Title: Evaluating the effectiveness of a telehealth delivered group exercise program for older adults developed by an interdisciplinary geriatric team

ABSTRACT

Background: Social isolation has detrimental consequences for older adults, including decreased life-space mobility, quality of life, cardiovascular function, increased anxiety and accelerated cognitive decline. This interdisciplinary model aims to assess the effects of a holistic telehealth delivered group exercise program, Veteran's Video Connect-Balance, Exercise, and Stability Training (VVC BEST). Method: This prospective quality improvement project was completed in two cycles of ten weeks from April-September 2020. Geriatricians and geriatric nursing staff screened and medically cleared older veterans. Geriatric physical therapists assigned individuals to a sitting or standing group based on functional level. The course structure entailed two telehealth classes per week of one-hour duration. Each week highlighted a different area of fitness aerobic conditioning, flexibility, strengthening, and balance training. Interventions were modified based on participant's cognitive, auditory, and/or visual impairments. Veterans were referred to in-person chiropractor or acupuncture services for musculoskeletal pain management to minimize polypharmacy. Veterans demonstrating low attendance were referred to telehealth psychology services for motivational interviewing. Primary outcome measures included performance on the modified Berg Balance Scale (mBBS). Secondary outcomes included patient satisfaction and self-reported activity level. Results: Twelve participants Mage = 85.7 (6.9) years (n=7 in sitting, n=5 in standing) completed an average of 27.8 (19.5) telehealth sessions. Veterans demonstrated a significant improvement in their mBBS scores, t(9) = -5.79, p < 0.001 and self-reported physical activity, χ2 (4, n = 9) = 11.14, p = 0.025. All participants reported satisfaction and would recommend VVC BEST. Technology constraints limited participation to seven individuals per class. Conclusions: High program satisfaction coupled with objective improvements in balance and increased self-reported physical activity demonstrate the acceptability and preliminary benefits of this telehealth interdisciplinary program. This program remains ongoing while older veterans continue to shelter-in-place due to COVID-19 restrictions.