Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study

Abstract

Background Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. Conclusions With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs.

Remotely Delivered Exercise to Rural Older Adults With Knee Osteoarthritis: A Pilot Study

“…Importantly, the current study demonstrated that with appropriate support, rural older adults can effectively participate in teleexercise. Indeed, the technology support needs during tele-EF classes in the current study were similar to the needs observed in an urban sample (16). In an initial study of tele-EF among 44 older adults with knee OA in Seattle ( 16), 69% of support calls occurred in the first 2 weeks of tele-EF, which is nearly identical to the 71% rate observed in the current study.…”

“…In an initial study of tele‐EF among 44 older adults with knee OA in Seattle ( 16 ), 69% of support calls occurred in the first 2 weeks of tele‐EF, which is nearly identical to the 71% rate observed in the current study. Further, the median tele‐EF class attendance rates were also similar (≥90%) between the two studies ( 16 ). Interestingly, the initial orientation session held with each participant lasted 11 minutes longer, on average, in the current study than the previous one from Seattle (mean = 30 vs. 19 minutes, respectively).…”

“…Indeed, the technology support needs during tele‐EF classes in the current study were similar to the needs observed in an urban sample ( 16 ). In an initial study of tele‐EF among 44 older adults with knee OA in Seattle ( 16 ), 69% of support calls occurred in the first 2 weeks of tele‐EF, which is nearly identical to the 71% rate observed in the current study. Further, the median tele‐EF class attendance rates were also similar (≥90%) between the two studies ( 16 ).…”

“…We have partnered with Sound Generations, a nonprofit organization that licenses and manages EnhanceFitness (EF), to adapt their evidence‐based exercise program for remote delivery ( 16 ). EF is a multicomponent, instructor‐led, group exercise program that is recommended by the CDC for adults with OA ( 17 ).…”

Immersive Virtual Reality Exergames to Promote the Well-being of Community-Dwelling Older Adults: Protocol for a Mixed Methods Pilot Study

“…More optimistically, restrictions and changes in lifestyle as a result of COVID-19 have increased technology adoption among older adults [ 36 - 39 ]. Various opportunities for using novel information and communication technologies (eg, mobile apps, activity trackers, and gamified exercises) have emerged aiming to complement remote exercise programs and potentially benefit older adults’ health and well-being while mitigating social distancing [ 40 , 41 ]. From wearables to applied games, digitally connected technologies are now filling the gap in many in-person activities that cannot be conducted because of the COVID-19 pandemic [ 42 ].…”