Instructors' Perceptions and Experiences of Teaching Online Exercise Classes to Older Adults: A Qualitative Study.

Online exercise programming has become increasingly popular in recent years, including for older adults. Instructors hold unique perspectives on such programming that could yield important insights for effective program design and delivery. The purpose of this study was to qualitatively examine instructors' perceptions and experiences teaching exercise classes online to older adults. Using qualitative description, 19 instructors from a community exercise program for seniors completed a one-on-one semistructured interview. We analyzed data using reflexive thematic analysis and generated three main themes: (a) characteristics of effective online instructors, (b) challenges to delivering online exercise programming to older adults, and (c) future of online exercise programming. Most participants enjoyed delivering online exercise classes and developing the unique skills (particularly related to fostering social experiences and engaging with participants) required to be effective online exercise instructors. Our findings speak to the importance of ensuring instructors are adequately trained to deliver online exercise to seniors.

Wireless physical activity monitor use among adults living with HIV in a community-based exercise intervention study: a quantitative, longitudinal, observational study.

OBJECTIVES: Our aim was to examine wireless physical activity monitor (WPAM) use and its associations with contextual factors (age, highest education level, social support and mental health) among adults living with HIV engaged in a community-based exercise (CBE) intervention. DESIGN: Quantitative, longitudinal, observational study. SETTING: Toronto YMCA, Ontario, Canada. PARTICIPANTS: Eighty adults living with HIV who initiated the CBE intervention. INTERVENTION: Participants received a WPAM to track physical activity during a 25-week CBE intervention involving thrice-weekly exercise, supervised weekly (phase 1) and a 32-week follow-up involving thrice-weekly exercise with no supervision (phase 2), completed in December 2018. OUTCOME MEASURES: Uptake was measured as participants who consented to WPAM use at initation of the intervention. Usage was defined as the proportion of days each participant had greater than 0 steps out of the total number of days in the study. We measured contextual factors using a baseline demographic questionnaire (age, highest education level), and median scores from the bimonthly administered Medical Outcomes Study-Social Support Scale and Patient Health Questionnaire (mental health), where higher scores indicated greater social support and mental health concerns, respectively. We calculated Spearman correlations between WPAM usage and contextual factors. RESULTS: Seventy-six of 80 participants (95%) consented to WPAM use. In phase 1, 66% of participants (n=76) and in phase 2, 61% of participants (n=64) used the WPAM at least 1 day. In phase 1, median WPAM usage was 50% (25th, 75th percentile: 0%, 87%; n=76) of days enrolled and in phase 2, 23% (0%, 76%; n=64) of days. Correlation coefficients with WPAM usage ranged from weak for age (ρ=0.26) and mental health scores (ρ=-0.25) to no correlation (highest education level, social support). CONCLUSIONS: Most adults living with HIV consented to WPAM use, however, usage declined over time from phase 1 to phase 2. Future implementation of WPAMs should consider factors to promote sustained usage by adults living with HIV. TRIAL REGISTRATION NUMBER: NCT02794415.

Navigating a New Normal: Perceptions and Experiences of an Online Exercise Program for Older Adults During COVID-19.

Online exercise programming has surged in popularity; however, little is known about older adults' perceptions and experiences of online exercise. The purpose of this study was to qualitatively examine older adults' (aged 59-82 years) experiences and perceptions of an online exercise program during the COVID-19 pandemic. Nineteen individuals (individuals who used the online exercise program and those who did not) completed a semistructured interview. Three main themes were generated from the data using reflexive thematic analysis: (a) can online exercise really work for older adults? (b) technology attitudes and experiences influence online participation, and (c) barriers and advantages of the online exercise program and the home environment. Most participants who took part were able to overcome initial barriers through technical support and experience. Our findings highlight ways to promote advantages and address barriers of online exercise for older adults and emphasize the importance of fostering social experiences and training online exercise instructors.

Online Exercise Programming Among Older Adults: A Scoping Review.

Online exercise programming may promote physical activity while at home, but little is known about its use among older adults. Using the Arksey and O'Malley framework, we describe the nature and extent of the research pertaining to the use of online exercise programming among adults 65 years of age and older. We ran two separate searches (January 2005-September 2020 and October 2020-October 2021), yielding 17 articles that met our inclusion criteria. A total of 1,767 participants (69% female) ranging from 65 to 94 years of age were included. Most studies delivered the online programs asynchronously. The majority of studies assessed the feasibility of online programs, with 14 studies investigating health-related outcomes such as physical, psychological, and social health. Future research should explore perceptions and experiences of online exercise programming among older adults and the mechanisms by which it impacts physical, psychological, social, and behavioral outcomes.

Is a Picture Worth a Thousand Words? Using Photo-Elicitation to Study Body Image in Middle-to-Older Age Women With and Without Multiple Sclerosis.

In this study, we explored how women with varying relationships to disability and aging used photographs to represent their body image experiences. Seven middle-aged and older adult women with and without multiple sclerosis were asked to provide up to 10 photographs that represented their body image and complete a one-on-one interview. We used reflexive thematic analysis to develop themes and interpret the findings. Overall, the women expressed not only complicated relationships with their bodies, represented through symbolism, scrutiny of body features (e.g., posture, varicose veins, and arthritis) but also deep reflection linked to positive body image and resilience. These findings revealed not only the nuanced experiences women have with aging, disability, and gender but also the commonly experienced ingrained views of body appearance as each participant illustrated a difficult negotiation with the aesthetic dimension of their body image. Finally, we provide important implications of the use of visual methods in body image research.

Distance-limited walk tests post-stroke: A systematic review of measurement properties.

BACKGROUND: Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE: To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS: Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS: Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS: The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.

Assessing the Measurement Properties of the Fitbit Zip® Among Adults Living With HIV.

PURPOSE: To assess the criterion and construct validity of the Fitbit Zip® to measure physical activity among adults living with HIV. METHODS: Participants were video recorded completing 2 walk tests while wearing the Fitbit Zip® and completed 3 self-reported physical activity questionnaires 1 week later. The authors calculated intraclass correlation coefficients (ICCs) to determine agreement between the number of steps taken and distance walked (Fitbit Zip®) with the visual count of number of steps taken and actual distance walked (walk tests). The authors tested 15 a priori hypotheses about predicted associations between questionnaire scores and physical activity measured by the Fitbit Zip®. RESULTS: Among the 34 participants, there was "excellent" agreement between the number of steps taken measured by the Fitbit Zip® and visually counted number of steps taken (ICC = .99) and number of steps taken at slow (ICC = .75), moderate (ICC = .85), and fast (ICC = .78) walking speeds. There was "poor" agreement between the Fitbit Zip® recorded distance and actual determined distance walked (ICC = .20). Three (20%) construct validity hypotheses were confirmed. CONCLUSIONS: The Fitbit Zip® demonstrated criterion validity for its ability to measure number of steps taken but not distance walked, and did not demonstrate construct validity for measuring physical activity among adults with HIV.

Use of Living Strategies among Adults Aging with HIV in Canada: Comparison by Age-Group Using Data from the HIV, Health and Rehabilitation Survey.

OBJECTIVE: To examine the type and frequency of living strategies used by adults living with HIV. METHODS: We conducted a cross-sectional web-based survey that included 51 living strategies: maintaining sense of control, attitudes and beliefs, blocking HIV out of the mind, and social interaction. We examined the frequency of use and compared the proportion of respondents who engaged in strategies across 3 age-groups (<40 years, 40-49 years, and ≥50 years). RESULTS: Of the 935 participants, the majority were men (79%) and most (≥60%) engaged "most" or "all of the time" in healthy lifestyle strategies and maintained a positive outlook living with HIV. Compared to younger participants, a higher proportion of older adults (≥50 years) engaged "most" or "all the time" in strategies that involved maintaining control over health and adopting positive attitudes and outlook living with HIV. CONCLUSIONS: Findings can help to inform the role of self-management to enhance successful aging with HIV.