IntroductionStimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults.MethodsCommunity-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program.ResultsTwenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months).ConclusionA home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.

BackgroundWith the number of older adults in society rising, frailty becomes an increasingly prevalent health condition. Regular physical activity can prevent functional decline and reduce frailty symptoms. In particular, home-based exercise programs can be beneficial in reducing frailty of older adults and fall risk, and in improving associated physiological parameters. However, adherence to home-based exercise programs is generally low among older adults. Current developments in technology can assist in enlarging adherence to home-based exercise programs. This paper presents the rationale and design of a study evaluating the adherence to and effectiveness of an individually tailored, home-based physical activity program for frail older adults driven by mobility monitoring through a necklace-worn physical activity sensor and remote feedback using a tablet PC.Methods/designFifty transitionally frail community-dwelling older adults will join a 6-month home-based physical activity program in which exercises are provided in the form of exercise videos on a tablet PC and daily activity is monitored by means of a necklace-worn motion sensor. Participants exercise 5 times a week. Exercises are built up in levels and are individually tailored in consultation with a coach through weekly telephone contact.DiscussionThe physical activity program driven by mobility monitoring through a necklace-worn sensor and remote feedback using a tablet PC is an innovative method for physical activity stimulation in frail older adults. We hypothesize that, if participants are sufficiently adherent, the program will result in higher daily physical activity and higher strength and balance assessed by physical tests compared to baseline. If adherence to and effectiveness of the program is considered sufficient, the next step would be to evaluate the effectiveness with a randomised controlled trial. The knowledge gained in this study can be used to develop and fine-tune the application of innovative technology in home-based exercise programs.Trial registrationNederlands Trial Register (NTR); trial number 4265. The study was prospectively registered (registration date 14/11/2013).

Increasing leg strength, leg power and overall balance can improve mobility and reduce fall risk. Sensor-based assessment of peak power during the sit-to-stand (STS) transfer may be useful for detecting changes in mobility and fall risk. Therefore, this study investigated whether sensor-based STS peak power and related measures are sensitive to the effects of increasing leg strength, leg power and overall balance in older adults. A further aim was to compare sensitivity between sensor-based STS measures and standard clinical measures of leg strength, leg power, balance, mobility and fall risk, following an exercise-based intervention. To achieve these aims, 26 older adults (age: 70-84 years) participated in an eight-week exercise program aimed at improving leg strength, leg power and balance. Before and after the intervention, performance on normal and fast STS transfers was evaluated with a hybrid motion sensor worn on the hip. In addition, standard clinical tests (isometric quadriceps strength, Timed Up and Go test, Berg Balance Scale) were performed. Standard clinical tests as well as sensor-based measures of peak power, maximal velocity and duration of normal and fast STS showed significant improvements. Sensor-based measurement of peak power, maximal velocity and duration of normal STS demonstrated a higher sensitivity (absolute standardized response mean (SRM): ≥ 0.69) to the effects of training leg strength, leg power and balance than standard clinical measures (absolute SRM: ≤ 0.61). Therefore, the presented sensor-based method appears to be useful for detecting changes in mobility and fall risk.

<b><i>Background:</i></b> The Lifestyle-integrated Functional Exercise (LiFE) program is an intervention integrating balance and strength activities into daily life, effective at reducing falls in at-risk people ≥70 years. There is potential for LiFE to be adapted to young seniors in order to prevent age-related functional decline. <b><i>Objective:</i></b> We aimed to (1) develop an intervention by adapting Lifestyle-integrated Functional Exercise (aLiFE) to be more challenging and suitable for preventing functional decline in young seniors in their 60s and (2) perform an initial feasibility evaluation of the program. Pre-post changes in balance, mobility, and physical activity (PA) were also explored. <b><i>Methods:</i></b> Based on a conceptual framework, a multidisciplinary expert group developed an initial aLiFE version, including activities for improving strength, neuromotor performances, and PA. Proof-of-concept was evaluated in a 4-week pre-post intervention study measuring (1) feasibility including adherence, frequency of practice, adverse events, acceptability (i.e., perceived helpfulness, adaptability, level of difficulty of single activities), and safety, and (2) changes in balance/mobility (Community Balance and Mobility Scale) and PA (1 week activity monitoring). The program was refined based on the study results. <b><i>Results:</i></b> To test the initial aLiFE version, 31 young seniors were enrolled and 30 completed the study (mean age 66.4 ± 2.7 years, 60% women). Of a maximum possible 16 activities, participants implemented on average 12.1 ± 1.8 activities during the intervention, corresponding to mean adherence of 76%. Implemented activities were practiced 3.6–6.1 days/week and 1.8–7.8 times/day, depending on the activity type. One noninjurious fall occurred during practice, although the participant continued the intervention. The majority found the activities helpful, adaptable to individual lifestyle, appropriately difficult, and safe. CMBS score increased with medium effect size (d = 0.72, <i>p</i> = 0.001). Increase in daily walking time (d = 0.36) and decrease in sedentary time (d = –0.10) were nonsignificant. Refinements included further increasing the task challenge of some strength activities and defining the most preferred activities in the trainer’s manual to facilitate uptake of the program. <b><i>Conclusion:</i></b> aLiFE has the potential to engage young seniors in regular lifestyle-integrated activities. Effectiveness needs to be evaluated in a randomized controlled trial.

Chair rise performance is incorporated in clinical assessments to indicate fall risk status in older persons. This study investigated the test-retest reliability of a pendant-sensor-based assessment of chair rise performance. Forty-one older persons (28 females, 13 males, age: 72–94) were assessed in two sessions with 3 to 8 days in between. Repeated chair rise transfers were measured after different instructions. Relative and absolute test-retest reliability of chair rise measurements in individual tests and average over all tests were evaluated by means of intra-class correlation coefficients (ICCs) and standard error of measurement (SEM) as a percentage of the measurement mean. Systematic bias between the measurements in test and retest was examined with paired t-tests. Heteroscedasticity of the measurements was visually checked with Bland-Altman plots. In the different test conditions, the ICCs ranged between 0.63 and 0.93, and the SEM% ranged between 5.7% and 21.2%. The relative and absolute reliability of the average over all tests were ICC = 0.86 and SEM% = 9.5% for transfer duration, ICC = 0.93 and SEM% = 9.2% for maximum vertical acceleration, and ICC = 0.89 and SEM% = 10.0% for peak power. The results over all tests indicated that a fall risk assessment application based on pendant-worn-sensor measured chair rise performance in daily life might be feasible.

The aim of this study was to analyze the clinical relevance of sensor-based daily life chair rise performance measured in old people. A pendant-sensor was worn during standardized tests and in daily life to detect chair rise transfers and analyze transfer peak power. Linear correlations between mean, median, 25th, and 75th percentile transfer peak powers in daily life and mean peak power in standardized tests were evaluated with Pearson correlation ( r). Associations between transfer peak powers in different experiments and outcomes of a clinical mobility test [timed-up-and-go (TUG)], a test of limitation in activities [Groningen activity restriction scale (GARS)], and a frailty test [Groningen frailty indicator (GFI)] were evaluated with Spearman correlation (ρ). Twenty-five old people (70-85 years) participated in the study. The results showed that chair rise peak powers assessed based upon one-week of daily life activities significantly correlated with peak power measured in standardized tests (r: [0.66, 0.74], p < 0.01). Chair rise peak power in daily life significantly associated with TUG scores (ρ: [-0.71, -0.58], ), GARS (ρ: [-0.62, -0.48], ), and GFI (ρ: [-0.52, -0.43], ). Chair rise peak powers in daily life had stronger associations with clinical measurements than standardized tests. In addition, chair rise peak powers measured in old people using assistive devices was significantly lower compared to those not using assistive devices. These results indicate usefulness of the pendant-sensor-based chair rise performance analysis in continuous monitoring and assessment of mobility, limitations in activities and frailty associated variables in old people's daily life.

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