BackgroundIntervention programs to promote physical activity in older adults, either in group or home settings, have shown equivalent health outcomes but different results when considering adherence. Group-based interventions seem to achieve higher participation in the long-term. However, there are many factors that can make of group exercises a challenging setting for older adults. A major one, due to the heterogeneity of this particular population, is the difference in the level of skills. In this paper we report on the physical, psychological and social wellbeing outcomes of a technology-based intervention that enable online group exercises in older adults with different levels of skills.MethodsA total of 37 older adults between 65 and 87 years old followed a personalized exercise program based on the OTAGO program for fall prevention, for a period of eight weeks. Participants could join online group exercises using a tablet-based application. Participants were assigned either to the Control group, representing the traditional individual home-based training program, or the Social group, representing the online group exercising. Pre- and post- measurements were taken to analyze the physical, psychological and social wellbeing outcomes.ResultsAfter the eight-weeks training program there were improvements in both the Social and Control groups in terms of physical outcomes, given the high level of adherence of both groups. Considering the baseline measures, however, the results suggest that while in the Control group fitter individuals tended to adhere more to the training, this was not the case for the Social group, where the initial level had no effect on adherence. For psychological outcomes there were improvements on both groups, regardless of the application used. There was no significant difference between groups in social wellbeing outcomes, both groups seeing a decrease in loneliness despite the presence of social features in the Social group. However, online social interactions have shown to be correlated to the decrease in loneliness in the Social group.ConclusionThe results indicate that technology-supported online group-exercising which conceals individual differences in physical skills is effective in motivating and enabling individuals who are less fit to train as much as fitter individuals. This not only indicates the feasibility of training together despite differences in physical skills but also suggests that online exercise might reduce the effect of skills on adherence in a social context. However, results from this pilot are limited to a small sample size and therefore are not conclusive. Longer term interventions with more participants are instead recommended to assess impacts on wellbeing and behavior change.

In this paper we describe the design and validation of a virtual fitness environment aiming at keeping older adults physically and socially active. We target particularly older adults who are socially more isolated, physically less active, and with less chances of training in a gym. The virtual fitness environment, namely Gymcentral, was designed to enable and motivate older adults to follow personalised exercises from home, with a (heterogeneous) group of remote friends and under the remote supervision of a Coach. We take the training activity as an opportunity to create social interactions, by complementing training features with social instruments. Finally, we report on the feasibility and effectiveness of the virtual environment, as well as its effects on the usage and social interactions, from an intervention study in Trento, Italy. 1

IntroductionStimulation 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.MethodsCommunity-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.ResultsTwenty-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).ConclusionA 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.

Background. Regular physical activity can substantially improve the physical wellbeing of older adults, preventing several chronic diseases and increasing cognitive performance and mood. However, research has shown that older adults are the most sedentary segment of society, spending much of their time seated or inactive. A variety of barriers make it difficult for older adults to maintain an active lifestyle, including logistical difficulties in going to a gym (for some adults, leaving home can be challenging), reduced functional abilities, and lack of motivation. In this paper, we report on the design and evaluation of Gymcentral. A training application running on tablet was designed to allow older adults to follow a personalized home-based exercise program while being remotely assisted by a coach. The objective of the study was to assess if a virtual gym that enables virtual presence and social interaction is more motivating for training than the same virtual gym without social interaction. Methods. A total of 37 adults aged between 65 and 87 years old (28 females and 9 males, mean age = 71, sd = 5.8) followed a personalized home-based strength and balance training plan for eight weeks. The participants performed the exercises autonomously at home using the Gymcentral application. Participants were assigned to two training groups: the Social group used an application with persuasive and social functionalities, while the Control group used a basic version of the service with no persuasive and social features. We further explored the effects of social facilitation, and in particular of virtual social presence, in user participation to training sessions. Outcome measures were adherence, persistence and co-presence rate. Results. Participants in the Social group attended significantly more exercise sessions than the Control group, providing evidence of a better engagement in the training program. Besides the focus on social persuasion measures, the study also confirms that a virtual gym service is effective for supporting individually tailored home-based physical training for older adults. The study also confirms that social facilitation tools motivate users to train together in a virtual fitness environment. Discussion. The study confirms that Gymcentral increases the participation of older adults in physical training compare to a similar version of the application without

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).