This study assessed the concurrent validity and test–retest-reliability of the Apple Health app on iPhone for measuring gait parameters in different age groups. Twenty-seven children, 28 adults and 28 seniors equipped with an iPhone completed a 6-min walk test (6MWT). Gait speed (GS), step length (SL), and double support time (DST) were extracted from the gait recordings of the Health app. Gait parameters were simultaneously collected with an inertial sensors system (APDM Mobility Lab) to assess concurrent validity. Test–retest reliability was assessed via a second iPhone-instrumented 6MWT 1 week later. Agreement of the Health App with the APDM Mobility Lab was good for GS in all age groups and for SL in adults/seniors, but poor to moderate for DST in all age groups and for SL in children. Consistency between repeated measurements was good to excellent for all gait parameters in adults/seniors, and moderate to good for GS and DST but poor for SL in children. The Health app on iPhone is reliable and valid for measuring GS and SL in adults and seniors. Careful interpretation is required when using the Health app in children and when measuring DST in general, as both have shown limited validity and/or reliability.

Lifestyle-integrated exercise is a promising approach to increase adherence levels of older adults compared to structured exercise programs as it saves time and effort and supports older adults in preventing falls and functional decline. The Lifestyle-integrated Functional Exercise (LiFE) program embodies this approach by integrating physical activity, balance, and strength activities into daily tasks of community-dwelling older adults aged 70+. A randomized controlled trial shows strong effectiveness of the original, resource-intensive one-on-one format of the LiFE program in terms of reducing falls, improving motor performance, and increasing physical activity. The positive effects of the original LiFE program have yet stimulated adaptions to group-based and information and communications technology-based formats, to younger seniors, for multicomponent interventions, and to populations with disabilities which resulted in 16 known studies about LiFE modifications. Evidence for the effectiveness of specific LiFE modifications exists for four programs, while seven adaptions are in the feasibility stage and one is still in the early development phase. A decade of existing LiFE research is summarized in this narrative review that, to the best of our knowledge, does not exist until now. The aim of this article is (1) to provide an overview of the number of LiFE modifications and their specifications, (2) to describe the current evidence regarding feasibility and effectiveness, and (3) to present challenges and potential of the different LiFE modifications. All adaptions of the LiFE program embody the benefits of the lifestyle-integrated approach and enable an enhancement of the successful LiFE concept.

Introduction There is increasing evidence that perturbation-based balance training (PBT) is highly effective in preventing falls at older age. Different PBT paradigms have been presented so far, yet a systematic comparison of PBT approaches with respect to feasibility and effectiveness is missing. Two different paradigms of PBT seem to be promising for clinical implementation: 1. Technology-supported training on a perturbation treadmill (PBTtreadmill); 2. Training of dynamic stability mechanisms in the presence of perturbations induced by unstable surfaces (PBTstability). This study aimed to compare both program's feasibility and effectiveness in fall-prone older adults. Methods In this three-armed randomized controlled trial, seventy-one older adults (74.9 ± 6.0 years) with a verified fall risk were randomly assigned into three groups: PBTtreadmill on a motorized treadmill, PBTstability using unstable conditions such as balance pads and a passive control group (CG). In both intervention groups, participants conducted a 6-weeks intervention with 3 sessions per week. Effects were assessed in fall risk (Brief-BEST), balance ability (Stepping Threshold Test, Center of Pressure, Limits of Stability), leg strength capacity, functional performance (Timed Up and Go Test, Chair-Stand), gait (preferred walking speed) and fear of falling (Short-FES-I). Results Fifty-one participants completed the study. Training adherence was 91% for PBTtreadmill and 87% for PBTstability, while no severe adverse events occurred. An ANCOVA with an intention-to-treat approach revealed statistically significant group effects in favor of PBTstability in the Brief-BEST (p=.009, η²=.131) and the Limits of Stability (p=.020, η²=.110), and in favor of PBTtreadmill in the Stepping Threshold Test (p<.001, η²=.395). The other outcomes demonstrated no significant group effects. Discussion/Conclusion Both training paradigms demonstrated high feasibility and were effective in improving specific motor performances in the fall-prone population and these effects were task-specific. PBTtreadmill showed higher improvements in reactive balance, which might have been promoted by the unpredictable nature of the included perturbations and the similarity to the tested surface perturbation paradigm. PBTstability showed more wide-ranging effects on balance ability. Consequently, both paradigms improved fall-risk-associated measures. The advantages of both formats should be evaluated in the light of individual needs and preferences. Larger studies are needed to investigate the effects of these paradigms on real-life fall rates.