Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: A Phase II Preclinical Exploratory Trial

Abstract

BackgroundReaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home.ObjectiveThe objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed.MethodsA total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study.ResultsParticipants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed.ConclusionsActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time.

The interplay of physical and social wellbeing in older adults: investigating the relationship between physical training and social interactions with virtual social environments

“…We classify the persuasion strategies in the literature in two major categories of (i) individual motivation strategies, where the persuasion mechanism does not require the presence of a social community and (ii) social motivation strategies, where the presence of a social group (e.g., co-participants, family and supporters) has a positive effect on the participant's exercising behavior (Silveira et al, 2013b).…”

“…This environment evolved from years of research in home-based training for older adults (Silveira et al, 2013a;Silveira et al, 2013b;Khaghani Far et al, 2012;Khaghani Far et al, 2014). The specific goal of the latest version, called Gymcentral (gymcentral.net) and discussed here, is to motivate people to train by providing users with a fitness club that is both personal (the training program is personalized) and social: members can interact and have the feeling of being in the same virtual space-even if they perform different exercises.…”

When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults (Preprint)

“…[2] The World Health Organization calls for a 10% increase in physical activity (PA), and encourages community-based collaborations to formulate evidence based, cost-effective means to achieve this goal. [3] PA can decrease the chance of falls, [4] cardiovascular disease, [5] and arthritis pain. [6][7][8] PA can increase memory performance [9] and improve functioning with arthritis.…”

“…Weinstock et al utilized videoconferencing between diabetes educators and older adults to enhance pedometer effectiveness and found that participants in the telemedicine group had fewer declines in PA and physical impairment compared to those not using telemedicine. [4] Silveira et al [5] and Wu et al [6] delivered PA interventions to older adults and found that community-based PA and videoconferencing produced higher retention, greater reduction in falls, and improvement in balance and health measures. [5,6] Compernolle et al [7] integrated pedometers and an Internet based PA program for adults at risk for chronic medical problems and found step counts and a computer-based intervention led to more accurate PA reports.…”

“…[4] Silveira et al [5] and Wu et al [6] delivered PA interventions to older adults and found that community-based PA and videoconferencing produced higher retention, greater reduction in falls, and improvement in balance and health measures. [5,6] Compernolle et al [7] integrated pedometers and an Internet based PA program for adults at risk for chronic medical problems and found step counts and a computer-based intervention led to more accurate PA reports. [7] Activity trackers can increase PA when used in the appropriate context and are particularly effective with support infrastructure.…”