Is It Really Home-Based? A Commentary on the Necessity for Accurate Definitions across Exercise and Physical Activity Programmes

Associations of Home-Based Individual and Family Exercise with Personal and Family Well-Being Amid the COVID-19 Pandemic: A Population-Based Survey in Hong Kong

Exercise benefits individuals, but research about exercising with family members (EFM) and personal and family well-being is scarce. We investigated the associations of home-based individual exercise (IE) and EFM with personal and family well-being amid the COVID-19 pandemic. A population-based cross-sectional survey on Hong Kong Chinese adults was conducted from February to March 2021, when COVID-19 was under control (N = 5825). Respondents reported the number of days IE and EFM occurred at home in the past 7 days (0, 1-2, 3-4, 5-6, 7), respectively. Family well-being, personal happiness, and personal/family adversity coping capability (ACC/FACC) were each measured with an 11-point scale (range 0-10). Psychological distress was measured using the four-item Patient Health Questionnaire (range 0-12). Associations were assessed using multiple linear regressions. Of 1911 respondents, 9.2% reported having ≥3 days of EFM. After adjusting for each other and sociodemographic characteristics, more frequent IE or EFM (≥3 vs. 0-2 days) was associated with greater family well-being, FACC, personal happiness, and lower psychological distress. Our findings suggest that home-based EFM or IE may promote personal/family well-being and highlight the potential for incorporating home-based exercise into public health strategies to enhance overall well-being.

Effectiveness of home-based walking exercise for patients with peripheral artery disease and intermittent claudication: a systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the effect of home-based exercise interventions on walking performance in patients with peripheral artery disease (PAD) and intermittent claudication (IC).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched the Medline, Web of Science, Embase, Scopus and Cochrane Library databases to identify randomised controlled trials of patients with PAD and IC published in English up to August 2024.

ELIGIBILITY CRITERIA

Randomised controlled trials of patients who participated in home-based exercise interventions and were assessed for walking performance were eligible for inclusion. Studies without available data were excluded.

DATA EXTRACTION AND SYNTHESIS

We analysed the pooled effect size on walking performance based on the standardised mean differences between groups. A leave-one-out sensitivity analysis was performed to ensure the robustness of the findings.

RESULTS

A total of eight studies were included in the meta-analysis. The duration of interventions in the included studies ranged from 6 to 52 weeks. In the pooled analysis, compared with control groups, the home-based exercise intervention groups showed improved pain-free walking distance (standardised mean difference 0.67, 95% CI 0.20 to 1.15), and maximal walking distance (0.47, 0.05 to 0.89). The overall heterogeneity score of pain-free walking distance was I2=83% (p<0.001), and for maximal walking distance, I2=78% (p<0.001).

CONCLUSIONS

Home-based exercise interventions for patients with PAD and IC were beneficial in improving pain-free walking distance and maximal walking distance. Future studies should consider multiple factors that may affect the effectiveness of home training and intervention compliance.

TRIAL REGISTRATION NUMBER

PROSPERO, CRD42024499020.

The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions

A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.

The effect of a home-based, gamified stability skills intervention on 4-5-year-old children's physical and cognitive outcomes: A pilot study

BACKGROUND

Stability skills (e.g., static/dynamic balance) are a precursor for other movement skill development (e.g., jumping, catching). However, young children consistently demonstrate low stability and movement skill ability. There is therefore a need to develop effective strategies to improve stability skills in early childhood.

AIM

To pilot the effect of a home-based gamified stability skills intervention on 4-5-year-old children's physical skills, self-perceptions and cognitions.

METHODS

One-hundred-and-eleven 4-5-year-old children participated from three schools. Two schools were allocated into the intervention group (n = 66 children, 33 boys) and one to the control group (n = 45 children, 25 boys). Stability, fundamental movement skills, perceived motor competence, and cognition were assessed at baseline and at post-intervention. The intervention group was given a booklet detailing the 12-week gamified stability skill intervention. The control group participated in their usual weekly activities.

RESULTS

A series of ANCOVAs controlling for baseline values demonstrated significantly higher stability skills (F(1,93) = 24.79, p < 0.001, partial η2 = 0.212), fundamental movement skills (F(1,94) = 15.5, p = < 0.001, partial η2 = 0.139), perceived motor competence (F(1,96) = 5.48, p = 0.021, partial η2 = 0.054) and cognition (F(1,96) = 15.5, p = < 0.001, partial η2 = 0.139) at post-test for the intervention versus control groups.

DISCUSSION

This study demonstrates that a home-based, gamified, stability skills intervention enhances stability skills, fundamental movement skills, perceived motor competence and cognition in children aged 4-5-years old.

Using the behavior change wheel to design a novel home-based exercise program for adults living with overweight and obesity: Comprehensive reporting of intervention development

Introduction

Physical activity and exercise are movement behaviors that support the lifestyle management of overweight and obesity. However, home-based exercise programs are commonly generic, and inconsistently undertake a holistic approach to program design.

Methods

This work applied the Behavior Change Wheel, supplemented with previously conducted interviews, to the development of a home-based exercise program, specifically for people living with overweight and obesity. This provided an understanding of the target behavior and identified a behavioral diagnosis. These findings were mapped onto the Capability, Opportunity, Motivation-Behavior model and Theoretical Domains Framework, identifying changes needed and corresponding intervention functions.

Results

Suitable Behavior Change Techniques were identified, alongside Capability Opportunity Motivation-Behavior components needed to facilitate an increase in exercise behaviors, and five key intervention functions. This housed the delivery of 24 Behavior Change Techniques, including goal setting, feedback, monitoring and repetition.

Conclusion

Applying the Behavior Change Wheel has enabled detailed development of a home-based exercise program for adults living with overweight and obesity.

Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil

Background

We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil.

Methods

The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency).

Results

Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes.

Conclusion

A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.

Home-based exercise interventions' impact on breast cancer survivors' functional performance: a systematic review

INTRODUCTION

Home-based exercise (HBE) programs can be a feasible strategy to enhance functional performance and promote physical activity (PA) in breast cancer survivors. A deeper analysis of the effects of HBE interventions, structured by HBE program type and treatment phase, is needed. This systematic review aimed to synthesize the evidence on HBE interventions' impact on breast cancer survivors' functional performance, PA levels, and program adherence rates, according to HBE intervention type and treatment phase.

METHODS

A comprehensive search of peer-reviewed articles reporting HBE interventions' effects on the outcomes of interest was performed in Pubmed, Google Scholar, EBSCO, Web of Science, Science Direct, and B-ON until January 15th, 2024. Data were synthesized according to Denton's domains to classify HBE interventions (prescription: structured vs. unstructured; Delivery method: supervised vs. facilitated vs. unsupervised) and treatment phase. Methodological quality appraisal was performed using the Effective Public Health Practice Project tool.

RESULTS

Twenty-six studies were included. Most studies conducted structured/facilitated interventions and reported positive effects on functional performance (particularly aerobic capacity), increases in PA levels, and high adherence rates (> 70%) during and post-treatment.

CONCLUSION

HBE interventions may be feasible to improve functional performance and promote physical activity among breast cancer survivors. Further studies are needed to confirm which HBE intervention type is more appropriate for each treatment phase. More evidence applying HBE interventions with different designs is required to allow the drawing of more solid conclusions. Studies exploring the effects of HBE interventions on the pre-treatment phase are needed.

Unsupervised physical activity interventions for people with COPD: A systematic review and meta-analysis

INTRODUCTION AND OBJECTIVES

Unsupervised PA interventions might have a role in the management of chronic obstructive pulmonary disease (COPD) but their effectiveness is largely unknown. Thus, we aimed to identify and synthesise data on the effects of unsupervised PA interventions in people with COPD.

MATERIAL AND METHODS

Databases were systematically searched in April 2020, with weekly updates until September 2021. Randomised controlled trials and quasi-experimental studies comparing unsupervised PA with usual care, were included. Primary outcomes were dyspnoea, exercise capacity and physical activity. The effect direction plot was performed to synthesise results. Meta-analysis with forest plots were conducted for the Chronic Respiratory Disease questionnaire - dyspnoea domain (CRQ-D), 6-minute walk distance (6MWD) and incremental shuttle walk distance (ISWD).

RESULTS

Eleven studies with 900 participants with COPD (68±10 years; 58.8% male, FEV1 63.7±15.8% predicted) were included. All interventions were conducted at home, most with daily sessions, for 8-12 weeks. Walking was the most common component. The effect direction plot showed that unsupervised PA interventions improved emotional function, fatigue, health-related quality of life, muscle strength and symptoms of anxiety and depression. Meta-analysis showed statistical, but not clinical, significant improvements in dyspnoea (CRQ-D, MD=0.12, 95% CI 0.09-0.15) and exercise capacity, measured with 6MWD (MD=13.70, 95% CI 3.58-23.83). Statistical and clinical significant improvements were observed in exercise capacity, measured with ISWD (MD=58.59, 95% CI 5.79-111.39). None to minor adverse events and a high adherence rate were found.

CONCLUSIONS

Unsupervised PA interventions benefits dyspnoea and exercise capacity of people with COPD, are safe and present a high adherence rate. Unsupervised PA interventions should be considered for people with COPD who cannot or do not want to engage in supervised PA interventions or as a maintenance strategy of PA levels.

Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

BACKGROUND

There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.

METHODS

In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale).

RESULTS

Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group.

CONCLUSION

The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Comparison between the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on mental health and quality of life of older adults: Secondary analysis from a randomized clinical trial

AIM

The objective of this study was to compare the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on the mental health and quality of life of community-dwelling older adults.

METHODS

This study presents a secondary analysis of a randomized clinical trial conducted during the COVID-19 pandemic. The sample comprised 38 elderly men and women (81.6% women, mean age 68 ± 6.4 years; mean weight 69.8 ± 12.1 km) without physical and/or cognitive impairments. The volunteers were divided into two groups: one group received virtual supervision (monitored via videoconference), while the other group received minimal supervision (monitored through weekly text messages). Both groups followed the same home-based physical exercise program, consisting of three sessions per week, differing only in the supervision strategy. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-21) in conjunction with the POMS questionnaire, which evaluates mood, and quality of life was assessed using the WHOQOL-OLD questionnaire.

RESULTS

Our findings demonstrated statistically significant superiority of virtual supervision compared with minimal supervision in relation to depression (-2.92, 95% confidence interval = -5.22 to -0.63). Conversely, minimal supervision exhibited superiority over virtual supervision regarding quality of life (-6.70, 95% confidence interval = -11.66 to -1.73).

CONCLUSIONS

Virtual supervision yielded better outcomes for the depression indicator, while minimal supervision favored the quality of life of older adults at the conclusion of the 12-week home-based physical exercise program. Geriatr Gerontol Int 2023; 23: 864-870.

The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review

Background

In an aging population, it is important to activate older adults in taking care of their own health. Increasing physical activity is one way to avoid or lessen age-related physical and mental impairments. Interest in the use of information and communication technology (ICT) tools to promote physical activity among older adults is growing considerably. Such tools are suitable for communicating activation factors-skills, knowledge, and motivation-by integrating a variety of behavior change techniques (BCTs) to enhance physical activity. Although activation factors have been incorporated into physical activity interventions using ICT, little is known about the actual integration methods used in such interventions or about the effects of activation factors on influencing behavior change.

Objective

The first aim of this study was to identify which of the activation factors were covered in physical activity-promoting ICT interventions for older adults and which BCTs were used to address them. The second objective was to classify the user interaction interfaces and delivery modes that were used to promote these activation factors.

Methods

The search engines of PubMed, Web of Science, and ScienceDirect were used to search for and identify articles examining the effectiveness of ICT interventions for promoting physical activity in older adults. References and related data were selected, extracted, and reviewed independently by 2 reviewers. The risk of bias was assessed, and any conflict was addressed by a third separate reviewer. Selected articles included older adults aged ≥55 years without pre-existing medical diseases and other physical or mental conditions that could hinder movement.

Results

In total, 368 records were retrieved, and 13 studies met all inclusion criteria. Articles differed in terms of themes, timescales, user interaction interfaces, and outcome measures; therefore, a quantitative data synthesis was not feasible. Motivation was the most promoted activation factor among all trials (33 times). An app and a smartwatch were used in the majority of intervention groups (7/20, 35%) for tracking physical activity and receiving personalized feedback based on the individual goals. Skills (25 times) and knowledge (17 times) were the next most commonly addressed activation factors. Face-to-face interaction was the most used approach to targeting users' skills, including providing instructions on how to perform a behavior and exchanging knowledge via education on the health consequences of insufficient physical activity. Overall, integrating all 3 activation factors and using multiple user interaction interfaces with a variety of delivery modes proved the most effective in improving physical activity.

Conclusions

This study highlights commonly used BCTs and preferred modes of their delivery. So far, only a limited number of available BCTs (21/102, 21%) have been integrated. Considering their effectiveness, a larger variety of BCTs that address skills, knowledge, and motivation should be exploited in future ICT interventions.

Remote maintenance cardiac rehabilitation (MAINTAIN): A protocol for a randomised feasibility study

Background

Long-term adherence to exercise is often poor for people with coronary heart disease (CHD) who have completed supervised, centre-based cardiac rehabilitation. The aim of this study is to assess the feasibility of a remotely prescribed, delivered and monitored cardiac rehabilitation intervention using a wearable device to support long-term adherence to exercise and physical activity during maintenance of cardiac rehabilitation.

Methods

After completing cardiac rehabilitation, 30 participants with CHD, will be randomised (1:1) to an intervention (n = 15) or a usual care group (n = 15) in a 12-month feasibility randomised controlled trial (RCT). The intervention will comprise of an exercise consultation, personalised exercise prescription delivered via a wearable activity monitor using biometric feedback, regular monitoring via check-ins, and feedback text-messages for 6-months. Participants will be assessed at baseline (following completion of cardiac rehabilitation) and at three-, six-, and 12-months post-randomisation. The primary outcome will be feasibility, including assessment of eligibility, recruitment, adherence, and acceptability. Secondary outcomes will include exercise capacity, physical activity behaviours, cardiovascular disease risk and quality of life. Semi-structured interviews will be conducted at three-, six-, and 12-months post-randomisation (and with those who drop-out) to explore the acceptability of the study intervention and procedures. A questionnaire will be offered to those who decline participation.

Discussion

The MAINTAIN study will evaluate the feasibility of conducting a future definitive multi-centre RCT testing a remotely prescribed and monitored long-term mHealth maintenance exercise programme, versus usual care, for people with CHD who have completed cardiac rehabilitation.

Trial registration number

ClinicalTrials.gov, NCT05292287. Registered on 22/03/2022.

"I Was Having My Midlife Fat Crisis": Exploring the Experiences and Preferences of Home-Based Exercise Programmes for Adults Living with Overweight and Obesity

The involvement of people with lived experience in the design of exercise programmes is more likely to lead to a more needs-sensitive and population-specific intervention. There is limited evidence of the integration of people with lived experience, particularly regarding home-based exercise programmes for adults living with overweight and obesity, despite this being a population that would significantly benefit from a suitably tailored programme. Semi-structured interviews were virtually conducted to explore 20 participants' experiences of exercising at home and their preferences for the design of future home-based exercise programmes. Codes were generated through thematic analysis, highlighting considerations such as comfort within a home-based environment, a desire for social connection, and the integration of technology. Four corresponding themes were generated, encapsulating participants' choice reasoning for home-based exercise, difficulties of engaging in home-based exercise, undertaking and adhering to home-based exercise, and factors that constitute the perfect programme. Although the involvement of people with lived experience in research can be time-consuming, this process is fundamental to the design of an effective and efficacious programme. These findings will inform the design and development of a home-based exercise programme for adults living with overweight and obesity.

Home-based exercise for adults with overweight or obesity: A rapid review

The COVID-19 pandemic has impacted the ability of people globally to consistently engage in their typical physical activity and exercise behaviour, contributing to the rising number of people living with overweight and obesity. The imposed government lockdowns and quarantine periods saw an increase in social media influencers delivering their own home-based exercise programmes, but these are unlikely to be an evidence-based, efficacious, long-term solution to tackle sedentary behaviour and increase physical activity. This rapid review aims to conceptualise home-based exercise and physical activity programmes, by extracting relevant programme characteristics regarding the availability of evidence and effectiveness of home-based exercise programmes. Fifteen studies met the inclusion criteria, of which there were varied reports of significant positive effects of the exercise programme on weight management and related outcomes. The two most common measures were Body Mass Index and body mass, as of which almost all reported a trend of post intervention reduction. Some programmes reported qualitative data, identifying barriers to physical activity and preferred programme components, highlighting a need to consider factors outside of physiological measures. The findings provide guidance and direction for the development of future home-based physical activity and exercise programmes for adults living with overweight and obesity.