Feasibility of a home-based physical activity program for older adults including exercise instructions by means of an I-Pad and monitoring by means of a necklace-worn motion sensor: a pilot study

The number of older people in our society is rising. In general, older adults
are more prone to chronic disease and compromised physical functioning, which
can lower their daily functioning and quality of life. Physical activity is
promising in health promotion. Home-based physical activity programs can
potentially be helpful in retaining daily functioning in older adults, reducing
fall risk and improving daily activity and quality of life. However, daily
physical activity and adherence in home-based exercise programs is generally
low. This compromises effectivity of home-based exercise programs in older
adults.
Current developments in technology can assist in providing and optimizing
home-based physical activity programs. Sensor technology combined with computer
technology creates possibilities to remotely monitor and influence daily
physical activity behavior in real life. A recent development in objective
ambulant activity monitoring is a necklace-worn motion sensor (the Mobility
Monitor). This Mobility Monitor can be used to measure daily physical activity
by detecting and monitoring postures and walking. This information can be used
in interventions aimed at enhancing daily activity and functioning in older
adults. The Mobility Monitor has been used and tested in previous studies
approved by the Medical Ethical Committee of the UMCG. The next step is to
determine the feasibility of a home-based exercise program including exercise
instructions by means of an I-Pad and monitoring by means of the Mobility
Monitor for older adults.

The aim of this pilot study is to demonstrate the feasibility of an
individualized home-based physical activity program including exercise
instructions by means of an I-Pad and monitoring by means of a necklace-worn
motion sensor (Mobility Monitor) for older adults. An additional aim is to get
a first impression on effectiveness of the program.

Primary research question is:
1. Is it feasible to perform a home-based exercise program including exercise
instructions by means of an I-Pad and monitoring by means of a necklace-worn
motion sensor (Mobility Monitor)?

Secondary research question is:
2. Does participation in a home-based exercise program (including the
application of the Mobility Monitor and an I-pad) improve the daily amount of
physical activity, measured both objective and self-reported?

In addition to answering these primary and secondary research questions, we aim
to collect user opinions on the home-based exercise program, exercise
instructions, monitoring by means of the Mobility Monitor, and use of the
I-Pad. It is expected that collecting user opinions will be helpful in
re-designing and improving the exercise program (including technology) for
later interventions.

Prospective cohort design.

A home-based physical activity intervention including exercise instructions by
means of an I-pad and monitoring by means of the Mobility Monitor. By means of
the I-Pad and Mobility Monitor information will be gathered with respect to
adherence to the program and physical activity behavior. Exercise routines will
be provided by means of an I-pad showing videos of the exercises. Feedback on
completion of the exercises as well as on daily activity will be provided by
means of automatic text- and visual feedback on the I-pad. Participants will be
exercising at home for 6 months (3 months intervention and 3 months follow-up)
and 5 times a week. The exercise program will be an individually tailored
program based on the Otago Kitchen Table exercise program. This program is
extensively tested and generally accepted in literature. Progression through
the levels in the exercise program will be individual and in consultation with
a coach through weekly telephone contact.
Measurement appointments will be at pre-, post- and follow-up (0, 3 and 6
months).

The intervention consists of a home-based physical activity intervention of 3
months with 3 months follow-up. The exercise program is based on the Otago
Kitchen Table exercise program. This program is promoted as one of the most
tested (4 randomized controlled trials and 1 controlled multi-center trial)
fall prevention programs by the Centers for Disease Control and Prevention
(Centers for Disease Control and Prevention
(http://www.cdc.gov/HomeandRecreationalSafety/Falls/compendium/1.2_otago.html).
The program is used worldwide. The program is an individually tailored program
of muscle strengthening and balance-retraining exercises of increasing
intensity, Overall, the fall rate was reduced by 35 percent among program
participants compared with those who did not take part.
Subjects are asked to perform 5 exercise sessions each week. It is possible to
progress in intensity during the program. Progression is initiated by the
subject. Safety is ensured by personal tailoring of the exercise intensity,
exercises that are based on functional every-day movements and weekly telephone
contact with the coach. At baseline, after 3 months and after 6 months several
questionnaires are completed. During the 6-month intervention, subjects wear
the Mobility Monitor during daytime. Wearing the Mobility Monitor causes no
additional risks.