Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial

Abstract

BackgroundHome-based exercise programs can improve physical functioning and health status of elderly people. Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success. We developed a tablet-based system—ActiveLifestyle—that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features.ObjectiveThe goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between (1) tablet-based and brochure-based interventions, (2) individual and social motivation strategies, and (3) active and inactive participants.MethodsA total of 44 autonomous-living elderly people (mean 75, SD 6 years) were assigned to 3 training groups: social (tablet guided, n=14), individual (tablet guided, n=13), and brochure (brochure guided, n=17). All groups joined a 12-week progressive home-based strength-balance training program. Outcome measures were gait performance under single and dual task conditions, dual task costs of walking, falls efficacy, and physical performance as measured by the Short Physical Performance Battery (SPPB). Furthermore, active (≥75% program compliance) and inactive (<75% program compliance) individuals were compared based on their characteristics and outcome measures.ResultsThe tablet groups showed significant improvements in single and dual task walking, whereas there were no significant changes observable in the brochure group. Between-groups comparisons revealed significant differences for gait velocity (U=138.5; P=.03, r=.33) and cadence (U=138.5, P=.03 r=.34) during dual task walking at preferred speed in favor of the tablet groups. The brochure group had more inactive participants, but this did not reach statistical significance (U=167, P=.06, r=.29). The active participants outperformed the inactive participants in single and dual task walking, dual task costs of walking, and SPPB scores. Significant between-groups differences were seen between the tablet groups and the brochure group, in favor of the tablet groups.ConclusionsA tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program. Social or individual motivation strategies were equally effective. The most prominent differences were observed between active and inactive participants. These findings suggest that in older adults a tablet-based intervention enhances training compliance; hence, it is an effective way to improve gait.

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review

“…Of these, 30 articles reporting data on the efficacy of an app-based intervention to improve diet, physical activity and/or sedentary behaviour for prevention were included for final review. Some articles [29–34] reported on the same studies, and as such, a total of 30 articles describing 27 studies were included in this review.

Fig. 1Flowchart of study selection process

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“…Twelve studies were conducted in North America [35–46], seven studies in Australia/New Zealand [29–32, 47–51], seven studies in Europe [33, 34, 52–57], and one study in the Middle-East [58]. Most studies were randomised controlled trials ( n  = 19) with 2-group [29, 31, 35, 40, 43–46, 48, 50, 52–55, 58] or 3-group [33, 34, 42, 47, 56, 57] study designs.…”

“…No significant between-group changes. Weight status No significant changes in weight status. Blood pressure Within-group improvements in systolic (F(1;30) = 4.946, p  = 0.03; Step-App: +1.19 mm Hg; CF-App: −3.23 mm Hg; Super-CF: −5.75 mm Hg) and diastolic blood pressure (F (1;30) = 12.585, p  < 0.001; Step-App: −2.12 mm Hg; CF-App: −4.31 mm Hg; Super-CF: −3.54). No significant between-group changes. Study quality FairCONSORT score: 12Percentage of fulfilled criteria: 50.0%Safran Naimark et al 2015 [58]Israel Study design 2-group RCT Duration Intervention exposure: 14 weeks (2010–2011)Measurement points: baseline, 14 weeksAttrition rate: 14% Sample Adults N  = 9947.9 years/≥18 years (age range not reported)36% (M), 64% (F)Random Behaviour change theory Control systems theory of self-regulation App features Newly designed app:eBalance app that includes goal setting, self-monitoring of physical activity, dietary intake, and calorie intake and expenditure; real-time performance feedback; information on nutrient intake compared to dietary recommendations. Intervention group Used the app, initial face-to-face information session on healthy lifestyle Control group Information session on healthy lifestyle only, instructed to continue living a healthy lifestyle as they understood it Multi-component versus stand-alone app intervention Multi-component Outcome Physical activity (minutes/week)Diet (diet quality score) Other relevant outcomes Weight status (body weight in kilogram, BMI)BMI Measures Physical activity and diet (questionnaire)Weight status (objective height and weight) Diet Significant between-group improvement in diet quality score in IG at 14 week follow-up (+71 ± 7.6; p  < 0.001). Physical activity Significant between-group increase in mean minutes/week of physical activity in IG at 14 week follow-up (+63.0 ± 20.8; p  = 0.02). Weight status Significant between-group decrease in body weight (kg) in IG at 14 week follow-up (−1.44 ± 0.40; p  = 0.03).Significant between-group decrease in BMI in IG at 14 week follow-up (−0.48 k/m 2  ± 0.13; p  = 0.03). Study quality HighCONSORT score: 16.5Percentage of fulfilled criteria: 67.3%Silveira et al 2013 [33]Van Het Reve et al 2014 [34]Switzerland Study design 3-group CT Duration Intervention exposure: 12 weeksMeasurement points: baseline, 12 weeksAttrition rate: 25% Sample Older adults N  = 4475.0 years/> 65 years36% (M), 64% (F)Convenience(participants in the intervention groups were randomised but not participants in the control group) Behaviour change theory Motivation theory, Transtheoretical model App features Commercially available app:ActiveLifestyle app that includes autonomous strength-balance physical training for independently living older adults. A strength-balance training plan with three levels: beginner, intermediate, and expert.…”

Effects of Physical Exercise Interventions on Gait-Related Dual-Task Interference in Older Adults: A Systematic Review and Meta-Analysis

“…Thus, 21 articles remained that met the inclusion criteria and were included in this review [16-18, 21, 42-58 [51,54] , and 4 were uncontrolled trials [42,43,45,52] . The quality scores ranged from 12 to 21 out of a maximum of 25.…”

“…Other secondary tasks included verbal fluency (e.g., enumerating animal names or naming words beginning with a particular letter) [42][43][44]54] , saying alternate letters of the alphabet [46,47] , adding and subtracting [50] , carrying a glass with water [52] , carrying a ball on a tray [55,56,58] , and holding steady interlocking rings on the end of long sticks held in front of the body [21] . Table 4 summarizes the outcomes of all 21 studies included.…”