Online Exercise Programming Among Older Adults: A Scoping Review

Frail Older Adults' Needs and Preferences for Mobile Health Exercise Interventions Guided by Nudge Theory: AQualitative Analysis

AIM

To explore frail older adults' preferences and needs regarding mobile health (mHealth) exercise interventions in China. Additionally, it sought to identify the nudge strategies necessary for initiating and sustaining exercise behaviours among frail older adults.

DESIGN

A qualitative study.

METHOD

The semi-structured interviews were conducted between April and May 2024 from two communities in Changsha, China. The data were analysed using a deductive framework analysis aligned to nudge theory, and an inductive thematic analysis to gather relevant needs and preferences.

RESULTS

This study involved 14 participants with pre-frailty or frailty, aged 60-82 years (median age of 64 years). While participants were generally receptive to new technologies, lower levels of health literacy and competing priorities often hindered their participation. Three primary functionality requirements were as follows. (1) Profession engagement: tailored exercise prescription, professional and timely feedback and guidance; (2) personalised knowledge encompassing pain management, successful cases and inspiration; (3) beneficial, tailored, dynamic, fragmented, challenging exercise courses. Participants showed positive attitudes towards simplification nudges, gamification nudges, social nudges, trustworthy nudges, reminder nudges, economic nudges, feedback nudges and pre-commitment nudges. Addressing privacy concerns was essential to build trust and acceptance among older adults.

CONCLUSION

These findings emphasised the importance of designing mHealth interventions that address frail older adults' specific needs and preferences while incorporating effective nudge strategies to promote engagement and adherence. Future researchers should explore wearables, ChatGPT language models, virtual coaching assistants, exercise snack to further optimise the experience and analyse the effects of nudges in mHealth exercise interventions among older adults.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Exercise systems or app development for frail older adults should meet three basic functionality and essential nudge strategies.

REPORTING METHOD

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

Older adults' engagement and interview data contribute a lot.

Synchronous Group-Based Online Exercise Programs for Older Adults Living in the Community: A Scoping Review

Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57-93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function.

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.

Older adults' perceptions and experiences of engaging in web- and mobile-based physical activity interventions: A systematic review and qualitative meta-synthesis

BACKGROUND

Web- and mobile-based physical activity interventions effectively promote physical and mental health among older adults, but participation and adherence are suboptimal.

METHODS

This qualitative review used the mega-aggregation approach. Searches were conducted in five databases from the earliest to November 2023. Quality assessment and data extraction used JBI tools. Data synthesis used the COM-B model as a guide.

RESULTS

Sixteen sub-themes were identified from the eight studies and categorized into the COM-B model. Sub‑themes were physical and psychological changes, digital skills and knowledge, older adult-friendly design, integration into daily routines, social influence, family engagement and support, health benefits and impairments, accessibility and flexibility, low cost, visibility and interaction, instructions and feedback, personalization and progression, incentives, self-efficacy, visual cues, self-monitoring.

DISCUSSION

Web- and mobile-based interventions motivate older adults to engage in physical activity, but modifications are necessary. This includes age-appropriate interfaces and contents, tailored behavioral change techniques, and family engagement.

Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

Older Adults' Continuance Intentions for Online Physical Exercise Classes

During the COVID-19 pandemic, lockdowns and social distancing measures drove the shift from in-person to online physical exercise classes, leading individuals to explore these digital alternatives. Guided by the Expectation-Confirmation Model, this article examines older adults' intentions to continue using online physical exercise classes. Semi-structured interviews were conducted with 17 adults aged 65 and older who had participated in online physical exercise classes during the pandemic. Transcripts were subject to thematic analysis using the NVivo software program. The results indicate that older adults recognize the usefulness of online physical exercise classes because of their ability to enhance their health and well-being. Their initial expectations were surpassed, and they were generally satisfied with the experience. However, in-person classes remained preferred due to their enhanced benefits. They also felt that the adoption of online classes was involuntary; instead of an autonomous decision guided by their needs and preferences, this was a viable solution imposed by the lockdown. Therefore, their continuance intentions are limited to specific conditions, namely a new lockdown or other physical impediments. Still, considering the flexibility that online physical exercise classes offer, accommodating time and physical constraints, participants highlighted the advantages of a hybrid approach for those who may face challenges attending in-person classes. Based on the findings, this article proposes that ECM provides a relevant, yet insufficient, framework for explaining older adults' continuance intentions for online physical exercise classes, suggesting the inclusion of additional explaining factors: perceived usefulness of non-technological alternatives, necessary conditions, and self-determination.

Volunteer-led online group exercise for community-dwelling older people: a feasibility and acceptability study

BACKGROUND

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs.

METHODS

This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months.

RESULTS

Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37-67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, p = 0.13). Twenty volunteers, older adults, and staff were interviewed and found the intervention acceptable. The seated exercises were perceived as safe, manageable, and enjoyable.

CONCLUSIONS

Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff.

TRIALS REGISTRATION

NCT04672200.

Frail2Fit study protocol: a feasibility and acceptability study of a virtual multimodal intervention delivered by volunteers to improve functional outcomes in older adults with frailty after discharge from hospital

INTRODUCTION

Physical activity (PA) and replete nutritional status are key to maintaining independence and improving frailty status among frail older adults. In response to the COVID-19 pandemic, healthcare has increasingly turned to virtual modes of delivery and there is interest in the use of trained volunteers to deliver PA and nutrition interventions. We aim to evaluate the feasibility and acceptability of training hospital volunteers to deliver an online intervention, comprising exercise, behaviour change and nutrition support, to older people with frailty after discharge from hospital.

METHODS

We will use a quasi-experimental mixed methods approach. Hospital volunteers (n=6) will be trained to deliver an online, 3-month, multimodal intervention to frail (Clinical Frailty Scale ≥5) adults ≥65 years (n=30) after discharge from hospital. Feasibility will be assessed by determining the number of volunteers recruited, trained and retained at the end of the study; the proportion of intervention sessions delivered; participant recruitment, retention and adherence to the intervention. To determine the acceptability of the intervention, interviews will be conducted among a purposive sample of older adults, and volunteers. Secondary outcomes will include physical function, appetite, well-being, quality of life, anxiety and depression, self-efficacy for managing chronic disease and PA. Outcomes will be measured at baseline, 3 months and 6 months.

ANALYSIS

Descriptive statistics will be used to describe feasibility and adherence to the intervention. Secondary outcomes at baseline will be compared at 3 and 6 months. Interviews will be transcribed verbatim and analysed using thematic analysis.

ETHICS AND DISSEMINATION

Health Research Authority ethical approval was obtained on 30 May 2022 (reference: 22/WA/0155). Results will be disseminated through peer-reviewed journal articles, volunteer organisations, National Health Service communication systems and social media platforms. A toolkit will be developed to facilitate roll out of volunteer training.

TRIAL REGISTRATION NUMBER

NCT05384730.