Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

The purpose of this study was to examine the feasibility and acceptability of remotely delivered, home-based exercise programs on physical function and well-being in self-isolating older adults during the COVID-19 pandemic. In a four-arm randomized controlled trial, 63 participants (aged 65 years and older) were allocated to one of three home-based daily (2 × 10-min) exercise interventions (exercise snacking, tai chi snacking, and combination) or control (UK National Health Service Web pages). Functional assessments were conducted via video call at baseline and 4-week follow-up. A web-based survey assessed the acceptability of each exercise program and secondary psychological/well-being outcomes. Ecological momentary assessment data, collected in Weeks 1 and 4, explored feeling states as antecedents and consequences of exercise. All intervention groups saw increased physical function at follow-up and displayed good adherence with exercise snacking considered the most acceptable program. Multilevel models revealed reciprocal associations between feelings of energy and exercise engagement. Further studies are needed with larger, more diverse demographic samples.</p

Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

The purpose of this study was to examine the feasibility and acceptability of remotely delivered, home-based exercise programs on physical function and well-being in self-isolating older adults during the COVID-19 pandemic. In a four-arm randomized controlled trial, 63 participants (aged 65 years and older) were allocated to one of three home-based daily (2 × 10-min) exercise interventions (exercise snacking, tai chi snacking, and combination) or control (UK National Health Service Web pages). Functional assessments were conducted via video call at baseline and 4-week follow-up. A web-based survey assessed the acceptability of each exercise program and secondary psychological/well-being outcomes. Ecological momentary assessment data, collected in Weeks 1 and 4, explored feeling states as antecedents and consequences of exercise. All intervention groups saw increased physical function at follow-up and displayed good adherence with exercise snacking considered the most acceptable program. Multilevel models revealed reciprocal associations between feelings of energy and exercise engagement. Further studies are needed with larger, more diverse demographic samples.</p

Feasibility and Acceptability of Home-Based Exercise Snacking and Tai Chi Snacking Delivered Remotely to Self-Isolating Older Adults During COVID-19

The purpose of this study was to examine the feasibility and acceptability of remotely delivered, home-based exercise programs on physical function and well-being in self-isolating older adults during the COVID-19 pandemic. In a four-arm randomized controlled trial, 63 participants (aged 65 years and older) were allocated to one of three home-based daily (2 × 10-min) exercise interventions (exercise snacking, tai chi snacking, and combination) or control (UK National Health Service Web pages). Functional assessments were conducted via video call at baseline and 4-week follow-up. A web-based survey assessed the acceptability of each exercise program and secondary psychological/well-being outcomes. Ecological momentary assessment data, collected in Weeks 1 and 4, explored feeling states as antecedents and consequences of exercise. All intervention groups saw increased physical function at follow-up and displayed good adherence with exercise snacking considered the most acceptable program. Multilevel models revealed reciprocal associations between feelings of energy and exercise engagement. Further studies are needed with larger, more diverse demographic samples.</p

The Efficacy of 12-Week Progressive Home-Based Strength and Tai-Chi Exercise Snacking in Older Adults:A Mixed-Method Exploratory Randomised Control Trial

Background: Maintaining physical function is important for independence and frailty prevention in later life, but very few older adults meet exercise recommendations. Previous studies found that 4-week ‘exercise and Tai-chi snacking’ as a viable alternative to traditional exercise is acceptable to healthy older adults. Objectives: This study aimed to investigate the effectiveness of a 12-week progressive exercise and Tai-chi snacking programme on physical function and psychological outcomes in pre-frail older adults. Design: Randomised controlled trial. Setting: Community-dwelling older adults. Participants: 90 older adults with impaired strength and balance were recruited. Participants were randomly allocated to an intervention or waitlist control group. Intervention: A 12-week progressive exercise and Tai-chi snacking programme. Measurements: Physical function (the short physical performance battery (SPPB), single-leg balance test and sit-to-stand test) was remotely measured at participants’ homes via video calls at baseline, 4-, 8-, and 12-weeks. The self-reported psychological outcomes were also assessed every 4 weeks using online questionnaires. A subset of 40 participants also completed in-person functional assessments, and 26 intervention participants underwent semi-structured interviews to feedback on their experiences. Results: The 12-week progressive home-based exercise and Tai-chi snacking improved SPPB strength (estimated mean difference in week 4: 1.05; week 8: 0.79; and week 12: 0.79) and balance (estimated mean difference in week 4: 0.71; week 8: 0.57; and week 12: 0.65) at each timepoint compared to control group. Timed-up-and-go (estimated mean difference in week 4: 1.94; week 8: 1.58; and week 12: 1.1) and total SPPB scores (estimated mean difference in week 4: 2.24; week 8: 1.79; and week 12: 1.76) were also better in the intervention group compared to the control group in lab subset participants. Based on the qualitative findings, Participants found the programme accessible and beneficial, making it suitable for older adults and increasing self-efficacy in physical activities. Conclusion: The home-based exercise and Tai-chi snacking programme significantly improved lower extremity strength, balance, and mobility in pre-frail older adults. This programme is considered to be a beneficial, acceptable and easy implemented physical function intervention.</p

Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting:User-Centered Design Study

Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults’ (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants’ homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants’ everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants’ attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them.</p

Exploring the potential of technology to promote exercise snacking for older adults who are prefrail in the home setting: user-centered design study.

Older adults have an increased risk of falls, injury, and hospitalization. Maintaining/increasing participation in physical activity (PA) into older age can prevent some of the age-related declines in physical functioning that may contribute to loss of independence and lower reported quality of life. 'Exercise snacking' has been created to overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Our aim was to explore: a) how the novel 'exercise snacking' approach, i.e. incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting; and b) what types of technologies would be acceptable for pre-frail older adults. Two design workshops (Study 1) were conducted, to understand older adults' (n=11, aged 69-89 years old) attitudes towards technology aimed at supporting exercise snacking at home and to inform the design of interactive prototypes. Based on the findings of Study 1, a feasibility home evaluation (Study 2) was conducted over one day for two prototypes (n=5 participants, aged 69-80). Participants were interviewed over the telephone afterwards about their experience. Transcripts were analyzed using Framework analysis. Results showed participants were positive towards using technology at home to support exercise snacking, but both the exercises and technology would need to be simple and match participants' everyday routines. Workshop discussions (Study 1) led to the design of two prototypes using a pressure mat to support resistance and balance exercises. The home evaluation (Study 2) identified that participants reported potential in using smart devices to support exercise snacking, but the low fidelity of the prototypes influenced participants' attitudes towards them. It also hampered the acceptability of these initial versions and highlighted challenges in fitting exercise snacking into everyday life. The study concluded that older adults were positive about using technology in their homes to support strength and balance exercise snacking. We have identified key points around the suitability of the home environment for facilitating exercise snacking. While promising, the initial prototypes' further refinement and optimization prior to feasibility, acceptability and efficacy testing is required. Developers and researchers can use these findings to inform the development and evaluation of more sophisticated technologies for integration in the home environment to support PA

The acceptability of homebased exercise snacking and Tai-chi snacking amongst high and low function UK and Taiwanese older adults

Introduction: Exercise “snacking” and Tai-chi ‘snacking’ protocols are designed to overcome typical barriers to older adults’ participation in muscle strength and balance exercise, using short bouts of home-based exercise. This study aimed to investigate the acceptability of homebred exercise- and Tai-chi snacking in British and Taiwanese older adults of high and low physical function. Methods: Thirty-three British and Thirty Taiwanese older adults took part in semi-structured interviews, after trying 1-week of exercise- and Tai-chi snacking. The interview schedule and deductive framework analysis was based on the seven components of the Theoretical Framework of Acceptability (TFA). Differences between the Taiwanese and United Kingdom participants and those considered high versus low physical function were also analysed. Results: Both snacking regimes were found to be convenient and easy to implement. Participants reported that no activity had to be given up, and considered the programmes would be beneficial to their physical and mental health. Interestingly, more UK-based participants preferred the elegant and relaxing movements of Tai-chi snacking, yet participants with low physical function experienced difficulties when mastering Tai-chi movements. A few high physical function participants perceived exercise snacking to be tedious. Discussion: Overall, the snacking exercise was found to be acceptable and useful. Personal affective attitude and different cultural backgrounds may affect exercise participation. Nevertheless, it is important to consider individuals’ physical function when designing exercise regime. The findings indicate that making Tai-chi snacking easier to master initially, building in progression and adding some upper body movements in the exercise snacking may further enhance acceptability.</p

The understanding and interpretation of innovative technology-enabled multidimensional physical activity feedback in patients at risk of future chronic disease

BACKGROUND:Innovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease. METHOD:We developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations. RESULTS:We identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active. CONCLUSION:Multidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change

The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status:a systematic review and meta-analysis

Abstract Background Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. Methods A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. Results Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (− 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. Discussion Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population