Web-based exercise versus supervised exercise for decreasing visceral adipose tissue in older adults with central obesity: a randomized controlled trial

Abstract

Background: Visceral adipose tissue (VAT) is a strong risk factor for cardiovascular disease and increases with age. While supervised exercise (SE) may be an effective approach, web-based exercise (WE) have other advantages such as being more readily accessible. Therefore, we evaluated the effects of WE on VAT, body composition and cardiometabolic risk markers in centrally obese older adults and compared the effects of WE to SE. We also explored the feasibility of WE. Methods: In a randomized controlled trial conducted in Umeå, Sweden during January 2018-November 2018, N = 77, 70-year-old men and women with central obesity (> 1 kg VAT for women, > 2 kg for men) were randomized to an intervention group (n = 38) and a wait-list control group (n = 39). The intervention group received 10 weeks of SE while the wait-list control group lived as usual. Following a 10-week wash-out-period, the wait-list control group received 10 weeks of WE. The primary outcome was changes in VAT. Secondary outcomes included changes in fat mass (FM), lean body mass (LBM), blood lipids, fasting blood glucose. Additionally, we explored the feasibility of WE defined as adherence and participant experiences. Results: WE had no significant effect on VAT (P = 0.5), although it decreased FM by 450 g (95% confidence interval [CI], 37 to 836, P < 0.05). The adherence to WE was 85% and 87-97% of the participants rated aspects of the WE intervention > 4 on a scale of 1-5. Comparing SE to WE, there was no significant difference in decrease of VAT (Cohen's δ effect size [ES], 0.5, 95% CI, − 24 to 223, P = 0.11), although SE decreased FM by 619 g (ES, 0.5, 95% CI, 22 to 1215, P < 0.05) compared to WE. Conclusions: Ten weeks of vigorous WE is insufficient to decrease VAT in centrally obese older adults, but sufficient to decrease FM while preserving LBM. The high adherence and positive experiences of the WE intervention implies that it could serve as an alternative exercise strategy for older adults with central obesity, with increased availability for a larger population.

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

“…The summary of analysis is provided in Table 3, which lists the themes/observations from reviewers that correspond with the objective statement and sorts articles from the most recent to the oldest. [25] Not reported Convenience of telemedicine, increased patientprovider communication, concerns adequately addressed, increased access Strong satisfaction Richards et al [24] Some patients prefer in-person consultations, technical literacy Pandemic created acceptance of technology, past experience with technology Not reported Kurihara et al [23] Technology needs further development, technical literacy Technical literacy, past experience with technology, perceived usefulness, increased patient-provider communication, perceived ease of use Not reported Alkirie et al [26] Technology needs further development Increased connectedness, self-management, flexibility, and access Not reported Ballin et al [27] Health literacy, availability of technology, technical literacy Enabled social interaction; decreased anxiety; increased connectedness, technical literacy, and access; televideo enables reading of body language; education; convenience of telemedicine Not reported Banbury et al [28] Technology needs further development, decrease in patient-provider communication, technical literacy, confidentiality/security Increased efficiency, access, and patient-provider communication, and improved standard of care Not reported Barnett et al [29] Discomfort for wearable monitors, technical literacy, technology needs further development Technical literacy, increased self-management, increased access, increased flexibility Not reported Batalik et al [30] Limits of reimbursement for telemedicine, some patients prefer in-person consultations, connectivity, technical literacy Pandemic created acceptance of technology, availability of technology, fewer miles driven to appointment, convenience of telemedicine, faster initiation of treatment, decreased costs Not reported Beller et al [31] Perceived lack of usefulness, lack of personal desire to get better, some patients prefer inperson consultations Increased connectedness, increased adherence, improved health behaviors Not reported Bernabe-Ortiz et al [32] Not reported Pandemic created acceptance of technology Not reported Bilgrami et al [33] Decrease in quality of life after intervention Perceived usefulness, perceived ease of use, increased adherence Strong satisfaction Broers et al [34] Technical literacy, availability of technology Increased adherence, increased self-management, increased weight loss, technical literacy Not reported Cho et al [35] Technology needs further development Technical literacy, perceived ease of use Not reported Claes et al [36] Lack of personal desire to get better, technology needs further development, technical literacy Increased adherence, increased self-management Not reported Coorey et al [37] Technology needs fur...…”

“…Occurrence, n (%) References Themes/observations 12 (9.1) [27,30,35,37,38,40,41,45,46,49,57,58] Increased self-management 11 (8.3) [23,25,31,33,41,43,47,51,52,61,62] Pandemic created acceptance of technology 10 (7.6) [32,34,35,37,38,40,43,46,58,67] Increased adherence 9 (6.8) [24,[27][28][29][30]41,52,53,60] Increased access 8 (6.1) [49,50,54,55,[62][63][64]66] Increased social support 7 (5.3) ...…”

“…The remaining five observations made up a total of 6% of the total occurrences: decrease in quality of life after intervention, discomfort for wearing monitors, workflow issues for providers, lack of data infrastructure, and interoperability. [23,25,26,[28][29][30][31]35,37,[41][42][43][44]49,57,60,62,65,66] Technical literacy 12 ( 14) [26,27,29,30,[36][37][38][39]45,49,57,62] Technology needs further development 8 ( 9) [22,28,35,41,43,51,60,62] Availability of technology 7 (8) [38,39,41,43,44,46,59] Cost 7 (8) …”

Current Evidence and Directions for Future Research in eHealth Physical Activity Interventions for Adults Affected by Cancer: Systematic Review

“…A finding from this review that stands in contrast to those of previous reviews in exercise oncology is that a higher percentage of unsupervised interventions (56%; those without face-to-face interaction) were successful at increasing PA levels compared with those that were partially supervised (41%; those with one or more face-to-face components) [ 7 , 119 ]. This may be because of feelings of autonomy promoted by unsupervised interventions, a factor that has been linked to increased intrinsic motivation and PA behavior change [ 120 - 122 ]. In addition, it may be in part because of the more frequent use of behavioral theories (unsupervised: 63%; supervised: 56%) and BCTs (unsupervised mean: 13.8; supervised mean: 11.8) in the included unsupervised interventions, which have been associated with effectiveness in web-based behavioral interventions [ 123 ].…”

Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial

“…Mobile health (mHealth) facilities (smartphone-based educational apps, web-based tools, SMS text messaging, PDA physiological status monitoring, and connected captors) improved the delivery of the components of rehabilitation when taken individually [ 22 ]. In patients with obesity, a 10-week web-based exercise program has shown a significant effect on patients’ FM [ 23 ]. In addition, mHealth nutrition management or therapeutic education had significant effects on body weight (BW) and BMI in obesity [ 24 , 25 ].…”