Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

Associations of exercise snacks with cognitive function among older adults in NHANES 2011-2014

BACKGROUND

With an aging global population, dementia incidence is rapidly increasing, affecting 50 million people worldwide. While physical activity has been linked to cognitive enhancement, the specific effects of intermittent short bouts of exercise, termed 'exercise snacks' (ES), on cognitive function (CF) in older adults are not well understood.

METHODS

We analyzed data from 2549 adults aged ≥60 years from the 2011-2014 National Health and Nutrition Examination Survey cycles. CF was assessed using standardized tests, and physical activity data were obtained from accelerometer measurements. ES was defined as 2-5 min of moderate-to-vigorous physical activity. Regression analyses, smoothed curve fitting, and threshold effect analyses were conducted, adjusting for relevant covariates.

RESULTS

Significant positive associations were found between CF and daily average Monitor-Independent Movement Summary specific to ES (MIMS-ES: β = 0.0001, 95 % CI: 0.0001-0.0001) and total time spent on ES (Time-ES: β = 0.0021, 95 % CI: 0.0014-0.0029). Each additional unit of MIMS-ES and each minute of ES daily increased CF scores by 0.0001 and 0.0021 points, respectively, suggesting benefits for cognitive health in aging populations. An inverted U-shaped relationship was observed, with inflection points at 2522.82 units/day for MIMS-ES and 91.57 min/day for Time-ES, indicating diminishing cognitive benefits beyond these thresholds.

CONCLUSION

ES was associated with higher CF. This practical form of physical activity offers an effective strategy for cognitive health and mitigating age-related decline, presenting a more accessible alternative to traditional continuous exercise.

Effects of exercise programmes delivered using video technology on physical performance and falls in people aged 60 years and over living in the community: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis synthesised the evidence and evaluated the effect of exercise programmes delivered using instructional videos compared with control on physical performance and falls in community-dwelling older people aged 60 years and older.

DESIGN

A systematic review and meta-analysis conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Central Register of Controlled Trials, TRIP and PEDro. Grey literature sources included theses and dissertations from Ethos and ProQuest.

ELIGIBILITY CRITERIA

Studies were included if they involved community-dwelling older people (aged >60 years) participating in exercise programmes delivered through instructional videos.

DATA EXTRACTION AND SYNTHESIS

Treatment effects were estimated using a random-effects model, reporting 95% CIs, mean differences (MD) and standardised MDs (SMD, Hedges' g) for outcomes measured in different units. The risk of bias was assessed using ROB2, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 7487 records were screened, with 16 studies (n=1910) meeting the inclusion criteria. Meta-analysis of 11 studies revealed significant effects of video-delivered exercise programmes in lower extremity strength (SMD=0.35, 95% CI 0.11 to 0.59; I2=70.35%, p<0.001, GRADE moderate quality), balance (SMD=0.45, 95% CI 0.07 to 0.83; I2=85.07%, p=0.02, GRADE low quality), mobility (MD=0.96, 95% CI 0.46 to 1.46; I2=53.31%, p<0.001, GRADE moderate quality) and physical performance SMD=0.36, 95% CI 0.17 to 0.56; I2=13.49%, p<0.001, GRADE moderate quality). No evidence of an effect of video-delivered exercise programmes on fear of falling was found (SMD=0.5, 95% CI -0.30 to 1.29; I2=95.48%, p=0.22, GRADE very low quality). There were insufficient data for reporting falls.

CONCLUSIONS

Video-delivered exercise programmes improved physical performance, particularly lower extremity strength, balance and mobility, with low to moderate quality evidence. There is uncertainty about the effect of video-delivered exercise programmes on the number of falls, number of fallers and fear of falling.

PROSPERO REGISTRATION NUMBER

CRD42023415530.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management

PURPOSE

To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers.

RECENT FINDINGS

A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

The wonders of mind-body practices during pregnancy: A topical review

This topical review provides an up-to-date overview of the latest advancements in mind-body therapies in the gynaecological research field. It explores the various mind-body practices and their multifaceted benefits for expectant mothers during the transformative phase of pregnancy, including physical, emotional, and psychological aspects. The research highlights the importance of these practices in promoting maternal and fetal well-being. Prenatal yoga is found to enhance physical health, reduce discomfort, and lower stress and anxiety levels, potentially leading to shorter labour durations. Meditation is revealed to reduce stress and anxiety while nurturing emotional resilience. Prenatal Pilates improves musculoskeletal health and prepares mothers for labour, emphasising controlled movements and breathing techniques. Breathing techniques prove to be helpful for pregnant women in effectively managing pain during labour. Acupressure and reflexology offer non-pharmacological pain relief for common discomforts. Tai Chi improves physical fitness, flexibility, and mental well-being. This brief review, using evidence available from pre-clinical studies in physiological gynaecology literature, demonstrates the role of mind-body practices in enhancing the pregnancy journey, emphasising their integration into daily routines to contribute to overall well-being. By selecting the right practice or combination, expectant mothers can experience an overall better pregnancy.

Home-Based Indoor Physical Activity Programs for Community-Dwelling Older Adults: A Systematic Review

CONTEXT

Home-based exercise programs are a good strategy to promote benefits to health for people who cannot visit gyms, clinics, or have limited time for physical activity outside.

OBJECTIVE

To synthesize the effect of home-based indoor physical activity on psychosocial outcomes and mobility in community-dwelling older adults.

DATA SOURCES

A comprehensive search was conducted in the MEDLINE, PubMed, Embase, SPORTDiscus, Cochrane Library, Scopus, and Google Scholar databases.

STUDY SELECTION

A total of 11 studies (13 publications) were included involving a total of 1004 older adults.

STUDY DESIGN

A systematic review of randomized controlled trials was conducted using the aforementioned 7 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Two authors independently selected studies, extracted data, and determined the risk of bias and evidence level using the Grading quality of evidence and strength of recommendations (GRADE) guidelines. We conducted a synthesis without meta-analysis (SWiM) to assess the outcome.

RESULTS

There is moderately certain evidence that home-based exercise programs reduced the fear of falling. Psychosocial (mental health and quality of life) and mobility outcomes may improve after participating in the intervention inside the home.

CONCLUSION

The review found very low to certain evidence that home-based exercises programs improved psychosocial outcomes (mental health and quality of life) and walking speed (mobility). Moderately certain evidence suggests that home-based exercises improved fear of falling.

PROTOCOL REGISTER NUMBER

CRD42020182008.

Exercise Snacks and Other Forms of Intermittent Physical Activity for Improving Health in Adults and Older Adults: A Scoping Review of Epidemiological, Experimental and Qualitative Studies

Exercise snacks, including other variants of brief intermittent bouts, are an emerging approach for increasing physical activity, although their operationalisation is unstandardised and their health benefits remain unclear. This scoping review aimed to explore characterisations of exercise snacks and summarise their effects on health in adults and older adults. Clinical trial registers (clinicaltrials.gov and ANZCTR) and electronic databases (PubMed, CINAHL, CENTRAL, PsycINFO) were searched from inception to 1 June 2023, for ongoing and published studies of exercise snacks. Backwards and forwards citation tracking was also conducted to identify additional eligible studies. Studies were included if they investigated exercise snacks-brief intermittent bouts of physical activity spread across the day-in adults or older adults. We included epidemiological, experimental, quasi-experimental and qualitative studies that examined the effect of exercise snacks on any health outcomes or described barriers to and enablers of these approaches. Thirty-two studies were included (7 trial registers, 1 published protocol, 3 epidemiological studies and 20 trials reported across 21 studies). Three main terms were used to describe exercise snacks: exercise snack(ing), snacktivity and vigorous intermittent lifestyle physical activity (VILPA). Participants were predominantly physically inactive but otherwise healthy adults or older adults. Exercise snacks were feasible and appeared safe. Epidemiological studies showed steep, near-linear associations of VILPA with reduced all-cause, cardiovascular and cancer mortality as well as reduced incidence of major adverse cardiovascular events and cancer. The limited trial evidence showed exercise snacks had modest effects on improving cardiorespiratory fitness, whereas effects on physical function, mood, quality of life and other health outcomes were equivocal. In conclusion, exercise snacks appear feasible and safe for adults and older adults and may have promising health benefits, but this is mostly based on findings from a limited number of small quasi-experimental studies, small randomised trials or qualitative studies. More studies are needed in individuals with chronic disease. This emerging physical activity approach may have appeal for individuals who find structured exercise unfeasible.Registration https://osf.io/qhu24/.

Therapeutic Quality Affects Physical Fitness Benefits of Home Exercise Interventions in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND AND PURPOSE

The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness.

METHODS

Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community-dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed.

RESULTS

Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated β = -.48; P = .049; moderate credibility) and lower-body strength (estimated β = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated β = -.97; P = .02; low credibility).

CONCLUSIONS

Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs.

Using Martial Arts Training as Exercise Therapy Can Benefit All Ages

Martial arts training focuses on whole-body movement patterning, philosophy, interpersonal interactions, and functional self-defense. Such training has positive impacts on physical, psychological, and cognitive well-being in older adults and children with and without clinical conditions. We hypothesize that martial arts training can be delivered as a form of exercise therapy for people at all ages to enhance overall health.

Practice and principle of traditional Chinese medicine for the prevention and treatment of COVID-19

Traditional Chinese medicine (TCM) has played an important role in the prevention and treatment of Coronavirus disease 2019 (COVID-19) epidemic in China. The integration of Chinese and Western medicine is an important feature of Chinese COVID-19 prevention and treatment. According to a series of evidence-based studies, TCM can reduce the infection rate of severe acute respiratory syndrome coronavirus 2 in high-risk groups. For patients with mild and moderate forms of COVID-19, TCM can relieve the related signs and symptoms, shorten the period of nucleic-acid negative conversion, and reduce conversion rate to the severe form of the disease. For COVID-19 patients with severe and critical illnesses, TCM can improve inflammatory indicators and blood oxygen saturation, shorten the hospital stay, and reduce the mortality rate. During recovery, TCM can improve patients' symptoms, promote organ function recovery, boost the quality of patients' life, and reduce the nucleic-acid repositive conversion rate. A series of mechanism research studies revealed that capability of TCM to treat COVID-19 through antiviral and anti-inflammatory effects, immune regulation, and protection of organ function via a multicomponent, multitarget, and multipathway approach.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review

Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.

Exercise snacking to improve physical function in pre-frail older adult memory clinic patients: a 28-day pilot study

BACKGROUND

Finding innovative yet feasible ways of preventing physical and cognitive decline in those at risk is a critical global challenge, with exercise being championed as a key precursor to robust health in later life. Exercise snacking, here defined as short bouts of sporadic [muscle-strengthening] exercise, is one such strategy designed to overcome typical participation barriers observed in older adults. This study examined the acceptability of exercise snacking amongst pre-frail older adults and explored the efficacy of this approach in improving physical function.

METHODS

In this single group design, 21 pre-frail outpatients with mild-cognitive impairment were recruited from a UK memory clinic. To be eligible, participants were aged ≥ 65-years who scored 3-8 (inclusive) on the short physical performance battery (SPPB) and were not regularly engaging in sport or exercise. Participants completed a 28-day, twice daily, exercise snacking intervention, consisting of five muscle-strengthening exercises, with the aim being to complete as many repetitions as possible of each exercise in a minute. Acceptability of the intervention was measured quantitatively and qualitatively using a survey and topic guide informed by the Theoretical Framework of Acceptability. Pre- and post-intervention physical function was measured using the SPPB, timed up-and-go (TUG), and 60s standing balance and sit-to-stand tests.

RESULTS

Eighteen participants provided follow-up data and showed 85% adherence to the exercise snacking intervention, measured as the proportion of all sessions completed out of a possible 56. Participants rated the intervention as highly acceptable (4.6/5) suggesting it supported their self-efficacy (4.3/5) was enjoyable (4.1/5) and had a low burden (2.1/5). Qualitative findings suggested the ease of use, flexibility of the programme, and perceived effectiveness was important, and particularly useful for non-exercisers. Changes in SPPB score (8(1) vs. 9(3), p < 0.01), TUG (11.32(4.02) vs. 9.18(5.25) seconds, p < 0.01) and in the 60-second sit-to-stand test (17 ± 5 vs. 23 ± 7 repetitions, p < 0.01) were seen between baseline and follow-up.

CONCLUSIONS

Exercise snacking is an acceptable and potentially efficacious format of exercise for pre-frail memory clinic attendees who are at heightened risk of falling and frailty. Large scale randomised controlled trials are required to confirm whether exercise snacking is effective in the short and long term.

CLINICALTRIALS

GOV REGISTRATION

NCT05439252 (30/06/2022).

The acceptability of homebased exercise snacking and Tai-chi snacking amongst high and low function UK and Taiwanese older adults

Introduction: Exercise "snacking" and Tai-chi 'snacking' protocols are designed to overcome typical barriers to older adults' participation in muscle strength and balance exercise, using short bouts of home-based exercise. This study aimed to investigate the acceptability of homebred exercise- and Tai-chi snacking in British and Taiwanese older adults of high and low physical function. Methods: Thirty-three British and Thirty Taiwanese older adults took part in semi-structured interviews, after trying 1-week of exercise- and Tai-chi snacking. The interview schedule and deductive framework analysis was based on the seven components of the Theoretical Framework of Acceptability (TFA). Differences between the Taiwanese and United Kingdom participants and those considered high versus low physical function were also analysed. Results: Both snacking regimes were found to be convenient and easy to implement. Participants reported that no activity had to be given up, and considered the programmes would be beneficial to their physical and mental health. Interestingly, more UK-based participants preferred the elegant and relaxing movements of Tai-chi snacking, yet participants with low physical function experienced difficulties when mastering Tai-chi movements. A few high physical function participants perceived exercise snacking to be tedious. Discussion: Overall, the snacking exercise was found to be acceptable and useful. Personal affective attitude and different cultural backgrounds may affect exercise participation. Nevertheless, it is important to consider individuals' physical function when designing exercise regime. The findings indicate that making Tai-chi snacking easier to master initially, building in progression and adding some upper body movements in the exercise snacking may further enhance acceptability.

Online Exercise Programming Among Older Adults: A Scoping Review

Online exercise programming may promote physical activity while at home, but little is known about its use among older adults. Using the Arksey and O'Malley framework, we describe the nature and extent of the research pertaining to the use of online exercise programming among adults 65 years of age and older. We ran two separate searches (January 2005-September 2020 and October 2020-October 2021), yielding 17 articles that met our inclusion criteria. A total of 1,767 participants (69% female) ranging from 65 to 94 years of age were included. Most studies delivered the online programs asynchronously. The majority of studies assessed the feasibility of online programs, with 14 studies investigating health-related outcomes such as physical, psychological, and social health. Future research should explore perceptions and experiences of online exercise programming among older adults and the mechanisms by which it impacts physical, psychological, social, and behavioral outcomes.

Characteristics and effects of physical exercise programs for older adults during the COVID-19 pandemic: an integrative review

Objective: To evaluate the characteristics of physical exercise programs for older adults and their effects during the COVID-19 pandemic. Methods: An integrative review was conducted between January and March 2022. A search was conducted in MEDLINE via PubMed, Lilacs via BVS, PEDro, and Cochrane Library. Experimental articles (randomized clinical trials, non-randomized trials, or quasi-experimental studies) published from 2019 to 2021, with no language restriction, and that used physical exercise programs for older adults (> 60 years) in their intervention were included. The studies were selected by reading the title, abstract, and full text. The selected articles had their results extracted using an online form, tabulated using an electronic spreadsheet, and analyzed qualitatively and quantitatively. Results: 113 studies were identified; 7 met the eligibility criteria and were included in the review, all randomized controlled trials. The multi-component exercise programs were more frequent (resistance, balance, flexibility, and aerobic), delivered remotely and performed 2 to 7 times a week, lasting between 30 and 50 minutes. Significant effects were observed on physical function, body composition, blood triglycerides, the incidence of falls, physical activity, and functional capacity. Conclusions: The physical exercise programs used during the COVID-19 pandemic showed promising results for older adults. The programs proved to be a viable alternative for maintaining the physical, mental, and cognitive functions of older adults in times of public calamity.

Tai chi or health education for older adults with hypertension: effects on mental health and psychological resilience to COVID-19

OBJECTIVE

To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19.

METHODS

A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response.

RESULTS

Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25-0.51; HAP-E = 0.24, 0.11-0.37), though positive intervention responses were more than twice as likely in TC (OR = 2.29, 1.07-4.57). Younger age, higher anxiety, and poorer mental health at baseline predicted greater odds of response. Small declines in health and wellbeing were reported at the first COVID-19 follow-up, with smaller declines in the TC arm (Cohen's d: TC = -0.15, -0.31-0.00; HAP-E = -0.34, -0.49 to -0.19). Health and wellbeing stabilized at the second COVID-19 follow-up. Most participants (>70%) reported that the interventions benefitted their health and wellbeing during COVID-19.

CONCLUSION

TC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience.

Barriers and enablers associated with participation in a home-based pragmatic exercise snacking program in older adults delivered and monitored by Amazon Alexa: a qualitative study

BACKGROUND

'Exercise snacking', which is characterised by shorter and more frequent exercise bouts compared with traditional exercise guidelines, may be an acceptable strategy for increasing physical activity and reducing sedentary behaviour in older adults.

AIM

The aim of this study was to evaluate the enablers and barriers for older adults associated with participation in a home-based exercise snacking program delivered and monitored using an Amazon Echo Show 5 device (Alexa).

METHODS

This study used an interpretive description qualitative design to conduct semi-structured interviews following a 12-week pilot study in 15 adults aged 60-89 years with at least one chronic condition. All participants were prescribed a home based, individualised, lower limb focussed 'exercise snacking' program (involving ≤ 10 min of bodyweight exercises 2-4 times per day) delivered and monitored by an Alexa. Qualitative interview data were analysed using thematic analysis.

RESULTS

All 15 participants (mean age 70.3 years) attended the semi-structured interview. Themes including time efficiency, flexibility, perceived health benefits, and motivation were enablers for participation in the 'exercise snacking' program. A lack of upper body exercises and omission of exercise equipment in the program, as well as a lack of time and motivation for performing exercise snacks three or more times per day, were barriers to participation.

CONCLUSION

While 'exercise snacking' is acceptable for older adults, future trials should provide equipment (e.g. adjustable dumbbells, exercise bands), prescribe whole-body exercise programs, and establish strategies to support participation in more than three exercise snacks per day.

Effectiveness of telehealth interventions on psychological outcomes and quality of life in community adults during the COVID-19 pandemic: A systematic review and meta-analysis

Physical distancing and contact restrictions have been implemented in most countries and territories due to the rapid spread of SARS-CoV-2. This has caused physical, emotional, and psychological distress for adults living in the community. Diversified telehealth interventions have been widely applied in health care and have proven to be cost-effective and well accepted by patients and health professionals. Currently, the effectiveness of telehealth interventions on psychological outcomes and quality of life among community adults during the COVID-19 pandemic remains unclear. A literature search was conducted using PubMed, PsycINFO, CINAHL, EMBASE, MEDLINE, and the Cochrane Library from 2019 to October 2022. Twenty-five randomized controlled trials with 3228 subjects were finally included in this review. Two independent reviewers performed the screening, extraction of key data points, and appraisal of the methodological quality. There were positive effects of telehealth interventions on anxiety, stress, loneliness, and well-being among community adults. Participants who were women or older adults were more likely to recover from negative emotions, increase well-being, and improve quality of life. The real-time and interactive interventions and remote cognitive-behavioural therapy (CBT) may be better choices during the COVID-19 pandemic. Based on the findings of this review, health professionals have more options and alternatives for delivering telehealth interventions in the future. Rigorously designed randomized controlled trials (RCTs) with higher statistical power and long-term follow-up should be conducted in the future to strengthen the currently weak evidence.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

Efficacy of a multicomponent exercise training program intervention in community-dwelling older adults during the COVID-19 pandemic: A cluster randomized controlled trial

The coronavirus disease 2019 (COVID-19) pandemic caused changes in lifestyle for older adults such as reduced physical activity and community participation. Community activity centers were randomly assigned to the intervention (n = 82) or control arm (n = 85). The intervention comprised one 60 min group exercise session per week in weeks 1-8 and an online home exercise program in weeks 9-16. Physical activity, physical performance, and prefrailty rates were assessed at baseline and 16 weeks. At 16 weeks, compared to the control arm, the intervention arm exhibited improved (p < 0.05) leisure-time physical activity (phi = 0.571), vigorous physical activity (phi = 0.534), and moderate-vigorous physical activity (phi = 0.344); prefrailty rates (phi = 0.179); and short physical performance battery results (η²_p = 0.113). The intervention thus effectively improved physical activity levels, physical performance, and prefrailty rates in community-dwelling older adults during the COVID-19 pandemic.

Adherence to eHealth-Delivered Exercise in Adults with no Specific Health Conditions: A Scoping Review on a Conceptual Challenge

Adherence has emerged as a focal point and critical determinant of success for physical activity interventions. The term is used for both traditional and digital interventions, and for prescribed and nonprescribed activities. Many other terms for adherence are being used interchangeably, as there is no consensus on its precise conceptualization. This scoping review aimed to advance the definition of adherence to eHealth programs, specifically for the adult population with no specific health conditions. A total of 2983 papers, published between 1 January 2016 and 13 March 2022, were retrieved from different databases (including grey literature). Of those, 13 studies met the eligibility criteria and were included for review. The selected studies used a wide array of technologies and consisted mainly of exercise interventions. Most of the reviewed publications contemplated exercise adherence as a percentage of expected dose. Most (8 out of 13) studies neither assessed nor specified an expected use of the involved technology. Results suggest a need for homogeneity in the conceptualization of adherence to physical activity and exercise, including those interventions delivered digitally.

Feasibility and acceptability of a remotely delivered, home-based, pragmatic resistance 'exercise snacking' intervention in community-dwelling older adults: a pilot randomised controlled trial

Background

Very few older adults meet current muscle strengthening exercise guidelines, and several barriers exist to supervised, community-based resistance exercise programs. Older adults therefore require access to feasible resistance exercise modalities that may be performed remotely. This pilot study assessed the feasibility and acceptability of undertaking a four-week home-based resistance ‘exercise snacking’ intervention (performed either once, twice, or thrice daily) when delivered and monitored remotely in older adults. 

Methods

Thirty-eight community-dwelling older adults [mean ± SD age 69.8 ± 3.8 y, 63% female] were randomised to complete resistance ‘exercise snacks’ (9-minute sessions) either once (n = 9), twice (n = 10), or thrice (n = 9) daily, or allocated to usual-activity control (n = 10). Exercise adherence and adverse events were assessed using an exercise diary, and acceptability of the intervention was explored using an online questionnaire. Physical function [balance, 5-times sit-to-stand (STS), and 30-second STS tests] was assessed remotely at baseline and follow-up using videoconferencing.

Results

The intervention was feasible and safe, with 100% participant retention, high adherence (97, 82, and 81% for once, twice, and thrice daily, respectively), and only two adverse events from a total of 1317 ‘exercise snacking’ sessions. The exercise intervention was rated as enjoyable (75% reported their enjoyment as ≥4 on a 5-point Likert scale), easy to perform, and most (82%) planned to continue similar exercise at home. We also found it was feasible to assess measures of physical function via videoconferencing, although effect sizes for 4-week changes in both 5-STS (d range, 0.4–1.4) and 30-STS (d range, 0.7–0.9) following the exercise intervention were similar to controls (d = 1.1 and 1.0 for 5-STS and 30-STS, respectively).

Conclusions

Resistance ‘exercise snacking’ may be a feasible strategy for engaging older adults in home-based resistance exercise when delivered and monitored remotely. The findings of this pilot feasibility trial support the need for longer-term studies in larger cohorts to determine the effectiveness of resistance ‘exercise snacking’ approaches for improving physical function in older adults.

Trial registration

The trial was retrospectively registered on 10/11/2021 with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12621001538831).

Staying Active While Staying Home: The Use of Physical Activity Technologies During Life Disruptions

One impact of the Covid-19 lockdowns was a restriction on people's ability to engage in physical activity in previously routine ways. This paper presents a two-stage mixed-method study exploring how people used technology to stay physically active during this period. We found that activity trackers reminded people to be active, while virtual coaching (i.e., video tutorials and online classes) helped them stay connected. The lockdown increased people's awareness of their activity levels and removed barriers to exercise, for example by giving them greater control over their time. However, it also created new challenges, with lack of time and space, injuries due to sudden changes in activity, and anxiety around lockdown, putting limits on physical activity. We highlight future directions that must be addressed to maximise the benefits of physical activity technologies for people trying to stay active during major life disruptions.