Feasibility, Usability and Enjoyment of a Home-based, Multi-component Exercise Program for Musculoskeletal Health Delivered via a Tablet Computer Exercise App for Community-dwelling Older Adults: An 8-week Prospective Pilot Study (Preprint)

BACKGROUND Many older adults choose and prefer to exercise at home, but to attain the greatest benefits the correct type and dose should be prescribed and adherence maintained. Advances in digital health technologies now provide the opportunity for exercise professionals to deliver and monitor personalized, evidence-based exercise programs to anyone at anytime. OBJECTIVE To evaluate the feasibility, usability and enjoyment of an online exercise prescription application as a platform for exercise professionals to remotely deliver and monitor an individually-tailored, home-based multi-component exercise program (delivered through tablet computers) to older adults living independently in the community. METHODS This was an 8-week, prospective single-arm pilot study in 20 adults aged ≥65 years living independently in the community [10 who owned a tablet computer (tablet owners) and 10 who did not (tablet non-owners)]. All participants were prescribed a home-based, muscle strengthening, weight-bearing impact and challenging balance/mobility program (3 days/week) using a commercial exercise prescription application (app) on a tablet computer. Study endpoints were feasibility (retention, adherence, adverse events), usability (System Usability Scale), physical activity enjoyment (Physical Activity Enjoyment Scale), changes in lower extremity function [Short Physical Performance Battery (SPPB)], and level of physical activity (questionnaire). Process measures related to participants’ experiences and perceptions of the exercise program and online application were also included. RESULTS A total of 19 participants (mean age 70 years) completed the study (19 of 20, 95%) and mean adherence to the exercise program was 84% (95% CI, 70, 97). There were two minor adverse events in two participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes [(95% CI, 0, 156), P=.049] and moderate-vigorous physical activity time by 41 minutes [(95% CI, -8, 90), P=.09]. For SPPB scores, there was a 0.3 point [(95% CI, -0.1, 0.7), P=.17] modest sized (effect size, d=0.42) improvement after 8 weeks. Mean system usability was high (mean  SD, 86  10 with 100 best imaginable]. There was no change in overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the online exercise app and the exercise program (median score 4 on a 5-point Likert scale). For all measures, there were no differences between previous tablet owners and non-owners. CONCLUSIONS This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multi-component exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app.