness assessment tools included the 2-minute step test, curl-up test, forward bending test, and squat test. Body weight was also assessed pre- and post-intervention. Results: The analysis showed a significant increment in all fitness scores (p-value ranged from <0.001 to 0.015) with no change in body weight. Psychological tests indicated an overall increment in the participants' well-being measured by the WHO-5 and unexpectedly, also in the stress level assessed through PSS-10. Conclusions: Enabled by technology, tele-exercise provides a flexible and convenient complementary approach to conventional workouts, helping individuals maintain an active lifestyle and improve their well-being. Positive effects on the sedentary population's lifestyles are discussed.

Impact of tele-exercise on quality of life, physical fitness, functional capacity and strength in different adult populations: a systematic review of clinical trials

Introduction

This study aimed to review the impact of tele-exercise on different adult populations, comparing synchronous and asynchronous interventions and their effects on outcomes such as quality of life, physical fitness, functional capacity, strength, and pain.

Methods

Randomised clinical trials and quasi-experimental studies published between 2014 and 2024 were included, totalling 16 studies with 1,416 participants. The interventions varied between synchronous teleexercise (via videoconference) and asynchronous (via apps and recorded videos). The review followed the PRISMA guidelines, ensuring a systematic approach to study selection, data extraction, and bias assessment.

Results

The results indicate that tele-exercise, especially synchronous, has the potential to primarily improve physical fitness, functional capacity, and pain perception, being effective for the elderly and individuals with specific conditions such as multiple sclerosis and obesity.

Discussion

However, the methodological heterogeneity of the studies and the lack of consistent data limit the generalisation of the findings, highlighting the need for more high-quality research.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024563241, PROSPERO (CRD42024563241).

Tele-exercise in multiple sclerosis: Systematic review and meta-analysis of effects on fatigue, depression, and overall health

BACKGROUND

Multiple sclerosis (MS) profoundly influences fatigue, depression, various physical and mental symptoms, and quality of life (QoL). Rehabilitation, including exercise training, has improved outcomes of MS, yet is often undertaken in facilities with direct supervision which present substantial barriers for accessibility and scalability. The delivery of exercise remotely via technology (tele-exercise) might overcome those barriers and improve outcomes in MS. This systematic review and meta-analysis examined the effect of tele-exercise for improving fatigue, depression, and overall health outcomes in MS patients.

METHOD

We undertook a comprehensive literature search across 5 electronic databases (PubMed, Scopus, Web of Science, The Cochrane Library, clinicaltrials.gov, and EMBASE) from inception through February 2024. Three reviewers screened all randomized controlled trials (RCTs) and assessed quality, and two reviewers extracted data. The meta-analysis used standardized mean difference (SMD) with Hedges' g method, a random effects model adjusted by Hartung-Knapp, and assessed heterogeneity (I² statistic), weighted studies (inverse variance), and evaluated publication bias (Begg's funnel plot and linear regression test).

RESULT

We located 13 RCTs for inclusion in the meta-analysis. Tele-exercise interventions demonstrated significant improvements across all outcomes: depression (SMD=-0.51, p < 0.001), fatigue (SMD=-0.58, p = 0.01), physical health (SMD=0.62, p = 0.001), QoL (SMD=0.38, p = 0.02), and mental health (SMD=-0.48, p = 0.001). Mind-Body Training consistently had larger effects than Combination Training.

CONCLUSION

Tele-exercise can improve fatigue, depression, mental and physical health, and overall QoL in MS patients. Further research is necessary to optimize tele-exercise protocols, assess long-term effects, and explore potential synergies with other intervention modalities such as telemedicine.

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.

Fitness and psychological effects of tele-exercise in healthy populations. Preliminary study

Background

The study investigates the impact of tele-exercise on physical fitness and psychological well-being in healthy individuals. Tele-exercise, facilitated by technology, offers a flexible and accessible alternative to traditional exercise, particularly beneficial during restricted in-person interactions.

Methods

In this study, 52 participants were divided into three groups: athletes, women, and young adults. They took part in an eight-week tele-exercise program, either synchronously or asynchronously. Physical fitness was evaluated using tests such as the 2-Minute Step and Curl Up Test, while psychological well-being was assessed using the Psychological General Well-Being Index (PGWBI) and Perceived Stress Scale (PSS-10).

Results

Significant improvements in physical fitness and psychological well-being were observed in post-intervention across all groups, regardless of training mode. In the fitness tests, a significant improvement was obtained in the 2-Minute-Step (p = 0.004), in the curls up (p = 0.017), and in squats test (p = 0.004). In the forward bending test, the increment was very close to the significance (p = 0.051). In the psychological well-being tests, both PGWBI and WHO-5 scores increased after the training (p = 0.024 and p = 0.001 respectively) with no significant change in the PSS-10 score. The study found that tele-exercise can effectively introduce physical activity to previously inactive individuals and motivate them to adopt healthier lifestyle behaviors.

Conclusions

The TELEexe4ALL project demonstrates the potential of tele-exercise to improve physical fitness and psychological well-being. The study suggests that tele-exercise is a feasible and well-accepted approach for enhancing overall wellness in healthy populations.

Effectiveness of physiotherapist-led tele-rehabilitation for older adults with chronic conditions: a systematic review and meta-analysis

BACKGROUND

Older adults live with chronic conditions worldwide. The aim of this systematic review was to determine the effectiveness of physiotherapist-led (PT-led) tele-rehabilitation on various health outcomes.

METHODS

Six databases were searched. Eligible studies were randomized controlled trials that included older adults (≥65 years) who had ≥1 chronic condition, and evaluated tele-rehabilitation (e.g., video, telephone) that was PT-led or overseen. Screening and data extraction were performed in duplicate. Meta-analyses were performed where appropriate. Cochrane's Risk of Bias 2.0 tool was used.

RESULTS

Fifteen studies were included. A meta-analysis of studies of knee osteoarthritis demonstrated that tele-rehabilitation is more effective than usual care for functional mobility (MD= -2.72, 95% CI= -3.56, -1.88, p < 0.001), quadriceps strength (MD= 15.54, 95% CI= 10.14, 20.95, p < 0.001), pain (MD= -1.2, 95% CI= -2.09, -0.39, p = 0.004) and physical function (MD= -5.95, 95% CI= -8.32, -3.58, p < 0.001). No clear differences were found between tele-rehabilitation and usual care or comparator interventions for outcomes related to physical activity level, gait speed, mental health, and quality of life.

CONCLUSIONS

PT-led tele-rehabilitation appears to be comparable to traditional methods at improving outcomes in older adults with various chronic conditions. However, high-quality trials are needed so future conclusions on the effectiveness of tele-rehabilitation can be made.

CRD42023428048.

The effect of different exercise on physical fitness, cognition, and mental health in healthy older adults

Objective

This study aimed to examine the effects of different exercise programs on physical fitness, cognition, and mental health in healthy older adults.

Methods

A randomized controlled study was performed with 89 healthy older adults. They were separated into four groups: the control (Con; n = 20), physical activity (PA; n = 23), cognitive training (CT; n = 23), and physical activity coupled with cognitive training groups (PA + CT; n = 23). The subjects in PA, CT, and PA + CT groups received exercise programs that lasted 40 min daily, conducted at least three days a week for 20 weeks. The PA group received regular aerobic physical activity interventions, the CT group received cognitive training interventions, and the PA + CT group received physical activity combined with cognitive training interventions. Physical fitness (by chair stand, biceps curl, 2-min step, 8-step up and walk, and sit and reach tests), cognitive function (attention, simple reaction time, and spatial memory), and mental health (anxiety and depression status) were evaluated before and after 20 weeks.

Results

The body composition results reveal no significant effects among the four groups after 20 weeks before and after aerobic exercise interventions (p > 0.05). Compared with Con, the PA, CT, and PA + CT groups significantly improved physical fitness parameters (p < 0.05). The post-hoc analysis demonstrated that the PA and PA + CT groups had higher fitness levels than the CT group. Similarly, a significant difference was observed in the cognitive index among the four groups (p < 0.05). As determined by post-hoc analysis, attention and simple reaction time differed sequentially between the Con, PA, CT, and PA + CT groups. The spatial memory was superior in the PA, CT, and PA + CT groups compared to the Con group (p < 0.05), with the PA + CT group exhibiting the highest level of performance. However, there was no significant difference in the mental health parameters among all the groups (p < 0.05).

Conclusion

A 20-week intervention involving different exercise methods can enhance physical fitness, cognition, and mental health in older adults. These methods include physical activity, cognitive training, and a combination of physical and cognitive training. The combined physical activity and cognitive training interventions yielded more favorable outcomes than individual physical or cognitive training interventions.

Emerging Technologies and Open-Source Platforms for Remote Physical Exercise: Innovations and Opportunities for Healthy Population-A Narrative Review

The emergence of tele-exercise as a response to the impact of technology on physical activity has opened up new possibilities for promoting physical health. By integrating innovative technologies and open-source platforms, tele-exercise encourages people to stay active. In our latest analysis, we delved into the scientific literature surrounding the use of tele-exercise technologies in training healthy individuals. After conducting an extensive search on the PubMed database using the keywords "tele-exercise" and "physical activity" (from 2020 to 2023), we identified 44 clinical trials that were applicable to tele-exercise, but less than 10% of them were aimed at healthy individuals, precisely 9.09% (four out of forty-four studies analyzed). Our review highlights the potential of tele-exercise to help maintain physical fitness and psychological well-being, especially when traditional fitness facilities are not an option. We also underscore the importance of interoperability, standardization, and the incorporation of biomechanics, exercise physiology, and neuroscience into the development of tele-exercise platforms. Nevertheless, despite these promising benefits, research has shown that there is still a significant gap in the knowledge concerning the definition and evaluation of training parameters for healthy individuals. As a result, we call for further research to establish evidence-based practices for tele-exercise in the healthy population.

Senescence Seclusion Syndrome: Appraising the Efficacy of Current Interventions

The proportion of senior citizens in the global population has been on a steady rise, and the current population is forecasted to double in a few decades. Against this backdrop, the prevalence of senescence seclusion syndrome, characterized by prolonged social isolation in the elderly, is increasing concurrently. Given the profound threats this syndrome poses to the mental, physical, and social well-being of this vulnerable demographic, implementing effective interventions is imperative to mitigate these threats and enhance the quality of life. This review aims to assess the efficacy of the interventional modalities critically. Studies were reviewed following comprehensive searches in databases such as PubMed, Scopus, and Google Scholar, and focusing on empirical studies from 2019 to 2024 that evaluated the efficacy of the major intervention categories - social, technological, psychological, and physical interventions. The findings indicate that initiatives that promote consistent social engagement, such as community-organized social events and structured group activities, significantly reduced loneliness and bolstered social connections. Furthermore, technological interventions, including artificial intelligence and virtual reality, have notably enhanced elderly connectivity with their communities. Additionally, psychological interventions, such as cognitive-behavioral therapy, have also been effective in alleviating symptoms of anxiety and depression associated with the syndrome, with group sessions enhancing social interaction and significantly diminishing isolation. Moreover, physical interventions involving group exercises and other activities have fostered improvements in the physical, mental, and social well-being of the elderly. This study underscores the importance of a multifaceted approach that is individualized according to preference and circumstance in addressing senescence seclusion syndrome.

Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review

OBJECTIVE

To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults.

DATA SOURCES

Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023.

REVIEW METHODS

Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool.

RESULTS

A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias.

CONCLUSION

The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.

Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial

BACKGROUND

Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk.

METHODS

A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12 weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linear models and Bonferroni's post hoc (α = 0.05).

DISCUSSION

Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone.

TRIAL REGISTRATION

NCT05309278. Registered on April 4, 2022.

Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI

This descriptive article explores the use of smart devices for health and wellness in the context of telehealth, highlighting rapidly evolving technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI). Key innovations, benefits, challenges, and opportunities related to the adoption of these technologies are outlined. The article provides a descriptive and accessible approach to understanding the evolution and impact of smart devices in the tele-exercise reality. Nowadays, technological advances provide solutions that were unthinkable just a few years ago. The habits of the general population have also changed over the past few years. Hence, there is a need to investigate this issue and draw the attention of the scientific community to this topic by describing the benefits and challenges associated with each topic. If individuals no longer go to exercise, the exercise must go to their homes instead.

Teleexercise for geriatric patients with failed back surgery syndrome

Introduction

Failed back surgery syndrome (FBSS) is defined as back pain which either persists after attempted surgical intervention or originates after a spine surgery. There is a high risk of perioperative morbidity and a high likelihood of extensive revision surgery in geriatric patients with FBSS or post-laminectomy foraminal stenosis.

Methods

There is a need for less invasive methodologies for the treatment of FBSS, such as patient-tailored exercise training, with attention to the cost and special needs of the geriatric patients with FBSS. This commentary will provide some background regarding teleexercise (utilizing an internet-based platform for the provision of exercise-related care) for FBSS and will propose three exercises which are easy to administer over online-based platforms and can be the subject of future investigation.

Results

Given the documented benefits of regular rehabilitative exercises for patients with FBSS, the high cost of face-to-face services, and the need for infection mitigation in the wake of the COVID-19 Pandemic, teleexercise may be a practical and cost-beneficial method of exercise delivery, especially for geriatric patients with limitations in mobility and access to care. It should be noted that, prescription of these exercises should be done after face-to-face evaluation by the physician and careful evaluation for any “red flag” symptoms.

Conclusion

In this commentary, we will suggest three practical exercise training methodologies and discuss the benefits of teleexercise for geriatric patients with FBSS. Future research should aim to assess the efficacy of these exercises, especially when administered through telehealth platforms.

Telerehabilitation in Older Thai Community-Dwelling Adults

To investigate the impact on physical performance and walking abilities associated with fall risk and disability in the senior population, we created a telerehabilitation system. This is a multi-site, community setting, pre−post experimental study. We recruited participants from four rural areas in Thailand. All participants received eight weeks of tele-exercise, three sessions per week, via the telerehabilitation system. After the intervention, all participants underwent the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and the six-minute walk test (6MWT) using a wearable sensor system. A total of 123 participants participated in the study and 2 participants dropped out while conducting the study, thus 121 participants were included in the analysis. In comparison to the baseline, we discovered a considerable improvement in the SPPB score (0.65 ± 0.22, p < 0.001), TUG (−1.70 ± 0.86, p < 0.001), and 6MWT (10.23 ± 7.33, p = 0.007). Our study demonstrates the benefits of telerehabilitation on SPPB, TUG, and 6MWT related to disabilities and fall risk. This telerehabilitation technology demonstrated its viability in the community environment and demonstrated its capacity to offer fundamental components of remote rehabilitation services within the healthcare system.

Tele-Exercise in Non-Hospitalized versus Hospitalized Post-COVID-19 Patients

The purpose of our study was to investigate the effect of tele-exercise (TE) performed for 4 consecutive weeks on fitness indicators in hospitalized post-COVID-19 patients versus non-hospitalized patients. Forty COVID-19 survivors were included, and divided into two groups: non-hospitalized versus hospitalized. Body composition, anthropometric characteristics, pulmonary function tests, single-breath diffusing capacity for carbon monoxide, 6-min walk tests (6MWT) and handgrip strength tests were recorded before and after a TE regimen (3 sessions per week, 60 min each session, warm-up and cool-down with mobility exercises, aerobic exercise such as walking outdoors, and multi-joint strength exercises). Following TE, the 6-min walk distance and handgrip were increased in both groups, with a greater observed response in the non-hospitalized group (6MWT: 32.9 ± 46.6% vs. 18.5 ± 14.3%, p < 0.001; handgrip: 15.9 ± 12.3% vs. 8.9 ± 7.6%, p < 0.001). Self-assessed dyspnea and leg fatigue were reduced in both groups, while a higher percentage of reduction was observed in the non-hospitalized group (dyspnea: 62.9 ± 42.5% vs. 37.5 ± 49.0%, p < 0.05; leg fatigue: 50.4 ± 42.2% vs. 31.7 ± 45.1%, p < 0.05). Post- vs. pre-TE arterial blood pressure decreased significantly in both groups, with the hospitalized group exhibiting more prominent reduction (p < 0.001). Both groups benefited from the TE program, and regardless of the severity of the disease the non-hospitalized group exhibited a potentially diminished adaptative response to exercise, compared to the hospitalized group.