Effectiveness of an individually tailored home-based exercise rogramme for pre-frail older adults, driven by a tablet application and mobility monitoring: a pilot study.

OBJECTIVES: To gain first insight into the effectiveness of a home-based exercise programme for pre-frail older adults with independent use of novel ICT technology. METHODS: A pilot study. Forty pre-frail older adults joined a six-month home-based exercise programme using a tablet PC for exercise administration and feedback, and a necklace-worn motion sensor for daily physical activity registration. Participants received weekly telephone supervision during the first 3 months and exercised independently without supervision from a coach during the last 3 months. Functional performance and daily physical activity were assessed at baseline, after three and 6 months. RESULTS: Twenty-one participants completed the programme. Overall, functional performance showed positive results varying from (very) small to large effects (Cohen's d 0.04-0.81), mainly during the supervised part of the intervention. Regarding daily physical activity, a slight improvement with (very) small effects (Cohen's d 0.07-0.38), was observed for both self-reported and objectively measured physical activity during the supervised period. However, during the unsupervised period this pattern only continued for self-reported physical activity. CONCLUSION: This pilot study showed positive results varying from (very) small to large effects in levels and maintenance of functional performance and daily physical activity, especially during the supervised first 3 months. Remote supervision seems to importantly affect effectiveness of a home-based exercise programme. Effectiveness of the programme and the exact contribution of its components should be further quantified in a randomized controlled trial. PRACTICE IMPLICATIONS: Home-based exercising using novel technology may be promising for functional performance and physical activity improvement in (pre-frail) older adults. TRIAL REGISTRATION: Netherlands Trial Register (NTR); trial number NL4049 . The study was prospectively registered (registration date 14/11/2013).

A Home-Based Exercise Program Driven by Tablet Application and Mobility Monitoring for Frail Older Adults: Feasibility and Practical Implications.

INTRODUCTION: Stimulation of a physically active lifestyle among older adults is essential to health and well-being. The objective of this study was to evaluate the feasibility and user opinion of a home-based exercise program supported by a sensor and tablet application for frail older adults. METHODS: Community-dwelling older adults (aged ≥70 y) living in The Netherlands were recruited in 2014. Participants exercised 3 months with and 3 months without supervision from a remote coach. Feasibility was operationalized as adherence to exercise (percentage of 5 exercise bouts per week completed) and to wearing the sensor (with 70% defined as sufficient adherence) and the number of problems reported. User opinion was measured with a questionnaire addressing ease of use of the technology and opinion on the program. RESULTS: Twenty-one of 40 enrolled participants completed the trial. Adherence overall was 60.9% (average of 3 bouts per week). Adherence among completers (69.2%) was significantly higher than adherence among dropouts (49.9%). Adherence was sufficient among completers during the 3 months of supervision (75.8%). Adherence to wearing the sensor was 66.7% and was significantly higher among completers than among dropouts (75.7% vs 54.2%). The rate of incidents was significantly lower among completers than among dropouts (0.4 vs 1.2 incidents per participant per week). Connectivity-related incidents were prominent. On a scale of 1 to 5, completers gave ratings of 4.3 (after 3 months) and 4.2 (after 6 months). CONCLUSION: A home-based exercise program using novel technology seems feasible when participants are given a stable internet connection. This program shows promise for stimulating physical activity among older frail adults, especially if it offers regular coaching.

Chair Rise Peak Power in Daily Life Measured With a Pendant Sensor Associates With Mobility, Limitation in Activities, and Frailty in Old People.

The aim of this study was to analyze the clinical relevance of sensor-based daily life chair rise performance measured in old people. A pendant-sensor was worn during standardized tests and in daily life to detect chair rise transfers and analyze transfer peak power. Linear correlations between mean, median, 25th, and 75th percentile transfer peak powers in daily life and mean peak power in standardized tests were evaluated with Pearson correlation ( r). Associations between transfer peak powers in different experiments and outcomes of a clinical mobility test [timed-up-and-go (TUG)], a test of limitation in activities [Groningen activity restriction scale (GARS)], and a frailty test [Groningen frailty indicator (GFI)] were evaluated with Spearman correlation (ρ). Twenty-five old people (70-85 years) participated in the study. The results showed that chair rise peak powers assessed based upon one-week of daily life activities significantly correlated with peak power measured in standardized tests (r: [0.66, 0.74], p < 0.01). Chair rise peak power in daily life significantly associated with TUG scores (ρ: [-0.71, -0.58], ), GARS (ρ: [-0.62, -0.48], ), and GFI (ρ: [-0.52, -0.43], ). Chair rise peak powers in daily life had stronger associations with clinical measurements than standardized tests. In addition, chair rise peak powers measured in old people using assistive devices was significantly lower compared to those not using assistive devices. These results indicate usefulness of the pendant-sensor-based chair rise performance analysis in continuous monitoring and assessment of mobility, limitations in activities and frailty associated variables in old people's daily life.

Validation and User Evaluation of a Sensor-Based Method for Detecting Mobility-Related Activities in Older Adults.

Regular physical activity is essential for older adults to stay healthy and independent. However, daily physical activity is generally low among older adults and mainly consists of activities such as standing and shuffling around indoors. Accurate measurement of this low-energy expenditure daily physical activity is crucial for stimulation of activity. The objective of this study was to assess the validity of a necklace-worn sensor-based method for detecting time-on-legs and daily life mobility related postures in older adults. In addition user opinion about the practical use of the sensor was evaluated. Twenty frail and non-frail older adults performed a standardized and free movement protocol in their own home. Results of the sensor-based method were compared to video observation. Sensitivity, specificity and overall agreement of sensor outcomes compared to video observation were calculated. Mobility was assessed based on time-on-legs. Further assessment included the categories standing, sitting, walking and lying. Time-on-legs based sensitivity, specificity and percentage agreement were good to excellent and comparable to laboratory outcomes in other studies. Category-based sensitivity, specificity and overall agreement were moderate to excellent. The necklace-worn sensor is considered an acceptable valid instrument for assessing home-based physical activity based upon time-on-legs in frail and non-frail older adults, but category-based assessment of gait and postures could be further developed.

Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: design of a prospective cohort study.

BACKGROUND: With the number of older adults in society rising, frailty becomes an increasingly prevalent health condition. Regular physical activity can prevent functional decline and reduce frailty symptoms. In particular, home-based exercise programs can be beneficial in reducing frailty of older adults and fall risk, and in improving associated physiological parameters. However, adherence to home-based exercise programs is generally low among older adults. Current developments in technology can assist in enlarging adherence to home-based exercise programs. This paper presents the rationale and design of a study evaluating the adherence to and effectiveness of an individually tailored, home-based physical activity program for frail older adults driven by mobility monitoring through a necklace-worn physical activity sensor and remote feedback using a tablet PC. METHODS/DESIGN: Fifty transitionally frail community-dwelling older adults will join a 6-month home-based physical activity program in which exercises are provided in the form of exercise videos on a tablet PC and daily activity is monitored by means of a necklace-worn motion sensor. Participants exercise 5 times a week. Exercises are built up in levels and are individually tailored in consultation with a coach through weekly telephone contact. DISCUSSION: The physical activity program driven by mobility monitoring through a necklace-worn sensor and remote feedback using a tablet PC is an innovative method for physical activity stimulation in frail older adults. We hypothesize that, if participants are sufficiently adherent, the program will result in higher daily physical activity and higher strength and balance assessed by physical tests compared to baseline. If adherence to and effectiveness of the program is considered sufficient, the next step would be to evaluate the effectiveness with a randomised controlled trial. The knowledge gained in this study can be used to develop and fine-tune the application of innovative technology in home-based exercise programs. TRIAL REGISTRATION: Nederlands Trial Register (NTR); trial number 4265. The study was prospectively registered (registration date 14/11/2013).

Chair rise transfer detection and analysis using a pendant sensor: an algorithm for fall risk assessment in older people.

Falls result in substantial disability, morbidity, and mortality among older people. Early detection of fall risks and timely intervention can prevent falls and injuries due to falls. Simple field tests, such as repeated chair rise, are used in clinical assessment of fall risks in older people. Development of on-body sensors introduces potential beneficial alternatives for traditional clinical methods. In this article, we present a pendant sensor based chair rise detection and analysis algorithm for fall risk assessment in older people. The recall and the precision of the transfer detection were 85% and 87% in standard protocol, and 61% and 89% in daily life activities. Estimation errors of chair rise performance indicators: duration, maximum acceleration, peak power and maximum jerk were tested in over 800 transfers. Median estimation error in transfer peak power ranged from 1.9% to 4.6% in various tests. Among all the performance indicators, maximum acceleration had the lowest median estimation error of 0% and duration had the highest median estimation error of 24% over all tests. The developed algorithm might be feasible for continuous fall risk assessment in older people.

Effects of remote feedback in home-based physical activity interventions for older adults: a systematic review.

OBJECTIVE: To evaluate the literature on effectiveness of remote feedback on physical activity and capacity in home-based physical activity interventions for older adults with or without medical conditions. In addition, the effect of remote feedback on adherence was inventoried. METHODS: A systematic review. Data sources included PubMed, PsycInfo, Cochrane and EMBASE. A best-evidence synthesis was used for qualitative summarizing of results. RESULTS: Twenty-four studies met the inclusion criteria for systematic effectiveness evaluation and 22 for adherence inventory. Three categories of contact were identified: frequent, non-frequent, and direct remote contact during exercising. Evidence for positive enhancement of physical activity or capacity varied from conflicting in frequent contact strategies (16 studies) to strong in non-frequent (5 studies) and direct contact strategies (3 studies). Adherence rates in intervention groups were similar or higher than treatment-as-usual or exercise control groups. CONCLUSION: Results imply with varying strength that interventions using frequent, non-frequent or direct remote feedback seem more effective than treatment as usual and equally effective as supervised exercise interventions. Direct remote contact seems a particularly good alternative to supervised onsite exercising. PRACTICE IMPLICATIONS: Remote feedback is promising in an older population getting increasingly used to new technology.