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

Abstract

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).

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

“…Older adults in our study reported the lack of equipment used in the exercise snacking program as an extrinsic barrier to participation. The previous trial of home-based exercise snacking in 38 community-dwelling older adults similarly observed barriers related to the lack of additional exercise variety, equipment and upper body exercises [ 12 ]. These barriers were inconsistent to those reported in the only other qualitative study exploring the barriers and enablers to participating in exercise snacking exercises [ 14 ].…”

“…Participants in that study reported various enablers to participation in the exercise snacking program, including that it could be completed at any time of day and integrated into their own activities of daily living [14]. Another study evaluating the experiences in 38 community-dwelling older adults participating in an exercise snacking program revealed similar enablers related to flexibility and time efficiency [12]. The reason(s) for poor engagement with current exercise guidelines for older adults are multifactorial but include a high perceived difficulty and/or complexity, time constraints, limited access to facilities, and cost [21,22].…”

“…Exercise snacking trials have reported improvements in cardiorespiratory fitness [10] and/or markers of metabolic health [9]. There is also emerging evidence that exercise snacking may be feasible for enhancing muscle mass, strength and function [11][12][13]. One study in 20 older adults reported an adherence rate of 98% and improvements in lower body muscle (mean change 8 repetitions) in the 60-s sit-to-stand performance when undertaking a 4-week, twice-daily exercise snacking program, with no adverse events reported [11].…”