Feasibility of home-based exercise with tablet and sensor: pilot study

Rationale: 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 sensor 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 sensor has been used and tested in previous studies approved by the Medical Ethical Committee of the UMCG (METc 2010.111; METc 201.022; METc 2011.054). 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 sensor for older adults.



Objectives: 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 necklace-worn motion sensor (Mobility Monitor), and use of a tablet solution (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.



Study design: Prospective cohort study.




Study population: Forty-eight transitionally frail, independently living older adults (70-85 years).



Intervention: A home-based physical activity intervention including exercise instructions by means of an I-pad and monitoring by means of a necklace-worn motion sensor (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), 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).



Main study parameters/endpoints:

Feasibility




Nature and extent of the burden and risks associated with participation, benefit and group relatedness: 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 sensor causes no additional risks.

Use of exercise instructions by means of a tablet and monitoring by means of a necklace-worn motion sensor is beneficial for adherence in home-based exercise programs for older adults.

Feasibility will be assessed at 3 and 6 months into the intervention.



Daily activity and physical parameters will be assessed at 0, 3 and 6 months into the intervention.

A home-based physical activity intervention including exercise instructions by means of a tablet and monitoring by means of a necklace-worn motion sensor (Mobility Monitor). By means of the tablet 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 a tablet 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 tablet. Participants will be exercising at home for 6 months (3 months intervention and 3 months follow-up), 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).