%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54629 %T Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults %A Arader,Lindsay %A Miller,Danielle %A Perrin,Alexandra %A Vicari,Frank %A Friel,Ciaran P %A Vrany,Elizabeth A %A Goodwin,Ashley M %A Butler,Mark %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 1983 Marcus Ave, Suite C102, New Hyde Park, NY, 11042, United States, 1 9084140238, markbutler@northwell.edu %K older adults %K personalized %K digital %K clinical trial %K remote %K physical activity %K back pain %K pain %K COVID-19 %K clinical trials %K pandemic %K chronic health %K digital intervention %K Fitbits %K Fitbit %K wearable %K wearables %K exercise %K gerontology %K geriatric %K geriatrics %K old %K older %K older people %K aging %K aged %K mobile phone %D 2025 %7 16.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults’ increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. Objective: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). Methods: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. Results: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials’ digital systems including SMS text message interventions and surveys (≥62% satisfied) and the use of wearable devices such as Fitbits (≥81% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. Conclusions: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics. %M 40239192 %R 10.2196/54629 %U https://www.jmir.org/2025/1/e54629 %U https://doi.org/10.2196/54629 %U http://www.ncbi.nlm.nih.gov/pubmed/40239192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59507 %T Wearable Activity Tracker–Based Interventions for Physical Activity, Body Composition, and Physical Function Among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Li,Ran %A Li,Yangan %A Wang,Lu %A Li,Lijuan %A Fu,Chenying %A Hu,Danrong %A Wei,Quan %+ Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China, 86 18980606730, weiquan@scu.edu.cn %K wearable activity tracker %K physical activity %K older adult %K systematic review %K meta-analysis %D 2025 %7 3.4.2025 %9 Review %J J Med Internet Res %G English %X Background: The global aging population faces great challenges. Wearable activity trackers have emerged as tools to promote physical activity among older adults, potentially improving health outcomes. However, the effectiveness of such interventions on physical activity, body composition, and physical function among community-dwelling older adults remains debated. Objective: This study conducted a systematic review and meta-analysis to evaluate the impact of wearable activity tracker–based interventions on physical activity, body composition, and physical function among community-dwelling older adults. Methods: We searched the PubMed, Embase, Web of Science, and CENTRAL databases from inception until January 2025 to identify related randomized controlled trials. The outcomes were focused on physical activity (physical activity time, daily step count, and daily sedentary time); body composition (BMI and body fat); and physical function (timed up and go test and chair stand test). Subgroup analysis by different controls (usual care or conventional interventions) and different follow-ups (immediate or short term) were performed. Results: In total 23 trials with 4566 participants were eligible for analysis. Compared to usual care, there was lo- to moderate-certainty evidence that the wearable activity tracker–based interventions significantly increased physical activity time (standardized mean difference [SMD]=0.28, 95% CI 0.10-0.47; P=.003) and daily step counts (SMD=0.58, 95% CI 0.33-0.83; P<.001) immediately after intervention, while no significant improvements were observed in daily sedentary time (mean difference [MD]=−1.56, 95% CI −10.88 to 7.76; I2=0%; P=.74). These interventions were at least as effective as conventional interventions but did not show superiority. Compared with usual care, the interventions using wearable activity trackers only demonstrated a notable increase in daily step count over short-term follow-up (SMD=0.23, 95% CI 0.11-0.36; P<.001). As for body composition and physical function, there was low- to moderate-certainty evidence that the wearable activity tracker–based interventions did not have a greater impact on BMI (MD=0.40, 95% CI −0.08 to 0.89; P=.11), body fat (MD=0.67, 95% CI −0.54 to 1.87; P=.28), the timed up and go test (MD=0.14, 95% CI −0.87 to 1.16; P=.78), or the chair stand test (SMD=−0.31, 95% CI −0.62 to 0; P=.05). Conclusions: This systematic review and meta-analysis indicate that wearable activity tracker–based interventions were effective in enhancing physical activity with low to moderate certainty, but did not significantly impact body composition or physical function, with low to moderate certainty, among community-dwelling older adults, particularly immediately after intervention. This intervention showed a more pronounced impact when compared to usual care, rather than to conventional interventions, with low to moderate certainty. It is important to note that this intervention showed moderate-certainty evidence toward improving daily step count, supporting its sustained impact during short-term follow-up. Trial Registration: PROSPERO CRD42024516900; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024516900 %M 40179387 %R 10.2196/59507 %U https://www.jmir.org/2025/1/e59507 %U https://doi.org/10.2196/59507 %U http://www.ncbi.nlm.nih.gov/pubmed/40179387 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66473 %T Older Adults’ Perspectives on Participating in a Synchronous Online Exercise Program: Qualitative Study %A Coletta,Giulia %A Noguchi,Kenneth S %A Beaudoin,Kayla %A McQuarrie,Angelica %A Tang,Ada %A Ganann,Rebecca %A Phillips,Stuart M %A Griffin,Meridith %K exercise %K older adults %K qualitative study %K qualitative %K experience %K attitude %K opinion %K perception %K perspective %K interview %K internet %K kinesiology %K physiotherapy %K synchronous %K online %K home-based %K gerontology %K geriatric %K older %K aging %K physical activity %D 2025 %7 3.4.2025 %9 %J JMIR Aging %G English %X Background: Older adults face several barriers to exercise participation, including transportation, lack of access, and poor weather conditions. Such barriers may influence whether older adults meet the Canadian 24-Hour Movement Guidelines. Recently, older adults have adopted technology for health care and are increasingly using digital health technologies to improve their access to care. Therefore, technology may be a valuable tool to reduce barriers to exercise and increase exercise participation rates within this population. Objective: This study aimed to explore older adults’ perceptions and experiences of exercise, in general, and specifically related to our synchronous online exercise program for community-dwelling older adults. Methods: A total of 3 registered kinesiologists and 1 physiotherapist with experience working with older adults delivered an 8-week, thrice-weekly synchronous online group-based exercise program for older adults in 3 cohorts. The program focused on strength, balance, and aerobic activity. Following the program, a qualitative study with interpretive descriptive design was conducted to explore participants’ perceptions and experiences. Participants were invited to take part in a 30-minute, one-on-one semistructured interview via Zoom with a research team member. Interview data were thematically analyzed to identify common themes. Results: A total of 22 older adults (16 women, 6 men; mean age 70, SD 4 years) participated in interviews. Three themes were identified as follows: (1) health, exercise, and aging beliefs; (2) the pandemic interruption and impacts; and (3) synchronous online exercise programs attenuate barriers to exercise. Participants discussed their exercise beliefs and behaviors and their desire to safely and correctly participate in exercise. Older adults found that their physical activity was curtailed, routines disrupted, and access to in-person exercise programs revoked due to the pandemic. However, many suggested that our synchronous online exercise program was motivational and attenuated commonly reported environmental barriers to participation, such as transportation concerns (eg, time spent traveling, driving, and parking), accessibility and convenience by participating at a location of their choice, and removing travel-related concerns during poor weather conditions. Conclusions: Given these reported experiences, we posit that synchronous online exercise programs may help motivate and maintain adherence to exercise programs for older adults. These findings may be leveraged to improve health outcomes in community-dwelling older adults. Trial Registration: ClinicalTrials.gov NCT04627493; https://clinicaltrials.gov/study/NCT04627493 %R 10.2196/66473 %U https://aging.jmir.org/2025/1/e66473 %U https://doi.org/10.2196/66473 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e68242 %T Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study %A Pereira,Ana P %A Janela,Dora %A Areias,Anabela C %A Molinos,Maria %A Tong,Xin %A Bento,Virgílio %A Yanamadala,Vijay %A Atherton,Jennesa %A Dias Correia,Fernando %A Costa,Fabíola %K women's health %K pelvic floor muscle training %K physical therapy %K menopause %K digital therapeutics %K biofeedback %K mobile phone %D 2025 %7 2.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ∼40%‐50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire–short form 7, Urinary Impact Questionnaire–short form 7, Colorectal-Anal Impact Questionnaire–short form 7, and Pelvic Organ Prolapse Impact Questionnaire–short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants’ daily lives decreased significantly (−19.55 points, 95% CI −22.22 to −16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (−18.09, 95% CI −19.99 to −16.20 and −15.08, 95% CI −17.52 to −12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms’ burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 %R 10.2196/68242 %U https://mhealth.jmir.org/2025/1/e68242 %U https://doi.org/10.2196/68242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e73174 %T Authors’ Reply: Balancing Challenges and Opportunities When Evaluating Remote Rehabilitation for Sarcopenia in Older Adults %A Zhang,Lu %A Ge,Ying %A Zhao,Wowa %A Shu,Xuan %A Kang,Lin %A Wang,Qiumei %A Liu,Ying %+ Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuai Fu Yuan Hutong, Dongcheng District, Beijing, 100730, China, 86 18612671468, pumch9887@163.com %K telerehabilitation %K elderly %K sarcopenia %K resistance exercise %K rehabilitation %K gerontology %K aging %K randomized controlled trial %K rehabilitation training %K body composition %K strength %K balance %K cardiorespiratory endurance %K self-care %K physical therapy %D 2025 %7 1.4.2025 %9 Authors' Reply %J J Med Internet Res %G English %X %M 40168657 %R 10.2196/73174 %U https://www.jmir.org/2025/1/e73174 %U https://doi.org/10.2196/73174 %U http://www.ncbi.nlm.nih.gov/pubmed/40168657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e71845 %T Balancing Challenges and Opportunities When Evaluating Remote Rehabilitation for Sarcopenia in Older Adults %A Zhang,Hao %A Liu,Xiangjie %+ Department of Geriatrics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, liuxiangjie1968@126.com, Wuhan, 430077, China, 86 15207461880, liuxiangjie1968@126.com %K telerehabilitation %K elderly %K sarcopenia %K resistance exercise %K rehabilitation %K gerontology %K aging %K randomized controlled trial %K rehabilitation training %K body composition %K strength %K balance %K cardiorespiratory endurance %K self-care %K physical therapy %D 2025 %7 1.4.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40168660 %R 10.2196/71845 %U https://www.jmir.org/2025/1/e71845 %U https://doi.org/10.2196/71845 %U http://www.ncbi.nlm.nih.gov/pubmed/40168660 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67539 %T Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial %A Pettersson,Beatrice %A Lundin-Olsson,Lillemor %A Skelton,Dawn A %A Liv,Per %A Zingmark,Magnus %A Rosendahl,Erik %A Sandlund,Marlene %+ , Department of Community Medicine and Rehabilitation, Umeå University, Universitetstorget 4, Umeå, 90187, Sweden, 46 907865224, beatrice.pettersson@umu.se %K geriatric medicine %K aging %K accidental falls %K independent living %K exercise therapy %K fall prevention %K electronic health %K mobile health %K preventive medicine %K self-management %K effectiveness %K randomized controlled trial %K older adults %K digital technology %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population. Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program. Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively. Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population. Trial Registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-036194 %M 40163860 %R 10.2196/67539 %U https://www.jmir.org/2025/1/e67539 %U https://doi.org/10.2196/67539 %U http://www.ncbi.nlm.nih.gov/pubmed/40163860 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72565 %T Authors’ Reply: Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge %A Kannan,Lakshmi %A Bhatt,Tanvi %+ Department of Physical Therapy, University of Illinois Chicago, 1919 W Taylor Street, Room 415, Chicago, IL, 60612, United States, 1 3123554443, tbhatt6@uic.edu %K exergame training %K Matter of Balance %K MOB %K pre-frail %K tele-exergame %K tele-rehabilitation %K gaming-based %K tele-exercise %K physical function %K frailty %K older adults %K aging %K physical activity %K dementia %K CogXergaming %K telehealth %K dynamic balance %D 2025 %7 28.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40153783 %R 10.2196/72565 %U https://www.jmir.org/2025/1/e72565 %U https://doi.org/10.2196/72565 %U http://www.ncbi.nlm.nih.gov/pubmed/40153783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69482 %T Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge %A Xie,Su-hang %+ Department of Rehabilitation Medicine, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, Beijing, 100853, China, 86 13041075258, hxkfxsh@163.com %K exergame training %K Matter of Balance %K MOB %K pre-frail %K tele-exergame %K tele-rehabilitation %K gaming-based %K tele-exercise %K physical function %K frailty %K older adults %K aging %K physical activity %K dementia %K CogXergaming %K telehealth %K dynamic balance %D 2025 %7 28.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40153778 %R 10.2196/69482 %U https://www.jmir.org/2025/1/e69482 %U https://doi.org/10.2196/69482 %U http://www.ncbi.nlm.nih.gov/pubmed/40153778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57537 %T Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial %A Tandon,Puneeta %A Ismond,Kathleen P %A Purdy,Graeme %A Cruz,Christofer %A Etruw,Evelyn %A Suderman,Kirsten %A Hyde,Ashley %A Stickland,Michael %A Spence,John C %A Lien,Dale C %A Bhanji,Rahima %A Prado,Carla M %A Miguel-Cruz,Antonio %A Joy,Anil A %A Yaskina,Maryna %A McNeely,Margaret L %+ Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 8540 112 Street, Edmonton, AB, T6G2X8, Canada, 1 7804929844, ptandon@ualberta.ca %K eHealth %K patient-centered care %K adults %K geriatrics %K self-management %K web-based %K nutrition %K exercise rehabilitation %K wearable %K activity tracker %K quality of life %K physical health %K 2-minute step test %K patients with cancer %K chronic diseases %K COVID-19 %K randomized controlled trial %K acceptability %K effectiveness %K intervention %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist–led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4%; cancer: 126/202, 62.4%). Adherence exceeded a priori targets, with 82% (105/128) attending >75% of the program elements including postintervention tests. Participants rated the program as “quite a bit” or “very” useful, with similar ratings between Heal-Me Light (56/64, 88%) and Heal-Me Intensive (51/58, 88%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 %M 40126542 %R 10.2196/57537 %U https://www.jmir.org/2025/1/e57537 %U https://doi.org/10.2196/57537 %U http://www.ncbi.nlm.nih.gov/pubmed/40126542 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67322 %T A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study %A Böttinger,Melissa Johanna %A Mellone,Sabato %A Klenk,Jochen %A Jansen,Carl-Philipp %A Stefanakis,Marios %A Litz,Elena %A Bredenbrock,Anastasia %A Fischer,Jan-Philipp %A Bauer,Jürgen M %A Becker,Clemens %A Gordt-Oesterwind,Katharina %K timed up and go test %K self-assessment %K instrumented assessment %K technology-based assess-ment %K physical capacity %K mobility %K aged %K mobile applications %K smartphone %K diagnostic self evaluation %D 2025 %7 21.3.2025 %9 %J JMIR Aging %G English %X Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment “up&go app.” Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the “up&go app” algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the “up&go app” in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the “up&go app” measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the “up&go app” and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84‐0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92‐0.97). Test-retest agreement had an ICC=0.79 (0.53‐0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn “up&go app,” was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The “up&go app” provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. %R 10.2196/67322 %U https://aging.jmir.org/2025/1/e67322 %U https://doi.org/10.2196/67322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66294 %T Digital Physical Activity and Sedentary Behavior Interventions for Community-Living Adults: Umbrella Review %A Russell,Eilidh %A Kirk,Alison %A Dunlop,Mark D %A Hodgson,William %A Patience,Mhairi %A Egan,Kieren %+ , Department of Computer and Information Sciences, University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 01415524400, eilidh.russell.2017@uni.strath.ac.uk %K physical activity %K sedentary behavior %K digital health interventions %K behavior change %K theoretical frameworks %K umbrella review %K mobile phone %K community-living adults %D 2025 %7 18.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions hold significant potential for improving physical activity (PA) and reducing sedentary behavior (SB) in adults. Despite increasing interest, there remain surprising gaps in the current knowledge of how best to deliver these interventions, including incorporating appropriate theoretical frameworks and behavior change techniques. Following numerous systematic reviews, there is now significant potential for umbrella reviews to provide an overview of the current evidence. Objective: This umbrella review aimed to explore digital PA and SB interventions for community-living adults across effectiveness, key components, and methodological quality. Methods: This review followed the Joanna Briggs Institute framework for umbrella reviews. Key search terms were developed iteratively, incorporating physical and sedentary activity alongside digital interventions. We searched 7 online databases (Web of Science Core Collection, CINAHL, APA PsycINFO, Inspec, the Cochrane Library, MEDLINE [Ovid], and PROSPERO) alongside gray literature databases. Information was extracted and tabulated from each included article on intervention effectiveness, key components, and content acknowledging both the digital and human elements. The study quality was appraised using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). The corrected covered area method was used to assess the overlap of primary studies included in the systematic reviews. All relevant research findings were extracted and reported. Results: Search terms identified 330 articles, of which 5 (1.5%) met the inclusion criteria. The most common PA outcomes identified were daily steps, moderate-to-vigorous PA, total PA, and PA change. Reviews with meta-analysis reported that digital interventions improved multiple PA outcomes (daily steps, moderate-to-vigorous PA time, and total PA time). However, findings from the remaining systematic reviews were mixed. Similarly, the findings for SB were contrasting. Regarding intervention components, monitor- and sensor-only intervention delivery methods were most frequently implemented. Eleven theoretical frameworks were identified, with social cognitive theory being the most prominent theory. In total, 28 different behavior change techniques were reported, with goal setting, self-monitoring, feedback, and social support being the most frequently used. All 5 systematic reviews were of low or critically low quality, each incorporating unique primary studies (corrected covered area=0%). Conclusions: This umbrella review highlights the potential of digital interventions to increase PA and reduce SB among community-living adults. However, the disparate nature of current academic knowledge means potentially efficacious research may not realistically translate to real work impact. Our review identified a lack of consensus around outcomes and components at both individual (eg, difficult to collate and compare findings) and multiple study (poor reported quality of systematic reviews) levels. Collective, concerted action is required to standardize outcomes and improve systematic review reporting to optimize future learning around digital interventions to increase PA and reduce SB in community-living adults, including traditionally overlooked populations, like informal carers. Trial Registration: PROSPERO CRD42023450773; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023450773 %M 40100250 %R 10.2196/66294 %U https://www.jmir.org/2025/1/e66294 %U https://doi.org/10.2196/66294 %U http://www.ncbi.nlm.nih.gov/pubmed/40100250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67406 %T Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study %A Moran,Ryan %A Wing,David %A Davey,Hope %A Barkai,Hava %A Nichols,Jeanne %K digital health %K fall prevention %K fall risk %K older adults %K geriatrics %K system usability scale %K Strong Foundations %K feasibility %K public health %K user acceptance %K exercise %K usability %K digital technology %K mobile phone %D 2025 %7 28.2.2025 %9 %J JMIR Form Res %G English %X Background: Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility. Objective: This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance. Methods: The “Strong Foundations” program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention’s (CDC’s) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021. Results: A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands. Conclusion: There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk. %R 10.2196/67406 %U https://formative.jmir.org/2025/1/e67406 %U https://doi.org/10.2196/67406 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e68957 %T Building Strong Foundations: Nonrandomized Interventional Study of a Novel, Digitally Delivered Fall Prevention Program for Older Adults %A Wing,David %A Nichols,Jeanne F %A Barkai,Hava Shoshana %A Culbert,Olivia %A Moreno,Daniel %A Higgins,Michael %A O'Brien,Anna %A Perez,Mariana %A Davey,Hope %A Moran,Ryan %+ , Exercise and Physical Activity Resource Center, University of California, San Diego, 9500 Gilman Drive #0811, CALIT2/Atkinson Hall Room 3504, San Diego, CA, 92093, United States, 1 858 534 9315, dwing@eng.ucsd.edu %K exercise %K older adults %K digital intervention %K Zoom %K balance %K posture %K strength %K fall prevention %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Injuries from falls are a major concern among older adults. Targeted exercise has been shown to improve fall risk, and recommendations for identifying and referring older adults for exercise-based interventions exist. However, even when very inexpensive or free, many do not use available fall prevention programs, citing barriers related to convenience and safety. These issues are even greater among older adults residing in rural areas where facilities are less abundant. These realities highlight the need for different approaches to reducing falls in novel ways that increase reach and are safe and effective. Web-based delivery of exercise interventions offers some exciting and enticing prospects. Objective: Our objective was to assess the efficacy of the Strong Foundations exercise program to change markers of physical function, posture, balance, strength, and fall risk. Methods: Strong Foundations is a once weekly (60 minutes), 12-week iterative program with 3 core components: postural alignment and control, balance and mobility, and muscular strength and power. We used a quasi-experimental design to determine changes in physical function specific to balance, postural control, and muscular strength among older adults at low or moderate risk of falling. Results: A total of 55 low-risk and 37 moderate-risk participants were recruited. Participants significantly improved on the 30-second Chair Stand (mean change of 1, SD 3.3 repetitions; P=.006) and Timed Up and Go (mean change of 0.2, SD 0.7 seconds; P=.004), with the moderate-risk group generally improving to a greater degree than the low-risk group. Additionally, Short Physical Performance Battery performance improved significantly in the moderate-risk category (P=.02). The majority of postural measures showed statistically significant improvement for both groups (P<.05). Measures of “relaxed” posture showed improvements between 6% and 27%. When an “as tall as possible” posture was adopted, improvements were ~36%. Conclusions: In this 12-week, iterative, web-based program, we found older adults experienced improvement not only in measures used in clinical contexts, such as the 30-second Chair Stand and Timed Up and Go, but also contextualized gains by providing deeper phenotypical measurement related to posture, strength, and balance. Further, many of the physical improvements were attenuated by baseline fall risk level, with those with the highest level of risk having the greater gains, and, thus, the most benefit from such interventions. %M 40009847 %R 10.2196/68957 %U https://aging.jmir.org/2025/1/e68957 %U https://doi.org/10.2196/68957 %U http://www.ncbi.nlm.nih.gov/pubmed/40009847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69109 %T Evaluating the Clinical Efficacy of an Exergame-Based Training Program for Enhancing Physical and Cognitive Functions in Older Adults With Mild Cognitive Impairment and Dementia Residing in Rural Long-Term Care Facilities: Randomized Controlled Trial %A Li,Aoyu %A Qiang,Wei %A Li,Jingwen %A Geng,Yan %A Qiang,Yan %A Zhao,Juanjuan %+ School of Software, Taiyuan University of Technology, No. 319, University Street, Yuji District, Jingzhong, 030600, China, 86 18636664123, zhaojuanjuan@tyut.edu.cn %K exergame %K mild cognitive impairment %K dementia %K long-term care facilities %K multicomponent training %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence is higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, older adults often lose interest in repetitive interventions. The exergame “WarioWare: Move It!” (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive experience. Objective: This study aimed to assess the clinical efficacy of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults living in LTCFs. Methods: The training program was conducted across multiple rural LTCFs in Shanxi Province, China. Participants were randomly assigned to the intervention or control group. The intervention protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures with Joy-Con controllers. Primary outcome measures were derived through clinical tests, including the sit and reach test, shoulder flexibility test, trunk rotation flexibility test, shoulder and elbow range of motion, figure-of-8 walk test, standing balance test, hand dexterity test, and cognitive function tests. Statistical analysis was performed using mixed ANOVA, with time as the within-participant factor and intervention group as the between-participant factor, to assess the training effects on the various outcome measures. Results: A total of 232 participants were recruited, including 32 (13.8%) patients with mild dementia, 18 (7.8%) with moderate dementia, and 182 (78.4%) with mild cognitive impairment, all of whom completed the study. The mixed ANOVA revealed significant group × time interactions across multiple physical flexibility assessments, including the remaining distance between the hands and toes during the forward bend (F2,156=8.484; P<.001; η²=0.098), the distance between the hands clasped behind the back (F2,156=3.666; P=.04; η²=0.045), and the angle formed by trunk rotation to the left and right (F2,156=17.353; P<.001; η²=0.182). Significant group × time interactions also emerged for shoulder joint forward flexion (F2,156=17.655; P<.001; η²=0.185), abduction (F2,156=6.281; P=.004; η²=0.075), and elbow flexion (F2,156=3.298; P=.049; η²=0.041). In addition, the time to complete the figure-of-8 walk test (F2,156=11.846; P<.001; η²=0.132) and the number of blocks moved within 1 minute (F2,156=4.016; P=.02; η²=0.049) showed significant interactions. Finally, all scale-based measures exhibited statistically significant group × time interactions (all P values <.001). Conclusions: The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting the health of older adults in resource-limited settings, demonstrating its potential for widespread application in diverse low-resource environments. Trial Registration: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971 %M 39969990 %R 10.2196/69109 %U https://www.jmir.org/2025/1/e69109 %U https://doi.org/10.2196/69109 %U http://www.ncbi.nlm.nih.gov/pubmed/39969990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54392 %T Web-Based Exercise and Nutrition Intervention to Improve Leg Muscle Strength and Physical Functioning in Older Adults: Pre-Post Pilot Study %A Dorhout,Berber Gijsbertha %A Wezenbeek,Nick %A de Groot,Lisette C P G M %A Grootswagers,Pol %K web-based lifestyle intervention %K resistance exercise %K protein intake %K muscle strength %K muscle mass %K older adults %K web-based exercise %K nutrition %K exercise %K resistance training %K sarcopenia %D 2025 %7 30.1.2025 %9 %J JMIR Form Res %G English %X Background: The lifestyle intervention ProMuscle, which combines resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass, and physical functioning in older adults. However, due to a growing shortage of health care professionals, the rapidly growing aging population cannot be personally guided in the future. Therefore, Uni2Move, a scalable web-based variant of ProMuscle, was designed to reach larger groups of older adults without putting additional burden on health care professionals. Objective: The current study investigated the effects of a web-based lifestyle intervention on muscle strength, protein intake, and physical functioning in healthy older adults. In addition, we conducted a qualitative study to gather key insights of the participants involved, as little is known about older adults’ perceptions of web-based lifestyle interventions. Methods: A pre-post pilot study was conducted in the Netherlands. In the 24-week intervention, 19 healthy adults aged >55 years were included. They performed resistance training at home twice a week for 24 weeks via web-based workout videos. Videos (45‐60 minutes) were recorded by the fitness trainer and mainly focused on training leg muscles. In addition, older adults were advised on increasing protein intake via two web-based consultations by a dietitian in the first 12 weeks and via an e-learning course in the second 12 weeks. Intervention adherence and acceptance was measured in week 25. The 1 repetition maximum knee extension strength, repeated chair rise test, and protein intake were measured at baseline, week 13, and week 25. Linear mixed models were used to test differences over time. Semistructured interviews were used to gather experiences of participants. Atlas.ti version 22 was used to analyze the interviews. Results: The mean age of participants (n=19) at baseline was 69 (SD 7) years. The 1 repetition maximum knee extension strength and repeated chair rise test improved significantly during the 24-week intervention with a mean difference of 7.0 kg (95% CI 4.8-9.3; P<.001) and −1.2 seconds (95% CI −1.7 to −0.6; P<.001), respectively. Total protein intake per day did not change, whereas protein intake during breakfast had increased significantly after 13 weeks with a mean difference of 6.9 g (95% CI 1.1-12.7; P=.01). Qualitative research revealed that advantages of the program included no need to travel and exercising in their own environment. Disadvantages were the lack of physical interaction and no corrections by the trainer. Conclusions: The results of the web-based exercise and nutrition intervention Uni2Move indicate potential improvements of muscle strength and physical functioning in healthy middle-aged and older adults. Providing such lifestyle interventions on the internet could reach an increased number of older adults, providing the opportunity to contribute to the health and independence of the rapidly growing aging population. %R 10.2196/54392 %U https://formative.jmir.org/2025/1/e54392 %U https://doi.org/10.2196/54392 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67846 %T A 4-Week Mobile App–Based Telerehabilitation Program vs Conventional In-Person Rehabilitation in Older Adults With Sarcopenia: Randomized Controlled Trial %A Zhang,Lu %A Ge,Ying %A Zhao,Wowa %A Shu,Xuan %A Kang,Lin %A Wang,Qiumei %A Liu,Ying %+ Department of Rehabilitation Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuai Fu Yuan Hutong, Dongcheng District, Beijing, 100730, China, 86 18612671468, pumch9887@163.com %K telerehabilitation %K elderly %K sarcopenia %K resistance exercise %K rehabilitation %K gerontology %K aging %K randomized controlled trial %K rehabilitation training %K body composition %K strength %K balance %K cardiorespiratory endurance %K self-care %K physical therapy %D 2025 %7 24.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sarcopenia is closely associated with a poor quality of life and mortality, and its prevention and treatment represent a critical area of research. Resistance training is an effective treatment for older adults with sarcopenia. However, they often face challenges when receiving traditional rehabilitation treatments at hospitals. Objective: We aimed to compare the effects of a digital rehabilitation program with those of traditional therapist-supervised rehabilitation training on older adults with sarcopenia. Methods: In total, 58 older adults with sarcopenia were recruited offline and randomized (1:1) into 2 groups: the telerehabilitation group (TRG, n=29, 50%) and the in-person rehabilitation group (IRG, n=29, 50%). Both groups underwent 4-week resistance training targeting 6 major muscle groups. The TRG received exercise guidance via a mobile app, while the IRG received in-person training from a therapist. Offline assessments of body composition, grip strength, and balance using the 30-Second Arm Curl Test (30SACT), 30-Second Sitting-to-Rising Test (30SSRT), quadriceps femoris extension peak torque (EPT) and extension total power (ETP), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), 6-Minute Walk Test (6MWT), and Instrumental Activities of Daily Living (IADL) scale, were conducted before and after the intervention. Results: Of the 58 patients, 51 (88%; TRG: n=24, 47%; IRG: n=27, 53%) completed the trial. After 4 weeks of intervention, the mean grip strength increased from 18.10 (SD 5.56) to 19.92 (SD 5.90) kg in the TRG (P=.02) and from 18.59 (SD 5.95) to 19.59 (SD 6.11) kg in the IRG (P=.01). The 30SACT and 30SSRT scores increased from 12.48 (SD 2.68) to 14.94 (SD 3.68) times (P=.01) and from 15.16 (SD 7.23) to 16.58 (SD 8.42) times (P=.045), respectively, in the TRG and from 12.25 (SD 4.19) to 14.68 (SD 4.36) times (P=.003) and from 14.31 (SD 4.04) to 16.25 (SD 4.91) times (P=.01), respectively, in the IRG. The quadriceps femoris EPT increased from 26.19 (SD 10.26) to 35.00 (SD 13.74) Nm (P=.004) in the TRG and from 26.95 (SD 11.81) to 32.74 (SD 12.33) Nm (P=.003) in the IRG. The BBS scores significantly improved in both groups (P<.001), with the mean TRG score increasing by 3.19 (SD 2.86) points and the mean IRG score by 3.06 (SD 2.44) points. Neither group exhibited significant within-group changes on the TUGT or the 6MWT. Both groups reported significant improvements in the IADL (TRG: P=.04; IRG: P=.02). Between-group comparisons revealed no significant differences in changes in all indicators. Conclusions: A 4-week remote resistance training program is effective in improving strength, balance, and the IADL in older adults with sarcopenia, with effects comparable to rehabilitation supervised by a physical therapist. Telerehabilitation may be a convenient and effective alternative for older adults with sarcopenia who have limited access to rehabilitation resources. Trial Registration: ChiCTR 2300071648; https://www.chictr.org.cn/showprojEN.html?proj=196313 %M 39854716 %R 10.2196/67846 %U https://www.jmir.org/2025/1/e67846 %U https://doi.org/10.2196/67846 %U http://www.ncbi.nlm.nih.gov/pubmed/39854716 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e50669 %T The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study %A Chang,Chien-Hsiang %A Wei,Chun-Chun %A Lien,Wei-Chih %A Yang,Tai-Hua %A Liu,Bo %A Lin,Yimo %A Tan,Poh Thong %A Lin,Yang-Cheng %K frailty %K exergame %K older adults %K intelligent rehabilitation %K reminiscence therapy %K eHealth care %D 2025 %7 21.1.2025 %9 %J JMIR Serious Games %G English %X Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=−4.51; P<.001), learnability (t96=−4.83; P<.001), and confidence (t96=−2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post–COVID-19 era. %R 10.2196/50669 %U https://games.jmir.org/2025/1/e50669 %U https://doi.org/10.2196/50669 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63567 %T Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study %A Hultman,Lisa %A Eklund,Caroline %A von Heideken Wågert,Petra %A Söderlund,Anne %A Lindén,Maria %A Elfström,Magnus L %+ Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås/Eskilstuna, 721 23, Sweden, 46 21 48 06 901, lisa.hultman@mdu.se %K behavior change intervention %K adherence %K integrated behavior change model %K autonomous motivation %K affective determinants %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process. Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention. Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops. Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed. Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention. %M 39832361 %R 10.2196/63567 %U https://formative.jmir.org/2025/1/e63567 %U https://doi.org/10.2196/63567 %U http://www.ncbi.nlm.nih.gov/pubmed/39832361 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e56718 %T Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study %A Dunston,Emily R %A Oza,Sonal %A Bai,Yang %A Newton,Maria %A Podlog,Leslie %A Larson,Kish %A Walker,Darren %A Zingg,Rebecca W %A Hansen,Pamela A %A Coletta,Adriana M %K physical activity %K physical function %K telerehabilitation %K remote exercise %K digital health %K cancer survivors %K older adults %K smartphone %D 2025 %7 13.1.2025 %9 %J JMIR Cancer %G English %X Background: Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective: We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods: In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (≥65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results: Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65‐92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5%) and III (n=18, 26.5%) being the most common. A follow-up telehealth assessment was completed by 29.4% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions: Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings. %R 10.2196/56718 %U https://cancer.jmir.org/2025/1/e56718 %U https://doi.org/10.2196/56718 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e64564 %T Identifying Community-Built Environment’s Effect on Physical Activity and Depressive Symptoms Trajectories Among Middle-aged and Older Adults: Chinese National Longitudinal Study %A Zhang,Kaili %A Huang,Bowen %A Divigalpitiya,Prasanna %+ , Zigong Academy of Urban Planning and Design, Number 19, Donghuan Road, Bancang Street, High-Tech Zone, Zigong, Sichuan Province, 643031, China, 86 15882073304, jpby5223248@gmail.com %K community-built environment %K physical activity %K depressive symptom trajectories %K middle-aged and older adults %K latent growth curve modeling %K longitudinal study %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The effects of physical activity (PA) across different domains and intensities on depressive symptoms remain inconclusive. Incorporating the community-built environment (CBE) into longitudinal analyses of PA’s impact on depressive symptoms is crucial. Objective: This study aims to examine the effects of PA at different intensities—low-intensity PA (eg, walking activities) and moderate-to-vigorous-intensity PA (eg, activities requiring substantial effort and causing faster breathing or shortness of breath)—across leisure-time and occupational domains on depressive symptom trajectories among middle-aged and older adults. Additionally, it investigated how CBEs influence depressive symptoms and PA trajectories. Methods: This longitudinal study included 6865 middle-aged and older adults from the China Health and Retirement Longitudinal Survey. A CBE variable system was developed using a community questionnaire to assess attributes of the physical built environment. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Latent growth curve modeling was applied to analyze 3 waves of the cohort data (2015, 2018, and 2020) to explore the differential effects of PA on depressive symptoms and the role of the CBE. Results: In the 2015 and 2018 waves, higher low-intensity leisure-time physical activity (LTPA) was associated with lower depressive symptoms (β=–.025, P=.01 and β=–.027, P=.005, respectively). Across all waves, moderate-to-vigorous-intensity LTPA showed no significant predictive effects (P=.21 in 2015, P=.57 in 2018, and P=.85 in 2020, respectively). However, higher occupational physical activity (OPA), particularly at moderate-to-vigorous intensities, was consistently associated with higher depressive symptoms. Parallel process latent growth curve modeling revealed that the initial level of total LTPA negatively predicted the initial level of depressive symptoms (β=–.076, P=.01). OPA exhibited dual effects, positively predicting the initial level of depressive symptoms (β=.108, P<.001) but negatively predicting their upward trajectory (β=–.136, P=.009). Among CBE variables, better infrastructure conditions (β=–.082, P<.001) and greater accessibility to public facilities (β=–.036, P=.045) negatively predicted the initial level of depressive symptoms. However, greater accessibility to public facilities positively predicted the upward trajectory of depressive symptoms (β=.083, P=.04). Better infrastructure conditions (β=.100, P=.002) and greater accessibility to public transport (β=.060, P=.01) positively predicted the initial level of total LTPA. Meanwhile, better infrastructure conditions (β=–.281, P<.001) and greater accessibility to public facilities (β=–.073, P<.001) negatively predicted the initial level of total OPA. Better infrastructure conditions positively predicted the declining trajectory of total OPA (β=.100, P=.004). Conclusions: This study underscores the importance of considering the differential effects of PA across domains and intensities on depressive symptoms in public policies and guidelines. Given the influence of the environment on PA and depressive symptoms, targeted community measures should be implemented. %M 39804686 %R 10.2196/64564 %U https://publichealth.jmir.org/2025/1/e64564 %U https://doi.org/10.2196/64564 %U http://www.ncbi.nlm.nih.gov/pubmed/39804686 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64539 %T Effect of Physical Exercise on Telomere Length: Umbrella Review and Meta-Analysis %A Sánchez-González,Juan Luis %A Sánchez-Rodríguez,Juan Luis %A González-Sarmiento,Rogelio %A Navarro-López,Víctor %A Juárez-Vela,Raúl %A Pérez,Jesús %A Martín-Vallejo,Javier %K aging %K chromosome %K exercise %K meta-analysis %K telomere %K telomerase %K genes %K genome %K DNA %D 2025 %7 10.1.2025 %9 %J JMIR Aging %G English %X Background: Telomere length (TL) is a marker of cellular health and aging. Physical exercise has been associated with longer telomeres and, therefore, healthier aging. However, results supporting such effects vary across studies. Our aim was to synthesize existing evidence on the effect of different modalities and durations of physical exercise on TL. Objective: The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a virtual reality physical activity platform in a community organization. Methods: We performed an umbrella review and meta-analysis. Data sources included PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We selected systematic reviews and meta-analyses of randomized and nonrandomized controlled clinical trials evaluating the effect of physical exercise on TL. Results: Our literature search retrieved 12 eligible systematic reviews, 5 of which included meta-analyses. We identified 22 distinct primary studies to estimate the overall effect size of physical exercise on TL. The overall effect size was 0.28 (95% CI 0.118-0.439), with a heterogeneity test value Q of 43.08 (P=.003) and I² coefficient of 51%. The number of weeks of intervention explained part of this heterogeneity (Q_B=8.25; P=.004), with higher effect sizes found in studies with an intervention of less than 30 weeks. Exercise modality explained additional heterogeneity within this subgroup (Q_B=10.28, P=.02). The effect sizes were small for aerobic exercise and endurance training, and moderate for high-intensity interval training. Conclusions: Our umbrella review and meta-analysis detected a small-moderate positive effect of physical exercise on TL, which seems to be influenced by the duration and type of physical exercise. High quality studies looking into the impact of standardized, evidence-based physical exercise programs on TL are still warranted. Trial Registration: PROSPERO CRD42024500736; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=500736 %R 10.2196/64539 %U https://aging.jmir.org/2025/1/e64539 %U https://doi.org/10.2196/64539 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e65981 %T Efficacy of Unsupervised YouTube Dance Exercise for Patients With Hypertension: Randomized Controlled Trial %A Sakairi,Mizuki %A Miyagami,Taiju %A Tabata,Hiroki %A Yanagisawa,Naotake %A Saita,Mizue %A Suzuki,Mai %A Fujibayashi,Kazutoshi %A Fukuda,Hiroshi %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 338133111, tmiyaga@juntendo.ac.jp %K dance %K video %K exercise therapy %K hypertension %K blood pressure therapy %K YouTube %K mHealth %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: High blood pressure (BP) is linked to unhealthy lifestyles, and its treatment includes medications and exercise therapy. Many previous studies have evaluated the effects of exercise on BP improvement; however, exercise requires securing a location, time, and staff, which can be challenging in clinical settings. The antihypertensive effects of dance exercise for patients with hypertension have already been verified, and it has been found that adherence and dropout rates are better compared to other forms of exercise. If the burden of providing dance instruction is reduced, dance exercise will become a highly useful intervention for hypertension treatment. Objective: This study aims to investigate the effects of regular exercise therapy using dance videos on the BP of patients with hypertension, with the goal of providing a reference for prescribing exercise therapy that is highly feasible in clinical settings. Methods: This nonblind, double-arm, randomized controlled trial was conducted at Juntendo University, Tokyo, from April to December 2023. A total of 40 patients with hypertension were randomly assigned to either an intervention group (dance) or a control group (self-selected exercise), with each group comprising 20 participants. The intervention group performed daily dance exercises using street dance videos (10 min per video) uploaded to YouTube. The control group was instructed to choose any exercise other than dance and perform it for 10 minutes each day. The activity levels of the participants were monitored using a triaxial accelerometer. BP and body composition were measured on the day of participation and after 2 months. During the intervention period, we did not provide exercise instruction or supervise participants’ activities. Results: A total of 34 patients were included in the study (16 in the intervention group and 18 in the control group). The exclusion criteria were the absence of BP data, medication changes, or withdrawal from the study. The mean age was 56 (SD 9.8) years, and 18 (53%) of the patients were female. The mean BMI was 28.0 (SD 6.3) m/kg2, and systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 139.5 (SD 17.1) mm Hg and 85.8 (SD 9.1) mm Hg, respectively. The basic characteristics did not differ between the two groups. In the multivariate analysis, SBP and DBP improved significantly in the intervention group compared to the control group (mean SBP –12.8, SD 6.1 mm Hg; P=.047; mean DBP –9.7, SD 3.3 mm Hg; P=.006). Conclusions: This study evaluated the effects of dance exercise on patients with hypertension, as previously verified, under the additional condition of using dance videos without direct staff instruction or supervision. The results showed that dance videos were more effective in lowering BP than conventional exercise prescriptions. Trial Registration: University Hospital Medical Information Network UMIN 000051251; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058446 %M 39787590 %R 10.2196/65981 %U https://cardio.jmir.org/2025/1/e65981 %U https://doi.org/10.2196/65981 %U http://www.ncbi.nlm.nih.gov/pubmed/39787590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62910 %T Testing the Recruitment Frequency, Implementation Fidelity, and Feasibility of Outcomes of the Heart Failure Activity Coach Study (HEALTHY): Pilot Randomized Controlled Trial %A Blomqvist,Andreas %A Bäck,Maria %A Klompstra,Leonie %A Strömberg,Anna %A Jaarsma,Tiny %+ Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, Linköping, SE-581 83, Sweden, 46 739617729, andreas.blomqvist@liu.se %K heart failure %K disease management %K physical activity %K sedentary %K older adults %K aging %K mobile health %K mHealth %K feasibility %K quality of life %K digital health %K smartphone %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). Objective: We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. Methods: In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants’ electronic health records (EHRs). Results: We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants’ daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was –1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was –9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). Conclusions: The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. Trial Registration: ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763 %M 39778202 %R 10.2196/62910 %U https://formative.jmir.org/2025/1/e62910 %U https://doi.org/10.2196/62910 %U http://www.ncbi.nlm.nih.gov/pubmed/39778202 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55032 %T Collecting Feedback From Neurologists and Patients to Guide Development of a Parkinson Disease App (DigiPark): Qualitative, Noninterventional Study %A Duracinsky,Martin %A Brown Hajdukova,Eva %A Péretz,Fabienne %A Sauzin,Julie %A Gouider-Khouja,Neziha %A Atlani,Caroline %A Dalili,Djamchid %K DigiPark %K Parkinson disease %K patient-centered app %K smartphones %K usability testing %K mHealth %K mobile health %D 2024 %7 31.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Parkinson disease (PD) is a worldwide, fast-growing, progressive neurodegenerative condition. Its multifaceted clinical presentation includes a wide range of motor and nonmotor symptoms. Smartphones present a potential solution to better monitor and subsequently alleviate PD symptoms. Objective: The aim of this study is to explore neurologists’ and patients’ needs and preferences regarding the design and functionality of a new smartphone app for PD, DigiPark. Methods: This qualitative, noninterventional study gathered data through two primary methods: (1) by conducting interviews with 9 neurologists and (2) through a usability test including 5 patients with PD. Results: The neurologists affirmed the necessity for a patient-centered app, highlighting the complexities of PD management. They advocated for personalized app functionalities to improve patients’ quality of life and emphasized the need for enhanced patient-provider communication. Feedback from the usability test indicated a preference for a clear, simple user interface, as well as elucidation of the app’s benefits. Concerns about the app’s time demands and the complexity of certain features like medication management were expressed. Furthermore, patients with PD consistently showed interest in features that could track and monitor their progress over time. This highlights the need to include clear benefits within the app to maintain user engagement and commitment. Conclusions: Neurologists’ and patients’ feedback on the design and functionality of the app complement each other. Collaborative efforts in shaping the app should better address genuine PD management needs. Future clinical trial inclusion can further validate the efficacy of DigiPark. %R 10.2196/55032 %U https://humanfactors.jmir.org/2024/1/e55032 %U https://doi.org/10.2196/55032 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63457 %T Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis %A Chen,Jiaren %A Park,Jong-Hwan %A Lin,Chien-Yu %A Lai,Ting-Fu %A Kim,Du-Ri %A Shin,Myung-Jun %A Moon,Eunsoo %A Kang,Jung Mo %A Lee,Jong Won %A Cho,Yoon Jae %A Liao,Yung %A Goh,Tae Sik %A Lee,Jung Sub %K bioelectrical impedance analysis %K oxidative stress %K cellular health %K cognitive function %K older adults %K BIA %K phase angle %K PhA %D 2024 %7 16.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants’ whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65‐96 years (women: n=444, 71%; men: n=191, 29%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95% CI 0.16‐1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95% CI 0.38‐1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95% CI 0.00‐0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95% CI 0.09‐0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95% CI 0.10‐0.38; P<.001), attention and calculation (b=0.21, 95% CI 0.06‐0.37; P=.01), memory (b=0.14, 95% CI 0.05‐0.22; P=.001), and language functions (b=0.07, 95% CI 0.01‐0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. %R 10.2196/63457 %U https://publichealth.jmir.org/2024/1/e63457 %U https://doi.org/10.2196/63457 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48778 %T Decomposition Analysis of the Prevalence of Denture Use Between Rural and Urban Older Individuals With Edentulism in China: Cross-Sectional Study %A Yuan,Lei %A Yuan,Yuan %A Ren,Haotian %A Zhang,Feng %A Zhao,Zhe %A Jiang,Qinqin %A Wei,Zhenbang %A Sun,Jin-hai %+ Department of Health Management, Faculty of Military Health Service, Naval Medical University, No 800 Xiangyin Road, Shanghai, 200433, China, 86 021 81871455, sunjinhai2003@sina.cn %K oral health %K older adults with edentulism %K edentulism %K denture %K decomposition analysis %K China %D 2024 %7 13.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Edentulism impacts the physical health and quality of life of older individuals. The prevalence, influencing factors, and differences in terms of edentulism in urban and rural areas of China are unclear. Objective: This study investigated the denture-wearing conditions and causes affecting older patients with edentulism in urban and rural areas of China and analyzed the differences. Methods: This cross-sectional study included the data of 5139 older individuals (age>65 years) with edentulism obtained from 23 Chinese provinces in 2018. Participants were divided into urban and rural groups based on their household registration. Factors influencing denture use in both groups were explored using binary logistic regression, while factors influencing differences in denture wearing in both groups were explored using the Fairlie decomposition model. Results: Of the 5139 participants, 67.05% (808/1205) from urban areas and 51.12% (2011/3934) from rural areas wore dentures. In the urban group, participants with a higher level of education (1-6 years: odds ratio [OR] 2.093, 95% CI 1.488-2.945; ≥7 years: OR 2.187, 95% CI 1.565-3.055) or who exercised (OR 2.840, 95% CI 2.016-3.999) preferred wearing dentures, but individuals with BMI<18.5 kg/m2 (OR 0.558, 95% CI 0.408-0.762) or widowed (OR 0.618, 95% CI 0.414-0.921) did not. In the rural group, a higher level of education (1-6 years: OR 1.742, 95% CI 1.429-2.123; ≥7 years: OR 1.498, 95% CI 1.246-1.802), living alone (OR 1.372, 95% CI 1.313-1.663), exercise (OR 1.612, 95% CI 1.340-1.940), high economic status (OR 1.234, 95% CI 1.035-1.472), residence in the eastern area (OR 2.045, 95% CI 1.723-2.427), presence of chronic diseases (1 disease: OR 1.534, 95% CI 1.313-1.793; ≥2 diseases: OR 1.500, 95% CI 1.195-1.882) were positively associated and age≥80 years (OR 0.318, 95% CI 0.247-0.408), BMI<18.5 kg/m2 (OR 0.692, 95% CI 0.590-0.813), and widowed (OR 0.566, 95% CI 0.464-0.690) or other marital status (OR 0.600, 95% CI 0.392-0.918) were negatively associated with denture use. The Fairlie decomposition model revealed that the number of chronic diseases (16.34%), education level (11.94%), region of residence (11.00%), annual income (10.55%), exercise (6.81%), and age (–0.92%) were the main factors responsible for differences between urban and rural edentulism and could explain the difference in the denture-wearing rate (58.48%) between both groups. Conclusions: Older individuals with edentulism with a higher education level and who exercise are more willing to wear dentures, while those with BMI<18.5 kg/m2 show a decreased willingness to wear dentures in both urban and rural areas in China. Controlling the number of chronic diseases, improving the education level and annual income, cultivating good exercise habits, and bridging the gap between the economic status of the east and west can narrow the differences in denture wearing among urban and rural older individuals with edentulism. %M 39671593 %R 10.2196/48778 %U https://www.i-jmr.org/2024/1/e48778 %U https://doi.org/10.2196/48778 %U http://www.ncbi.nlm.nih.gov/pubmed/39671593 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59504 %T A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial %A Blair,Cindy K %A Brown-Glaberman,Ursa %A Walters,Scott T %A Pestak,Claire %A Boyce,Tawny %A Barriga,Laura %A Burgess,Ellen %A Tawfik,Bernard %A Killough,Cynthia %A Kinney,Anita Y %A Demark-Wahnefried,Wendy %A Meisner,Angela L %A Wiggins,Charles L %A Pankratz,V Shane %A Davis,Sally %+ Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131, United States, 1 505 925 7907, CiBlair@salud.unm.edu %K cancer survivor %K physical performance %K physical activity %K physical function %K older adults %K activity tracker %K mobile phone %D 2024 %7 13.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30% of older cancer survivors meet the recommended guidelines for physical activity. Objective: This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing. Methods: The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life. Results: Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing. Conclusions: The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population. Trial Registration: ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889 International Registered Report Identifier (IRRID): DERR1-10.2196/59504 %M 39671575 %R 10.2196/59504 %U https://www.researchprotocols.org/2024/1/e59504 %U https://doi.org/10.2196/59504 %U http://www.ncbi.nlm.nih.gov/pubmed/39671575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64437 %T Mitochondrial Fitness Science Communication for Aging Adults: Prospective Formative Pilot Study %A Maxwell,Cathy A %A Grubbs,Brandon %A Dietrich,Mary S %A Boon,Jeffrey T %A Dunavan,John %A Knickerbocker,Kelly J %A Patel,Maulik R %+ College of Nursing, University of Utah, 10 South, 2000 Eaast, Salt Lake City, UT, 84112, United States, 1 7065738853, cathy.maxwell@nurs.utah.edu %K older adults %K physical activity %K exercise %K science communication %K gerontology %K usability %K behavior change %K mitochondria %K fitness %K health intervention %K digital health %K evaluation %K feasibility study %K community dwelling %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our previous work revealed strong community interest in the concept of mitochondrial fitness, which led to the development of a video-based science communication intervention to prompt behavior change in adults aged 50 years and older. Objective: This study aimed to conduct formative and summative evaluations of MitoFit, an instructional, biologically based communication intervention aimed at improving physical activity in older adults aged 50 years and older. Methods: In the phase-1 formative evaluation, community-dwelling older adults (N=101) rated the acceptability, appropriateness, and helpfulness of our MitoFit video series, titled “How to Slow Down Aging Through Mitochondrial Fitness.” In the phase-2 summative evaluation, a subgroup of phase-1 participants (n=19) participated in a 1-month MitoFit intervention prototype to evaluate the intervention and data collection feasibility. Results: In phase 1, participants (mean age 67.8, SD 8.9 y; 75/100, 75% female) rated the MitoFit videos as acceptable (≥4 out of 5 on a Likert-scale survey; from 97/101, 96% to 100/101, 99%), appropriate (101/101, 100%), and helpful (from 95/101, 94% to 100/101, 99%) to support adaptation and continued work on our novel approach. Previous knowledge of mitochondria ranged from 52% (50/97; What are mitochondria?) to 80% (78/97; What are the primary functions of mitochondria?). In phase 2, participants (mean age 71.4, SD 7.9 y; 13/19, 72% female) scored better than the national average (50) on the Patient-Reported Outcomes Measurement Information System-19 for physical function (57), social activities (55.5), depression (41), fatigue (48.6), and sleep disturbance (49.6) but worse for anxiety (55.3) and pain interference (52.4). Additionally, 95% (18/19) of participants demonstrated MitoFit competencies within 2 attempts (obtaining pulse: 19/19, 100%; calculating maximum and zone 2 heart rate: 18/19, 95%; and demonstration of exercises: 19/19, 100%). At 1 month after instruction, 68% (13/19) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. A walking pulse was documented by 85% (11/13) of participants. The time needed to walk 1 mile ranged from 17.4 to 27.1 minutes. The number of miles walked in 1 month was documented by 62% (8/13) of participants and ranged from 10 miles to 31 miles. The number of days of strength training ranged from 2 to 31 days/month. Intervention feasibility scores ranged from 89% (17/19; seems easy to follow) to 95% (18/19; seems implementable, possible, and doable). Overall, 79% (15/19) stated an intention to continue the MitoFit intervention. Furthermore, 4 weeks after delivery of the prototype intervention, the percentage of participants doing aerobic activity for regular moderate activity increased from 35% (6/17) to 59% (10/17; P=.03). Conclusions: MitoFit was enthusiastically embraced and is a cost-effective, scalable, and potentially efficacious intervention to advance with community-dwelling older adults. %M 39671578 %R 10.2196/64437 %U https://formative.jmir.org/2024/1/e64437 %U https://doi.org/10.2196/64437 %U http://www.ncbi.nlm.nih.gov/pubmed/39671578 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e62689 %T The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study %A Klein,Melina %A von Bosse,Alexa %A Kunze,Christophe %K touch-based digital technology %K gerontology %K geriatric %K older %K elderly %K aging %K aged %K tablet-based technology %K tablet %K digital care application %K mHealth %K mobile health %K app %K health app %K home care setting %K caring relatives %K dementia %K MCI %K Alzheimer %K mild cognitive impairment %K cognition %K prototype %K digital health %K telehealth %K dementia %K memory loss %K patient care %K patient health %K patient support %D 2024 %7 10.12.2024 %9 %J JMIR Aging %G English %X Background: The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning. Objective: This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity. Methods: We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data. Results: Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology. Conclusions: The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings. %R 10.2196/62689 %U https://aging.jmir.org/2024/1/e62689 %U https://doi.org/10.2196/62689 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53304 %T Common Physical Performance Tests for Evaluating Health in Older Adults: Cross-Sectional Study %A Banarjee,Chitra %A Choudhury,Renoa %A Park,Joon-Hyuk %A Xie,Rui %A Fukuda,David %A Stout,Jeffrey %A Thiamwong,Ladda %+ Department of Mechanical Engineering, University of Central Flordia, 12760 Pegasus Drive, Orlando, FL, 32816, United States, 1 4078232416, joonpark@ucf.edu %K functional capacity %K physical activity %K fear of falling %K physical performance tests %K Short Physical Performance Battery %K 6-minute walk test %K Incremental Shuttle Walk Test %K geriatrics %K aging %D 2024 %7 29.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Interdisciplinary evaluation of older adults’ health care is a priority in the prevention of chronic health conditions and maintenance of daily functioning. While many studies evaluate different physical performance tests (PPTs) from a retrospective view in predicting mortality or cardiopulmonary health, it remains unclear which of the commonly used PPTs is the most effective at evaluating the current health of older adults. Additionally, the time and participant burden for each PPT must be considered when planning and implementing them for clinical or research purposes. Objective: This cross-sectional study aimed to determine how elements of overall physical capacity, performance, and other nongait factors in older adults affect the results of 3 commonly used tests: the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), and Incremental Shuttle Walk Test (ISWT). Methods: A total of 53 community-dwelling older adults met the inclusion and exclusion criteria (mean age 77.47, SD 7.25 years; n=41, 77% female; and n=21, 40% Hispanic). This study evaluated older adults using 3 different PPTs including the SPPB, 6MWT, and ISWT, as well as constructed multiple linear regression models with measures of physical activity, static balance, and fear of falling (FoF). The nongait measures included 7 days of physical activity monitoring using the ActiGraph GT9X Link instrument, objective measurement of static balance using the BTrackS Balance System, and FoF using the short Fall Efficacy Scale-International. Results: The models revealed that the complete SPPB provided the most comprehensive value, as indicated by a greater R2 value (0.523), and that performance on the SPPB was predicted by both moderate to vigorous physical activity (P=.01) and FoF (P<.001). The ISWT was predicted by moderate to vigorous physical activity (P=.02), BMI (P=.02), and FoF (P=.006) and had a similar R2 value (0.517), whereas the gait component of the SPPB (P=.001) and 6MWT (P<.001) was predicted by only FoF and had lower R2 values (0.375 and 0.228, respectively). Conclusions: The results indicated the value of a multicomponent, comprehensive test, such as the SPPB, in evaluating the health of older adults. Additionally, a comparison of the 2 field walking tests (ISWT and 6MWT) further distinguished the ISWT as more responsive to overall health in older adults. In comparing these commonly used PPTs, clinicians and researchers in the field can determine and select the most optimal test to evaluate older adults in communities and research settings. %M 39612490 %R 10.2196/53304 %U https://www.i-jmr.org/2024/1/e53304 %U https://doi.org/10.2196/53304 %U http://www.ncbi.nlm.nih.gov/pubmed/39612490 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56810 %T Gaming-Based Tele-Exercise Program to Improve Physical Function in Frail Older Adults: Feasibility Randomized Controlled Trial %A Kannan,Lakshmi %A Sahu,Upasana %A Subramaniam,Savitha %A Mehta,Neha %A Kaur,Tanjeev %A Hughes,Susan %A Bhatt,Tanvi %+ College of Applied Health Sciences, University of Illinois at Chicago, 1919, W Taylor St (M/C 898), Chicago, IL, 60612, United States, 1 3123554443, tbhatt6@uic.edu %K exergame training %K Matter of Balance %K MOB %K pre-frail %K tele-exergame %K tele-rehabilitation %K gaming-based %K tele-exercise %K physical function %K frailty %K older adults %K aging %K physical activity %K dementia %K CogXergaming %K telehealth %K dynamic balance %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty leads to reduced physical activity can cause increased fall risk. This contributes to accelerated aging processes, leading to adverse health outcomes and reduced quality of life. We have developed and piloted the design, usability, safety, and feasibility of a gaming-based cognitive-motor (CogXergaming) tele-exercise protocol in prefrail older adults. Objective: This pilot randomized control trial tested preliminary feasibility and effectiveness of the CogXergaming telehealth protocol for improving physical function. Methods: Community-dwelling, prefrail older adults were randomly assigned to CogXergaming (n=13) or a control group (n=14). The CogXergaming group received supervised tele-exercises in a gaming format for 6 weeks (3 sessions per week) comprising 18 sessions lasting 90 minutes each. Control group participants participated in a Matter of Balance (MOB), an 8-week, once-a-week structured 90-minute tele-session that has been shown to reduce the fear of falling and increase physical activity. Feasibility of training was obtained by computing the median duration of training sessions for the CogXergaming group. Effectiveness was assessed using dynamic balance control (Four Square Step Test), subjective self-efficacy (Activities-Specific Balance Confidence scale), gait function (Tinetti Performance Oriented Mobility Assessment), muscle strength (30-second chair stand test), and endurance (2-minute step in-place test). Results: Of the 45 participants enrolled in the study, 4 participants from CogXergaming group and 5 from MOB group lost contact after signing the consent form and did not receive their respective intervention. Eighteen participants were randomized to each group. In the CogXergaming group, 15 (83%) completed the intervention, with 3 (16%) dropping out in the first week. In the MOB group, 16 (88%) completed the program, with 2 (11%) withdrawing during the first week. In addition, there was a significant time group interaction for Four Square Step Test (F1,21=5.55, P=.03), Tinetti Performance Oriented Mobility Assessment (F1,25=4.16, P=.05), and 30-second chair stand test (F1,21=5.06, P=.03), with a significant improvement in these measures for the CogXergaming group post training, compared with no change observed in the MOB group. Conclusions: These pilot findings indicate that CogXergaming is feasible and applicable in prefrail older adults. Such game-based protocols can be beneficial in improving physical function among community-dwelling, prefrail older adults, however, the efficacy of such training requires further investigation. Trial Registration: ClinicalTrials.gov NCT04534686; https://clinicaltrials.gov/study/NCT04534686 %M 39602215 %R 10.2196/56810 %U https://www.jmir.org/2024/1/e56810 %U https://doi.org/10.2196/56810 %U http://www.ncbi.nlm.nih.gov/pubmed/39602215 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63092 %T Social Robots and Sensors for Enhanced Aging at Home: Mixed Methods Study With a Focus on Mobility and Socioeconomic Factors %A Vagnetti,Roberto %A Camp,Nicola %A Story,Matthew %A Ait-Belaid,Khaoula %A Mitra,Suvobrata %A Fowler Davis,Sally %A Meese,Helen %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Magistro,Daniele %+ Department of Sport Science, School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG11 8NS, United Kingdom, 44 1158483522, daniele.magistro@ntu.ac.uk %K older adults %K motor difficulties %K socioeconomic status %K social assistive robots %K monitoring technologies %K mixed methods %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Population aging affects society, with a profound impact on daily activities for those of a low socioeconomic status and with motor impairments. Social assistive robots (SARs) and monitoring technologies can improve older adults’ well-being by assisting with and monitoring home activities. Objective: This study explored the opinions and needs of older adults, including those with motor difficulties and of a low socioeconomic status, regarding SARs and monitoring technologies at home to promote daily activities and reduce sedentary behaviors. Methods: A mixed methods approach was used, with 31 older adults divided into 3 groups: those of a low socioeconomic status, those with motor difficulties, and healthy individuals. Focus groups were conducted, and they were analyzed using thematic analysis. Perceived mental and physical well-being were assessed using the 12-Item Short Form Health Survey, and attitudes toward robots were evaluated using the Multidimensional Robot Attitude Scale. Results: The results identified 14 themes in four key areas: (1) technology use for supporting daily activities and reducing sedentary behaviors, (2) perceived barriers, (3) suggestions and preferences, and (4) actual home technology use. Lower perceived physical well-being was associated with higher levels of familiarity, interest, perceived utility, and control related to SARs. Lower perceived psychological well-being was linked to a more negative attitude, increased concerns about environmental fit, and a preference for less variety. Notably, older adults from the low–socioeconomic status group perceived less control over SARs, whereas older adults with motor difficulties expressed higher perceived utility compared to other groups, as well as higher familiarity and interest compared to the low–socioeconomic status group. Conclusions: Participants indicated that SARs and monitoring technologies could help reduce sedentary behaviors by assisting in the management of daily activities. The results are discussed in the context of these outcomes and the implementation of SARs and monitoring technologies at home. This study highlights the importance of considering the functional and socioeconomic characteristics of older adults as future users of SARs and monitoring technologies to promote widespread adoption and improve well-being within this population. %M 39586076 %R 10.2196/63092 %U https://aging.jmir.org/2024/1/e63092 %U https://doi.org/10.2196/63092 %U http://www.ncbi.nlm.nih.gov/pubmed/39586076 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58261 %T Functional Monitoring of Patients With Knee Osteoarthritis Based on Multidimensional Wearable Plantar Pressure Features: Cross-Sectional Study %A Xie,Junan %A Li,Shilin %A Song,Zhen %A Shu,Lin %A Zeng,Qing %A Huang,Guozhi %A Lin,Yihuan %+ School of Future Technology, South China University of Technology, No. 777 East Xingye Avenue, Panyu District, Guangzhou, China, 86 13719139981, shul@scut.edu.cn %K knee osteoarthritis %K KOA %K 40-m fast-paced walk test %K 40mFPWT %K timed up-and-go test %K TUGT %K timed up and go %K TUG %K functional assessment %K monitoring %K wearable %K gait %K walk test %K plantar %K knee %K joint %K arthritis %K gait analysis %K regression model %K machine learning %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA. Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system. Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models. Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389%, and RMSE of 1.905 seconds for the prediction of the TUGT. Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts. %M 39586093 %R 10.2196/58261 %U https://aging.jmir.org/2024/1/e58261 %U https://doi.org/10.2196/58261 %U http://www.ncbi.nlm.nih.gov/pubmed/39586093 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57352 %T The Effect of Young People–Assisted, Individualized, Motion-Based Video Games on Physical, Cognitive, and Social Frailty Among Community-Dwelling Older Adults With Frailty: Randomized Controlled Trial %A Wong,Arkers Kwan Ching %A Zhang,Melissa Qian %A Bayuo,Jonathan %A Chow,Karen Kit Sum %A Wong,Siu Man %A Wong,Bonnie Po %A Liu,Bob Chung Man %A Lau,David Chi Ho %A Kowatsch,Tobias %K frailty %K gaming intervention %K motion-based %K video games %K older adults %K gerontology %K geriatrics %K randomized controlled trial %K RCT %K physical fitness %K adolescents %K young people–assisted %K eHealth literacy %K well-being %K therapists %K youth volunteers %K social support %K exergames %K gamification %K active games %K physical activity %D 2024 %7 20.11.2024 %9 %J JMIR Serious Games %G English %X Background: The aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. Objective: This study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. Methods: This randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P<.05. Results: A total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect (β=−0.63, P=.03). The intervention group demonstrated enhancements in hand strength and BMI, but no statistically significant between-group differences were observed. The intervention group also exhibited significant improvements in cognitive function (β=2.43, P<.001), while the control group’s scores declined. Short-term memory improved for both groups, with no significant differences noted. Both groups experienced a reduction in depression levels, with a significant within-group effect at T2 (β=−1.16, P=.001). Improvements in social connectedness and eHealth literacy were observed in both groups, with the latter showing a significant within-group effect at T2 (β=3.56, P=.002). No significant effects were found for social isolation, physical activities, or quality of life. Conclusions: The growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness. Trial Registration: ClinicalTrials.gov NCT05267444; https://clinicaltrials.gov/study/NCT05267444 %R 10.2196/57352 %U https://games.jmir.org/2024/1/e57352 %U https://doi.org/10.2196/57352 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58175 %T Quantifying the Enhancement of Sarcopenic Skeletal Muscle Preservation Through a Hybrid Exercise Program: Randomized Controlled Trial %A Guo,Hongzhi %A Cao,Jianwei %A He,Shichun %A Wei,Meiqi %A Meng,Deyu %A Yu,Ichen %A Wang,Ziyi %A Chang,Xinyi %A Yang,Guang %A Wang,Ziheng %K sarcopenia %K older adults %K physical exercise program %K explainable artificial intelligence %K tai chi %D 2024 %7 15.11.2024 %9 %J JMIR Aging %G English %X Background: Sarcopenia is characterized by the loss of skeletal muscle mass and muscle function with increasing age. The skeletal muscle mass of older people who endure sarcopenia may be improved via the practice of strength training and tai chi. However, it remains unclear if the hybridization of strength exercise training and traditional Chinese exercise will have a better effect. Objective: We designed a strength training and tai chi exercise hybrid program to improve sarcopenia in older people. Moreover, explainable artificial intelligence was used to predict postintervention sarcopenic status and quantify the feature contribution. Methods: To assess the influence of sarcopenia in the older people group, 93 participated as experimental participants in a 24-week randomized controlled trial and were randomized into 3 intervention groups, namely the tai chi exercise and strength training hybrid group (TCSG; n=33), the strength training group (STG; n=30), and the control group (n=30). Abdominal computed tomography was used to evaluate the skeletal muscle mass at the third lumbar (L3) vertebra. Analysis of demographic characteristics of participants at baseline used 1-way ANOVA and χ2 tests, and repeated-measures ANOVA was used to analyze experimental data. In addition, 10 machine-learning classification models were used to calculate if these participants could reverse the degree of sarcopenia after the intervention. Results: A significant interaction effect was found in skeletal muscle density at the L3 vertebra, skeletal muscle area at the L3 vertebra (L3 SMA), grip strength, muscle fat infiltration, and relative skeletal muscle mass index (all P values were <.05). Grip strength, relative skeletal muscle mass index, and L3 SMA were significantly improved after the intervention for participants in the TCSG and STG (all P values were <.05). After post hoc tests, we found that participants in the TCSG experienced a better effect on L3 SMA than those in the STG and participants in the control group. The LightGBM classification model had the greatest performance in accuracy (88.4%), recall score (74%), and F1-score (76.1%). Conclusions: The skeletal muscle area of older adults with sarcopenia may be improved by a hybrid exercise program composed of strength training and tai chi. In addition, we identified that the LightGBM classification model had the best performance to predict the reversion of sarcopenia. Trial Registration: ClinicalTrials.gov NCT05694117; https://clinicaltrials.gov/study/NCT05694117 %R 10.2196/58175 %U https://aging.jmir.org/2024/1/e58175 %U https://doi.org/10.2196/58175 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58186 %T Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial %A Mundada,Pallavi %A Makhija,Deepa %A Mata,Sunita %A Kachare,Kalpana %A Manathottathil,Aparna %A Sharma,Abha %A Rao,Bhogavalli Chandra Sekhara %A Rana,Rakesh %A Tripathi,Arunabh %A Rana,Kiran %A Joshi,Vandana %A Raturi,Ashish %A Singh,Anukampa %A Srikanth,N %A Acharya,Rabinarayan %+ Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Government of India, 61-65, opp. D Block, Janakpuri Institutional Area, Janakpuri, New Delhi, 110058, India, 91 9911331074, drdeepamakhija@yahoo.co.in %K Ayush Rasayana A %K Ayush Rasayana B %K cluster-randomized trial %K geriatrics %K Ayurveda %K quality of life %K complementary and alternative medicine %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. Objective: This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. Methods: This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People’s Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. Results: The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. Conclusions: This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations International Registered Report Identifier (IRRID): DERR1-10.2196/58186 %M 39527794 %R 10.2196/58186 %U https://www.researchprotocols.org/2024/1/e58186 %U https://doi.org/10.2196/58186 %U http://www.ncbi.nlm.nih.gov/pubmed/39527794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53156 %T Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial %A Kershner,Kyle %A Morton,David %A Robison,Justin %A N'dah,Kindia Williams %A Fanning,Jason %+ Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Road, Winston-Salem, NC, 27109, United States, 1 3367585042, fanninjt@wfu.edu %K virtual reality %K physical activity %K videoconference %K social connection %K remote meeting %K gerontology %K physical inactivity %K at-home intervention %K descriptive statistics %K eHealth %K comorbidity %K cybersickness %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from –5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98% (59/60) and 96% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 %M 39514256 %R 10.2196/53156 %U https://formative.jmir.org/2024/1/e53156 %U https://doi.org/10.2196/53156 %U http://www.ncbi.nlm.nih.gov/pubmed/39514256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60183 %T Efficacy of a Wearable Activity Tracker With Step-by-Step Goal-Setting on Older Adults’ Physical Activity and Sarcopenia Indicators: Clustered Trial %A Ho,Mu-Hsing %A Peng,Chi-Yuan %A Liao,Yung %A Yen,Hsin-Yen %+ School of Gerontology and Long-term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei City, 11031, Taiwan, 886 2 2736 1661 ext 6326, yenken520@gmail.com %K behavioral change technique %K chronic disease prevention %K health promotion %K mHealth %K sedentary behavior %K smartwatch %D 2024 %7 1.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia. Objective: The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults’ physical activity and sarcopenia indicators. Methods: The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests. Results: All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group. Conclusions: A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults’ physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations. %M 39486024 %R 10.2196/60183 %U https://www.jmir.org/2024/1/e60183 %U https://doi.org/10.2196/60183 %U http://www.ncbi.nlm.nih.gov/pubmed/39486024 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59141 %T Home-Based, Low-Intensity, Gamification-Based, Interactive Physical-Cognitive Training for Older Adults Using the ADDIE Model: Design, Development, and Evaluation of User Experience %A Kamnardsiri,Teerawat %A Kumfu,Sirintip %A Munkhetvit,Peeraya %A Boripuntakul,Sirinun %A Sungkarat,Somporn %K exergame %K physical-cognitive training %K computer-based interventions %K gamification %K older adults %K instructional design model %K low-intensity %D 2024 %7 29.10.2024 %9 %J JMIR Serious Games %G English %X Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence. Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting. Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants’ enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05. Results: As for experts’ consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision–based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user’s perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001). Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults’ enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions. %R 10.2196/59141 %U https://games.jmir.org/2024/1/e59141 %U https://doi.org/10.2196/59141 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e60209 %T Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study %A Ding,Huitong %A Ho,Kristi %A Searls,Edward %A Low,Spencer %A Li,Zexu %A Rahman,Salman %A Madan,Sanskruti %A Igwe,Akwaugo %A Popp,Zachary %A Burk,Alexa %A Wu,Huanmei %A Ding,Ying %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Gifford,Katherine A %A Shih,Ludy C %A Au,Rhoda %A Lin,Honghuang %K physical activity %K remote monitoring %K wearable device %K adherence %K older adults %D 2024 %7 25.10.2024 %9 %J JMIR Aging %G English %X Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited. Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies. Methods: This study included 22 participants from the Boston University Alzheimer’s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days. Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use. Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data. %R 10.2196/60209 %U https://aging.jmir.org/2024/1/e60209 %U https://doi.org/10.2196/60209 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60270 %T Home-Based Digital Exercise Training Program to Improve Physical Function of Older Sepsis Survivors: Protocol of the HEAL Sepsis Randomized Clinical Trial %A Zeidan,Rola S %A Ohama,Margaret K %A Evripidou,Natalia %A Anton,Stephen D %A Hamed,Laith L %A Lin,Yi %A Leeuwenburgh,Christiaan %A Guirguis,Faheem W %A Efron,Philip A %A Flynn,Sheryl %A Smith,Barbara %A Bacher,Rhonda %A Bakarasan,Naveen %A Sarmiento Delgado,Juan %A Mankowski,Robert T %+ Department of Physiology and Aging, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32603, United States, 1 3523923791, rmankowski@uabmc.edu %K sepsis %K physical function %K exercise %K rehabilitation %K remotely delivered %K aging %D 2024 %7 17.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While sepsis, an exaggerated response to infection, can affect people of all age groups, it is more prevalent in middle-aged and older adults. Older adults suffer worse short-term and long-term outcomes than younger patients. Older sepsis survivors are commonly discharged to long-term acute care facilities, where they often die within 1 year. Those who return home from the hospital lose the momentum of physical function improvement after early inpatient rehabilitation, and often face exacerbation of comorbidities and decline in physical function. Additionally, patients who are discharged home often live at distant locations and are not able to commute to rehabilitation centers due to their poor health status. Therefore, remotely delivered exercise interventions tailored to this population hold promise to improve physical function safely and effectively after sepsis. However, this type of intervention has yet to be tested in this population. Objective: This study aims to assess the safety, feasibility, and ease of recruitment and retention of participants for a remotely delivered physical activity intervention for improving physical function in middle-aged and older sepsis survivors. Methods: The proposed intervention will be delivered through a digital health platform that comprises a patient-facing mobile app and a 12-week physical activity program specifically designed for middle-aged and older sepsis survivors with poor health status who may face challenges participating in traditional out-patient or community-based exercise interventions. This study is ongoing and plans to enroll 40 sepsis survivors aged 55 years and older who will be randomized to either a remotely delivered exercise intervention group or a control group (electronic health diary). Both groups will use a tablet containing the Health in Motion app (Blue Marble Health). The intervention group will receive a clinician-designed personalized avatar-guided home exercise program and reminders while the control group will self-report daily activities using the in-app health diary feature. Results: This study is the first to use a home-based, remotely monitored 12-week exercise program to improve physical function in sepsis survivors. This study will evaluate the safety, feasibility, and efficacy, providing the necessary knowledge to design and calculate power for future larger trials. Conclusions: This study will provide important information for planning a future randomized clinical trial to test the efficacy of a remotely delivered exercise intervention in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05568511; https://clinicaltrials.gov/study/NCT05568511 International Registered Report Identifier (IRRID): DERR1-10.2196/60270 %M 39418096 %R 10.2196/60270 %U https://www.researchprotocols.org/2024/1/e60270 %U https://doi.org/10.2196/60270 %U http://www.ncbi.nlm.nih.gov/pubmed/39418096 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63067 %T The Impact of Social Support on the Relationship Between Physical Exercise and Cognitive Function in Older Adults: Sociological Perspective %A Li,Yuan %A Zhai,Qun %A Peng,Weihang %K social support %K physical exercise %K cognitive function %K elderly %K sociological perspective %D 2024 %7 4.10.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/63067 %U https://publichealth.jmir.org/2024/1/e63067 %U https://doi.org/10.2196/63067 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55322 %T Development of a 12-Week Unsupervised Online Tai Chi Program for People With Hip and Knee Osteoarthritis: Mixed Methods Study %A Zhu,Shiyi Julia %A Bennell,Kim L %A Hinman,Rana S %A Harrison,Jenny %A Kimp,Alexander J %A Nelligan,Rachel K %+ Department of Physiotherapy, School of Health Sciences, Centre for Health, Exercise and Sports Medicine, University of Melbourne, 161 Barry Street, Parkville, Melbourne, 3010, Australia, 61 3 8344 0556, k.bennell@unimelb.edu.au %K intervention development %K osteoarthritis %K Tai Chi %K web-based intervention %K online %K telehealth %K unsupervised exercise %K exercise %K physical activity %K arthritis %K development %K web based %K hip %K knee %K gerontology %K geriatric %K older adult %K aging %K bone %K workout %K digital health %K eHealth %K literature review %K telemedicine %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Osteoarthritis is a leading contributor to global disability. While evidence supports the effectiveness of Tai Chi in improving symptoms for people with hip/knee osteoarthritis, access to in-person Tai Chi classes may be difficult for many people. An unsupervised online Tai Chi intervention for people with osteoarthritis can help overcome accessibility barriers. The Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention. Objective: This study aims to develop an unsupervised online Tai Chi program for people with hip/knee osteoarthritis. Methods: An iterative process was conducted using the AHEAD framework. Initially, a panel of Tai Chi instructors and people with osteoarthritis was assembled. A literature review was conducted to inform the content of a survey (survey 1), which was completed by the panel and additional Australian Tai Chi instructors to identify Tai Chi movements for potential inclusion. Selection of Tai Chi movements was based on 3 criteria: those that were appropriate (for people with hip/knee osteoarthritis aged 45+ years), safe (to be performed at home unsupervised), and practical (to be delivered online using prerecorded videos). Movements that met these criteria were then ranked in a second survey (survey 2; using conjoint analysis methodology). Survey findings were discussed in a focus group, and the Tai Chi movements for program use were identified. A draft of the online Tai Chi program was developed, and a final survey (survey 3) was conducted with the panel to rate the appropriateness and safety of the proposed program. The final program was developed, and usability testing (think-aloud protocol) was conducted with people with knee osteoarthritis. Results: The panel consisted of 10 Tai Chi instructors and 3 people with osteoarthritis. The literature review identified Yang Style 24 as a common and effective Tai Chi style used in hip/knee osteoarthritis studies. Surveys 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion. This list was refined and informed by a focus group, with 10 Tai Chi movements being selected for inclusion (known as the Yang Style 10 form). Survey 3 (n=13) found that 92% (n=12) of the panel members believed that the proposed draft Tai Chi program was appropriate and safe, resulting in its adoption. The final program was produced and hosted on a customized website, “My Joint Tai Chi,” which was further refined based on user feedback (n=5). “My Joint Tai Chi” is currently being evaluated in a randomized controlled trial. Conclusions: This study demonstrates the use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (“My Joint Tai Chi”) for people with hip/knee osteoarthritis. This intervention is now being tested for effectiveness and safety in a randomized controlled trial. %M 39348676 %R 10.2196/55322 %U https://aging.jmir.org/2024/1/e55322 %U https://doi.org/10.2196/55322 %U http://www.ncbi.nlm.nih.gov/pubmed/39348676 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58316 %T Graded Intensity Aerobic Exercise to Improve Cerebrovascular Function and Performance in Older Veterans: Protocol for a Randomized Controlled Trial %A Bello,Medina Oneyi %A Mammino,Kevin Michael %A Vernon,Mark Anthony %A Wakeman,Daniel G %A Denmon,Chanse Aerius %A Krishnamurthy,Lisa Crystal %A Krishnamurthy,Venkatagiri %A McGregor,Keith Matthew %A Novak,Thomas Samuel %A Nocera,Joe Robert %+ Joseph Maxwell Cleland Atlanta Veteran Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA, 30033, United States, 1 404 321 6111 ext 207099, Medina.Bello@va.gov %K aerobic exercise %K exercise %K functional magnetic resonance imaging %K fMRI %K veterans %K quality of life %K sedentary lifestyle %K elderly %K geriatrics %K geriatric %K older adults %K cardiovascular disease %K health promotion %K aging %K cognitive %K cognitive health %K physical health %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing health care challenges resulting from a rapidly expanding aging population necessitate examining effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence. Objective: This work aims to implement a multimodal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise-induced adaptations to sedentary older adults’ brains and behaviors. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise-induced changes to cerebral perfusion, cerebral vascular reactivity (CVR), and cognitive and sensorimotor task-dependent functional magnetic resonance imaging (fMRI) after prescribed exercise. Methods: Sedentary older adults (aged 65-80 years) were randomly assigned to either a 12-week aerobic-based interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness used the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, and cortical activation using fMRI during verbal fluency and motor tapping tasks. A battery of cognitive-executive and motor function tasks outside the scanning environment will be performed before and after the interventions. Results: Our studies and others show that improved cardiovascular fitness in older adults results in improved outcomes related to physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI, which corresponds with improved task performance (cognitive-executive and motor). We hypothesize that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR through a greater magnitude of reactivity in brain areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To differentiate between neural and vascular adaptations in these regions, we will map changes in basal perfusion and CVR over the inferior frontal and the motor cortices—regions we have previously shown to be beneficially altered during fMRI BOLD (blood oxygen level dependent), such as verbal fluency and motor tapping, through improved cardiovascular fitness. Conclusions: Exercise is one of the most impactful interventions for improving physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention is supported, it would add critically important insights into the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction. Trial Registration: ClinicalTrials.gov NCT05932069; https://clinicaltrials.gov/study/NCT05932069 International Registered Report Identifier (IRRID): DERR1-10.2196/58316 %M 39326042 %R 10.2196/58316 %U https://www.researchprotocols.org/2024/1/e58316 %U https://doi.org/10.2196/58316 %U http://www.ncbi.nlm.nih.gov/pubmed/39326042 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58714 %T Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study %A Happe,Lisa %A Sgraja,Marie %A Quinten,Vincent %A Förster,Mareike %A Diekmann,Rebecca %+ Junior Research Group “Nutrition and Physical Function in Older Adults”, Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, Oldenburg, 26127, Germany, 49 441 798 2354, lisa.happe@uol.de %K gerontechnology %K physical activity %K diet %K technical assistance system %K health data %K qualitative research %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ≥70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ≥70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants’ ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. %M 39288403 %R 10.2196/58714 %U https://aging.jmir.org/2024/1/e58714 %U https://doi.org/10.2196/58714 %U http://www.ncbi.nlm.nih.gov/pubmed/39288403 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53064 %T Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial %A Glavas,Costas %A Scott,David %A Sood,Surbhi %A George,Elena S %A Daly,Robin M %A Gvozdenko,Eugene %A de Courten,Barbora %A Jansons,Paul %+ Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 448776661, cglavas@deakin.edu.au %K older adults %K type 2 diabetes mellitus %K voice activation %K digital health %K exercise %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. Objective: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. Methods: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent–treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software (“Buddy Link”; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). Results: In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference –67, SD 23; 95% CI –113 to –21 min/d), which was represented by a medium to large effect size (d=–0.6). Conclusions: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true %M 39270212 %R 10.2196/53064 %U https://aging.jmir.org/2024/1/e53064 %U https://doi.org/10.2196/53064 %U http://www.ncbi.nlm.nih.gov/pubmed/39270212 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53727 %T Physical Activity Mobile App (CareFit) for Informal Carers of People With Dementia: Protocol for a Feasibility and Adaptation Study %A Egan,Kieren %A Macdonald,Bradley %A Hodgson,William %A Kirk,Alison %A Fawcett,Barbara %A Dunlop,Mark D %A Maguire,Roma %A Flynn,Greg %A Stott,Joshua %A Windle,Gill %+ Digital Health and Wellness Research Group (DHAWG), University of Strathclyde, Livingstone Tower, 26 Richmond St, Glasgow, G1 1XQ, United Kingdom, 44 141 548 3189, kieren.egan@strath.ac.uk %K carers %K dementia %K physical activity %K sedentary %K cross platform app %K caregivers %K mobile phone %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity is a critical component of both well-being and preventative health, reducing the risk of both chronic mental and physical conditions and early death. Yet, there are numerous groups in society who are not able to undertake as much physical activity as they would like to. This includes informal (unpaid) carers, with the United Kingdom national survey data suggesting that 81% would like to do more physical activity on a regular basis. There is a clear need to develop innovations, including digital interventions that hold implementation potential to support regular physical activity in groups such as carers. Objective: This study aims to expand and personalize a cross-platform digital health app designed to support regular physical activity in carers of people with dementia for a period of 8 weeks and evaluate the potential for implementation. Methods: The CareFit for dementia carers study was a mixed methods co-design, development, and evaluation of a novel motivational smartphone app to support home-based regular physical activity for unpaid dementia carers. The study was planned to take place across 16 months in total (September 1, 2022, to December 31, 2023). The first phase included iterative design sprints to redesign an initial prototype for widespread use, supported through a bespoke content management system. The second phase included the release of the “CareFit” app across Scotland through invitations on the Apple and Google stores where we aimed to recruit 50 carers and up to 20 professionals to support the delivery in total. Partnerships for the work included a range of stakeholders across charities, health and social care partnerships, physical activity groups, and carers’ organizations. We explored the implementation of CareFit, guided by both Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Complex Intervention Frameworks. Results: Project processes and outcomes were evaluated using mixed methods. The barriers and enablers for professional staff to signpost and use CareFit with clients were assessed through interviews or focus groups and round stakeholder meetings. The usability of CareFit was explored through qualitative interviews with carers and a system usability scale. We examined how CareFit could add value to carers by examining “in-app” data, pre-post questionnaire responses, and qualitative work, including interviews and focus groups. We also explored how CareFit could add value to the landscape of other online resources for dementia carers. Conclusions: Results from this study will contribute new knowledge including identifying (1) suitable pathways to identify and support carers through digital innovations; (2) future design of definitive studies in carer populations; and (3) an improved understanding of the Reach, Effectiveness, Adoption, Implementation, and Maintenance across a range of key stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/53727 %M 39265159 %R 10.2196/53727 %U https://www.researchprotocols.org/2024/1/e53727 %U https://doi.org/10.2196/53727 %U http://www.ncbi.nlm.nih.gov/pubmed/39265159 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56502 %T A Voice-Activated Device Exercise and Social Engagement Program for Older Adult–Care Partner Dyads: Pilot Clinical Trial and Focus Group Study Evaluating the Feasibility, Use, and Estimated Functional Impact of EngAGE %A Huisingh-Scheetz,Megan %A Nicholson III,Roscoe F %A Shervani,Saira %A Smith,Chelsea %A Danilovich,Margaret %A Finch,Laura %A Montoya,Yadira %A Hawkley,Louise C %+ Department of Medicine, University of Chicago, 5841 South Maryland Ave., Suite W707, MC 6098, Chicago, IL, 60637, United States, 1 7737028311, megan.huisingh-scheetz@bsd.uchicago.edu %K voice-activated device %K voice-activated devices %K frailty %K frail %K weak %K weakness %K technology %K activity %K physical activity %K exercise %K exercising %K caregiver %K caregivers %K caregiving %K caretaker %K caretakers %K caretaking %K care-giver %K care-givers %K care-giving %K care-taker %K care-takers %K care-taking %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K voice activation %K digital health %K technology %K exercises %K online exercises %K participatory design %K new devices %K health devices %K technology development %K mobile phone %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Maintaining exercise is essential for healthy aging but difficult to sustain. EngAGE is a socially motivated exercise program delivered over a voice-activated device that targets older adult–care partner dyads. Objective: This 10-week pilot study aimed to assess EngAGE feasibility and use, obtain user experience feedback, and estimate potential impact on function. Methods: In total, 10 older adults aged ≥65 years were recruited from an independent living residence together with their self-identified care partners. EngAGE delivered National Institute on Aging Go4Life exercises to older adults daily, while care partners received progress reports and prompts to send encouraging messages that were read aloud by the device to the older adult. Older adults’ use was tracked, and physical function was assessed at baseline and follow-up. Follow-up focus group data provided qualitative feedback. Results: On average, participants completed 393.7 individual exercises over the 10-week intervention period or 39.4 exercises/wk (range 48-492, median 431, IQR 384-481, SD 112.4) without injury and used EngAGE on an average of 41 of 70 days or 4.1 d/wk (range 7-66, median 51, IQR 23-56, and SD 21.2 days). Mean grip strength increased nonsignificantly by 1.3 kg (preintervention mean 26.3 kg, SD 11.0; postintervention mean 27.6 kg, SD 11.6; P=.34), and 4 of 10 participants improved by a minimal clinically important difference (MCID) of 2.5 kg. Further, the time for 5-repeated chair stands significantly reduced by 2.3 seconds (preintervention mean 12, SD 3.6 s; postintervention mean 9.7, SD 2.7 s; P=.02), and 3 of 9 participants improved by an MCID of –2.3 seconds. Furthermore, 3-meter usual walk performance was brisk at baseline (mean 2.1, SD 0.4 s) and decreased by 0.1 seconds (postintervention 2, SD 0.4 s; P=.13), although 5 of 9 participants improved by a MCID of 0.05 m/s. Qualitative results showed perceived benefits, favored program features, and areas for improvement. Conclusions: We present a pilot study of a new voice-activated device application customized to older adult users that may serve as a guide to other technology development for older adults. Our pilot study served to further refine the application and to inform a larger trial testing EngAGE’s impact on functional outcomes, a necessary step for developing evidence-based technology tools. %M 39265155 %R 10.2196/56502 %U https://aging.jmir.org/2024/1/e56502 %U https://doi.org/10.2196/56502 %U http://www.ncbi.nlm.nih.gov/pubmed/39265155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55079 %T Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial %A Bronas,Ulf G %A Marquez,David X %A Fritschi,Cynthia %A Petrarca,Katherine %A Kitsiou,Spyros %A Ajilore,Olu %A Tintle,Nathan %+ School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, United States, 1 2123055756, ub2154@cumc.columbia.edu %K sedentary time %K physical activity %K cognition %K older adults %K Latinos %K mobile phone %D 2024 %7 5.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. Objective: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. Methods: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. Results: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean –35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. Conclusions: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Trial Registration: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5 %M 39235836 %R 10.2196/55079 %U https://www.jmir.org/2024/1/e55079 %U https://doi.org/10.2196/55079 %U http://www.ncbi.nlm.nih.gov/pubmed/39235836 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57601 %T Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study %A Suffoletto,Brian %A Kim,David %A Toth,Caitlin %A Mayer,Waverly %A Glaister,Sean %A Cinkowski,Chris %A Ashenburg,Nick %A Lin,Michelle %A Losak,Michael %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K gait %K balance %K fall %K falls %K functional decline %K fall risk %K fall risks %K mobility %K phone %K sensors %K patient monitoring %K monitoring %K emergency department %K emergency departments %K ED %K emergency room %K ER %K discharge %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K prediction %K mobile phone %D 2024 %7 4.9.2024 %9 %J JMIR Aging %G English %X Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored. Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge. Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants’ perceptions of the app’s usability and safety. Results: Of the 617 approached patients, 149 (24.1%) consented to participate, and of these 149 participants, 9 (6%) dropped out. Overall, participants completed 55.6% (912/1639) of TUG tests. Data quality was optimal in 31.1% (508/1639) of TUG tests. At 3-month follow-up, 83.2% (99/119) of respondents found the app easy to use, and 95% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness. Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design. %R 10.2196/57601 %U https://aging.jmir.org/2024/1/e57601 %U https://doi.org/10.2196/57601 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e50066 %T The Rationale Behind the Design Decisions in an Augmented Reality Mobile eHealth Exergame to Increase Physical Activity for Inactive Older People With Heart Failure %A Berglund,Aseel %A Klompstra,Leonie %A Orädd,Helena %A Fallström,Johan %A Strömberg,Anna %A Jaarsma,Tiny %A Berglund,Erik %K sedentary %K exercise %K exertion %K exergames %K technology %K training %K inactivity %K eHealth application %K heart disease %K physical activity %D 2024 %7 21.8.2024 %9 %J JMIR Serious Games %G English %X Physical activity is important for everyone to maintain and improve health, especially for people with chronic diseases. Mobile exergaming has the potential to increase physical activity and to specifically reach people with poor activity levels. However, commercial mobile exergames are not specially designed for older people with chronic illnesses such as heart failure. The primary aim of this viewpoint is to describe the underlying reasoning guiding the design choices made in developing a mobile exergame, Heart Farming, tailored specifically for sedentary older people diagnosed with heart failure. The goal of the exergame is to increase physical activity levels by increasing the daily walking duration of patients with heart failure by at least 10 minutes. The rationale guiding the design decisions of the mobile exergame is grounded in the thoughtful integration of gamification strategies tailored for application in cardiovascular care. This integration is achieved through applying gamification components, gamification elements, and gamification principles. The Heart Farming mobile exergame is about helping a farmer take care of and expand a virtual farm, with these activities taking place while the patient walks in the real world. The exergame can be adapted to individual preferences and physical condition regarding where, how, when, and how much to play and walk. The exergame is developed using augmented reality so it can be played both indoors and outdoors. Augmented reality technology is used to track the patients’ movement in the real world and to interpret that movement into events in the exergame rather than to augment the mobile user interface. %R 10.2196/50066 %U https://games.jmir.org/2024/1/e50066 %U https://doi.org/10.2196/50066 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48787 %T Immersive and Nonimmersive Virtual Reality–Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis %A Lo,Hermione Hin Man %A Zhu,Mengting %A Zou,Zihui %A Wong,Cho Lee %A Lo,Suzanne Hoi Shan %A Chung,Vincent Chi-Ho %A Wong,Samuel Yeung-Shan %A Sit,Regina Wing Shan %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 209, Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China (Hong Kong), 852 2252 8452, reginasit@cuhk.edu.hk %K virtual reality %K VR %K physical therapy %K musculoskeletal %K pain %K physiotherapy %K chronic pain %K musculoskeletal pain %K low back pain %K neck pain %K osteoarthritis %K knee pain %K shoulder pain %K disability %K kinesiophobia %K arthritis %K systematic %K review methods %K review methodology %K immersive %K simulation %K simulations %D 2024 %7 19.8.2024 %9 Review %J J Med Internet Res %G English %X Background: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. Objective: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. Methods: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. Results: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] –1.79, 95% CI –2.72 to –0.87; P<.001), improving disability (SMD –0.44, 95% CI –0.72 to –0.16; P=.002), and kinesiophobia (SMD –2.94, 95% CI –5.20 to –0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD –8.15, 95% CI –15.29 to –1.01; P=.03), and kinesiophobia (SMD –4.28, 95% CI –8.12 to –0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD –0.55, 95% CI –1.02 to –0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias. Conclusions: Both nonimmersive and immersive VR–assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. Trial Registration: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302912 %M 39159449 %R 10.2196/48787 %U https://www.jmir.org/2024/1/e48787 %U https://doi.org/10.2196/48787 %U http://www.ncbi.nlm.nih.gov/pubmed/39159449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50075 %T Association of Wearable Device–Measured Step Volume and Variability With Blood Pressure in Older Chinese Adults: Mobile-Based Longitudinal Observational Study %A Xiao,Han %A Zhou,Zechen %A Ma,Yujia %A Li,Xiaoyi %A Ding,Kexin %A Dai,Xiaotong %A Chen,Dafang %+ Department of Epidemiology and Biostatistics, Peking University, 38 Xueyuan Road, Haidian, Beijing, 100191, China, 86 13701248872, hx624@ic.ac.uk %K older adults %K physical activity %K step volume %K step variability %K blood pressure %K wearable devices %K mHealth apps %K mobile health apps %K mobile phone %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The paucity of evidence on longitudinal and consecutive recordings of physical activity (PA) and blood pressure (BP) under real-life conditions and their relationships is a vital research gap that needs to be addressed. Objective: This study aims to (1) investigate the short-term relationship between device-measured step volume and BP; (2) explore the joint effects of step volume and variability on BP; and (3) examine whether the association patterns between PA and BP varied across sex, hypertension status, and chronic condition status. Methods: This study used PA data of a prospective cohort of 3070 community-dwelling older adults derived from a mobile health app. Daily step counts, as a proxy of step volume, were derived from wearable devices between 2018 and 2022 and categorized into tertiles (low, medium, and high). Step variability was assessed using the SD of daily step counts. Consecutive daily step count recordings within 0 to 6 days preceding each BP measurement were analyzed. Generalized estimation equation models were used to estimate the individual and joint associations of daily step volume and variability with BP. Stratified analyses by sex, the presence of hypertension, and the number of morbidities were further conducted. Results: A total of 3070 participants, with a median age of 72 (IQR 67-77) years and 71.37% (2191/3070) women, were included. Participants walked a median of 7580 (IQR 4972-10,653) steps and 5523 (IQR 3590-7820) meters per day for a total of 592,597 person-days of PA monitoring. Our results showed that higher levels of daily step volume were associated with lower BP (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure). Compared with participants with low step volume (daily step counts <6000/d) and irregular steps, participants with high step volume (≥9500/d) and regular steps showed the strongest decrease in systolic BP (–1.69 mm Hg, 95% CI –2.2 to –1.18), while participants with medium step volume (6000/d to <9500/d) and regular steps were associated with the lowest diastolic BP (–1.067 mm Hg, 95% CI –1.379 to –0.755). Subgroup analyses indicated generally greater effects on women, individuals with normal BP, and those with only 1 chronic disease, but the effect pattern was varied and heterogeneous between participants with different characteristics. Conclusions: Increased step volume demonstrated a substantial protective effect on BP among older adults with chronic conditions. Furthermore, the beneficial association between step volume and BP was enhanced by regular steps, suggesting potential synergistic protective effects of both increased step volume and step regularity. Targeting both step volume and variability through PA interventions may yield greater benefits in BP control, particularly among participants with hypertension and a higher chronic disease burden. %M 39141900 %R 10.2196/50075 %U https://www.jmir.org/2024/1/e50075 %U https://doi.org/10.2196/50075 %U http://www.ncbi.nlm.nih.gov/pubmed/39141900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47116 %T The Impact of a Gamified Intervention on Daily Steps in Real-Life Conditions: Retrospective Analysis of 4800 Individuals %A Mazéas,Alexandre %A Forestier,Cyril %A Harel,Guillaume %A Duclos,Martine %A Chalabaev,Aïna %+ Laboratoire Sport et Environnement Social (SENS), Université Grenoble Alpes, 1741 Rue de la Piscine, Grenoble, 38000, France, 33 476635081, alexandre.mazeas@univ-grenoble-alpes.fr %K behavior change %K daily steps %K exercise %K gamification %K intervention %K mHealth %K mobile health %K mobile phone %K physical activity %K real world data %K retrospective %K self-determination theory %K step %K steps %D 2024 %7 12.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts. Objective: This study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program. Methods: Data from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants’ characteristics were included in multilevel models to test the study objectives. Results: Participants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants’ initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect. Conclusions: In real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants’ initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants. %M 39133533 %R 10.2196/47116 %U https://www.jmir.org/2024/1/e47116 %U https://doi.org/10.2196/47116 %U http://www.ncbi.nlm.nih.gov/pubmed/39133533 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57402 %T Toward Safe and Confident Silver Drivers: Interview Study Investigating Older Adults’ Driving Practices %A Kim,Sunyoung %A Sivangula,Phaneendra %+ Department of Library and Information Science, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sk1897@comminfo.rutgers.edu %K older adults %K driving %K transportation %K healthy aging %K aging in place %K quality of life %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As the aging population in the United States continues to increase rapidly, preserving the mobility and independence of older adults becomes increasingly critical for enabling aging in place successfully. While personal vehicular transport remains a popular choice among this demographic due to its provision of independence and control over their lives, age-related changes may heighten the risk of common driving errors and diminish driving abilities. Objective: This study aims to investigate the driving practices of older adults and their efforts to maintain safe and confident driving habits. Specifically, we sought to identify the factors that positively and negatively influence older adults’ driving performance and confidence, as well as the existing efforts put into sustaining their driving abilities. Methods: We recruited 20 adults aged ≥65 years who remained active drivers during the recruitment from the greater New York area. Then, we conducted semistructured interviews with them to examine their perceptions, needs, and challenges regarding safe and confident driving. Results: Our findings uncovered a notable disparity between older adults’ self-perceived driving skills and the challenges they face, particularly caused by age-related limitations and health conditions such as vision and memory declines and medication routines. Drawing on these findings, we proposed strategies to bridge this gap and empower older adults to drive safely and confidently, including fostering a realistic understanding of their capabilities, encouraging open dialogue regarding their driving, encouraging regular assessments, and increasing awareness of available resources. Conclusions: This study uncovered a noticeable disparity between the perceived driving competence of older adults and the actual challenges they confront while driving. This divergence underscores a significant need for better support beyond the existing aid available to preserve older adults’ driving skills. We hope that our recommendations will offer valuable insights for practitioners and scholars committed to enhancing the overall well-being and quality of life for older adults as they age in their homes. %M 39133531 %R 10.2196/57402 %U https://aging.jmir.org/2024/1/e57402 %U https://doi.org/10.2196/57402 %U http://www.ncbi.nlm.nih.gov/pubmed/39133531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53145 %T Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial %A Philippi,Keito F A %A Zeier,Peter %A Brahmer,Alexandra %A Neuberger,Elmo W I %A Sandner,Magdalena %A Hagenah,Matthias %A Porten,Thilo %A Lenz,Regina %A Ochmann,David T %A Wedekink,Florian %A Wischhusen,Jörg %A Lutz,Beat %A Lieb,Klaus %A Wessa,Michèle %A Simon,Perikles %+ Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sports Science, Johannes Gutenberg-University Mainz, Albert-Schweitzer-Straße 22, Mainz, 55128, Germany, 49 6131 3923531, simonpe@uni-mainz.de %K physical exercise %K web-based %K COVID-19 %K lockdown %K aerobic capacity %K depression %K feasibility %K aerobic %K anxiety %K randomized controlled trial %K prepandemic cohort %K mental health %K pandemic %K remote exercise %K intervention %K pre-COVID-19 %K lockdown cohort %K pandemic-related %K adult %K adults %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. Objective: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre–COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. Methods: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre–COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre–COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre–COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants’ health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. Results: Dropout rates were low in both cohorts in the IG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre–COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre–COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. Conclusions: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. Trial Registration: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078 %M 39116428 %R 10.2196/53145 %U https://www.jmir.org/2024/1/e53145 %U https://doi.org/10.2196/53145 %U http://www.ncbi.nlm.nih.gov/pubmed/39116428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50063 %T The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure %A Berglund,Aseel %A Jaarsma,Tiny %A Orädd,Helena %A Fallström,Johan %A Strömberg,Anna %A Klompstra,Leonie %A Berglund,Erik %+ Department of Computer and Information Science, Linköping University, Linköping, Sweden, 46 732703862, aseel.berglund@liu.se %K mobile health apps %K physical activity %K exergames %K player-centered design %K heart failure %K human-computer interaction %K mobile phone %D 2024 %7 7.8.2024 %9 Viewpoint %J JMIR Form Res %G English %X Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework’s pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing. %M 39110976 %R 10.2196/50063 %U https://formative.jmir.org/2024/1/e50063 %U https://doi.org/10.2196/50063 %U http://www.ncbi.nlm.nih.gov/pubmed/39110976 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55693 %T Exploring Older Adults' Perceptions of Using Digital Health Platforms for Self-Managing Musculoskeletal Health Conditions: Focus Group Study %A Clohessy,Sophie %A Kempton,Christian %A Ryan,Kate %A Grinbergs,Peter %A Elliott,Mark T %+ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 1214142789, m.elliott.3@bham.ac.uk %K musculoskeletal %K digital health platform %K physiotherapy self-management %K digital triaging %K phone app %K qualitative %K focus group %K mobile phone %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies can assist and optimize health care processes. This is increasingly the case in the musculoskeletal health domain, where digital platforms can be used to support the self-management of musculoskeletal conditions, as well as access to services. However, given a large proportion of the population with musculoskeletal conditions are older adults (aged ≥60 years), it is important to consider the acceptability of such platforms within this demographic. Objective: This study aims to explore participants’ opinions and perceptions on the use of digital platforms for supporting the self-management of musculoskeletal conditions within older adult (aged ≥60 years) populations and to gather their opinions on real examples. Methods: A total of 2 focus groups (focus group 1: 6/15, 40%; focus group 2: 9/15, 60%) were conducted, in which participants answered questions about their thoughts on using digital health platforms to prevent or manage musculoskeletal conditions. Participants were further presented with 2 example scenarios, which were then discussed. Interviews were audio recorded, transcribed, and analyzed thematically. Participants were aged ≥60 years and with or without current musculoskeletal conditions. Prior experience of using smartphone apps or other digital health platforms for musculoskeletal conditions was not required. Focus groups took place virtually using the Teams (Microsoft Corp) platform. Results: A total of 6 themes were identified across both focus groups: “experiences of digital health platforms,” “preference for human contact,” “barriers to accessing clinical services,” “individual differences and digital literacy,” “trust in technology,” and “features and benefits of digital health technologies.” Each theme is discussed in detail based on the interview responses. The findings revealed that most participants had some existing experience with digital health platforms for preventing or managing musculoskeletal conditions. Overall, there was a lack of trust in and low expectations of quality for digital platforms for musculoskeletal health within this age group. While there was some concern about the use of digital platforms in place of in-person health consultations, several benefits were also identified. Conclusions: Results highlighted the need for better communication on the benefits of using digital platforms to support the self-management of musculoskeletal conditions, without the platforms replacing the role of the health care professionals. The concerns about which apps are of suitable quality and trustworthiness lead us to recommend raising public awareness around the role of organizations that verify and assess the quality of digital health platforms. %M 39088803 %R 10.2196/55693 %U https://aging.jmir.org/2024/1/e55693 %U https://doi.org/10.2196/55693 %U http://www.ncbi.nlm.nih.gov/pubmed/39088803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58174 %T Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis %A Shi,Beibei %A Li,Guangkai %A Wu,Shuang %A Ge,Hongli %A Zhang,Xianliang %A Chen,Si %A Pan,Yang %A He,Qiang %+ School of Physical Education, Shandong University, 17922 Jingshi Road, Lixia District, Shandong Province, Jinan, 250061, China, 86 0531 88395374, hq@sdu.edu.cn %K eHealth %K lifestyle risk behaviors %K older adults %K multiple health behavior change %K mobile phone %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. Objective: The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. Methods: The literature search was conducted in 6 electronic databases—PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus—from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. Results: A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD –0.23, 95% CI –0.33 to –0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Conclusions: eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult–oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418 %M 39083787 %R 10.2196/58174 %U https://www.jmir.org/2024/1/e58174 %U https://doi.org/10.2196/58174 %U http://www.ncbi.nlm.nih.gov/pubmed/39083787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54599 %T The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial %A Johnson,Joshua K. %A Longhurst,Jason K %A Gevertzman,Michael %A Jefferson,Corey %A Linder,Susan M %A Bethoux,Francois %A Stilphen,Mary %+ Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code M83-13, Cleveland, OH, 44915, United States, 1 2169030621, johnsoj8@ccf.org %K rehabilitation %K physical therapy %K PT %K physiotherapy %K telehealth %K Parkinson disease %K tele-rehabilitation %K telerehabilitation %K TR %K exercise %K physical activity %K exercise therapy %K tele-health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K Parkinson’s disease %K Parkinson %K Parkinsons %K Parkinsonism %K PD %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. Objective: The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. Methods: This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Results: Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non–study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as “good” or “very good” across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). Conclusions: High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. Trial Registration: ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747 %M 39083792 %R 10.2196/54599 %U https://formative.jmir.org/2024/1/e54599 %U https://doi.org/10.2196/54599 %U http://www.ncbi.nlm.nih.gov/pubmed/39083792 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56433 %T The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions %A Herold,Fabian %A Theobald,Paula %A Gronwald,Thomas %A Kaushal,Navin %A Zou,Liye %A de Bruin,Eling D %A Bherer,Louis %A Müller,Notger G %+ Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, Potsdam, 14476, Germany, 49 0331977213858, fabian.herold@uni-potsdam.de %K physical activity %K dementia prevention %K cognitive health %K hybrid: aging in place %K active %K exercises %K exercising %K healthy lifestyle %K dementia %K dementia onset %K dementia care %K preventive %K prevention %K cognitive health %K cognition %K cognitive %K hybrid %K hybrid model %D 2024 %7 31.7.2024 %9 Viewpoint %J JMIR Aging %G English %X A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas. %M 39083334 %R 10.2196/56433 %U https://aging.jmir.org/2024/1/e56433 %U https://doi.org/10.2196/56433 %U http://www.ncbi.nlm.nih.gov/pubmed/39083334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53450 %T A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial %A Wu,Yi-Chen %A Shen,Shu-Fen %A Chen,Liang-Kung %A Tung,Heng-Hsin %+ Department of Nursing,National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Pei-Tao district 112, Taipei, 11221, Taiwan, 886 0953005831, shannontung719@gmail.com %K geriatric population %K community-dwelling older adult %K web-based resilience-enhancing program %K resilience %K physical activity %K well-being %K pandemic. %D 2024 %7 25.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults’ independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. Objective: This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program’s strengths and limitations. Methods: A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. Results: A web-based participatory program enhancing 3 skills—coping, control belief, and manageability for resilience—was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=–4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI –10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI –24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI –2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. Conclusions: This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. Trial Registration: ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491 %M 39052335 %R 10.2196/53450 %U https://www.jmir.org/2024/1/e53450 %U https://doi.org/10.2196/53450 %U http://www.ncbi.nlm.nih.gov/pubmed/39052335 %0 Journal Article %@ 2291-9279 %I %V 12 %N %P e52231 %T Impact of Fruit and Vegetable Enzyme Supplementation on Aerobic Performance and Lactate Response in Older Adults Following High-Intensity Interval Exercise Through Exergaming: Randomized Experimental Matched-Pair Study %A Lin,Shu-Cheng %A Wang,Chien-Yen %A Hou,Tien-Hung %A Chen,Hong-Ching %A Wang,Chia-Chi %K Ring Fit Adventure %K training load %K older adult training %K training impulse %K food supplement %K older adults %K exergames %K exergame %K Taiwan %K female %K fruits %K vegetables %K blood lactate %K exercise %K feasibility %K aerobic %K enzymes %K enzyme %K female older adults %K fitness %K food intake %K diet %K exergaming %K enzyme supplements %K older adults training %K female older adult %K older adult %D 2024 %7 25.6.2024 %9 %J JMIR Serious Games %G English %X Background: Exercise offers substantial health benefits but can induce oxidative stress and inflammation, especially in high-intensity formats such as high-intensity interval exercise (HIIE). Exergaming has become an effective, enjoyable fitness tool for all ages, particularly older adults. Enzyme supplements may enhance exercise performance by improving lactate metabolism and reducing oxidative stress. Objective: This study investigates the efficacy of fruit and vegetable enzyme supplementation in modulating fatigue and enhancing aerobic capacity in older adults following HIIE through exergaming. Methods: The study recruited 16 older adult female participants and allocated them into 2 distinct groups (enzyme and placebo) based on their pretest lactate levels. This division used pairwise grouping to guarantee comparability between the groups, ensuring the integrity of the results. They engaged in HIIE using Nintendo Switch Ring Fit Adventure, performing 8 sets of 20 seconds of maximum effort exercise interspersed with 30 seconds of rest, totaling 370 seconds of exercise. Key metrics assessed included blood lactate levels, heart rate, rating of perceived exertion, and training impulse. Participants in the enzyme group were administered a fruit and vegetable enzyme supplement at a dosage of 30 mL twice daily over a period of 14 days. Results: The enzyme group showed significantly lower blood lactate levels compared to the placebo group, notably after the fourth (mean 4.29, SD 0.67 vs mean 6.34, SD 1.17 mmol/L; P=.001) and eighth (mean 5.84, SD 0.63 vs mean 8.20, SD 1.15 mmol/L; P<.001) exercise sessions. This trend continued at 5 minutes (mean 6.85, SD 0.82 vs mean 8.60, SD 1.13 mmol/L; P=.003) and 10 minutes (mean 5.91, SD 1.16 vs mean 8.21, SD 1.27 mmol/L; P=.002) after exercise. Although both groups exceeded 85% of their estimated maximum heart rate during the exercise, enzyme supplementation did not markedly affect the perceived intensity or effort. Conclusions: The study indicates that fruit and vegetable enzyme supplementation can significantly reduce blood lactate levels in older adults following HIIE through exergaming. This suggests a potential role for these enzymes in modulating lactate production or clearance during and after high-intensity exercise. These findings have implications for developing targeted interventions to enhance exercise tolerance and recovery in older adults. Trial Registration: ClinicalTrials.gov NCT06466408; https://clinicaltrials.gov/study/NCT06466408 %R 10.2196/52231 %U https://games.jmir.org/2024/1/e52231 %U https://doi.org/10.2196/52231 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56357 %T Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study %A Chien,Shih-Ying %A Wong,Alice MK %A Wu,Ching-Yi %A Beckman,Sara L %+ Department of Industrial Design, Chang Gung University, No.259, Wen-Hwa 1st Road, Kweishan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5669, shihying@mail.cgu.edu.tw %K interactive electronic pegboard %K stroke %K hand dexterity %K cognitive rehabilitation %K system %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants’ attention, executive functioning, and cognitive abilities. Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients’ cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care. %M 38904991 %R 10.2196/56357 %U https://humanfactors.jmir.org/2024/1/e56357 %U https://doi.org/10.2196/56357 %U http://www.ncbi.nlm.nih.gov/pubmed/38904991 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46072 %T Adherence to 24-Hour Movement Guidelines Among Chinese Older Adults: Prevalence, Correlates, and Associations With Physical and Mental Health Outcomes %A Liang,Wei %A Wang,Yanping %A Huang,Qian %A Shang,Borui %A Su,Ning %A Zhou,Lin %A Rhodes,Ryan E %A Baker,Julien Steven %A Duan,Yanping %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, 15 Baptist Road, Kowloon Tong, Hong Kong, 999077, China (Hong Kong), 852 34113038, duanyp@hkbu.edu.hk %K physical activity %K sedentary behavior %K sleep %K cardiometabolic indicators %K physical fitness %K mental health %K post–COVID-19 era %K older adults %K COVID-19 %K systolic blood pressure %K diastolic blood pressure %K depression %K loneliness %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is known that 24-hour movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are crucial components affecting older adults’ health. Canadian 24-hour movement guidelines for older adults were launched in 2020, emphasizing the combined role of these 3 movement behaviors in promoting older adults’ health. However, research on the prevalence and correlates of guideline adherence and its associations with health-related outcomes is limited, especially among Chinese older adults. Objective: This study aimed to investigate the prevalence and correlates of meeting 24-hour movement guidelines among Chinese older adults. Furthermore, this study aimed to examine the associations of guideline adherence with older adults’ physical and mental health outcomes. Methods: Using a stratified cluster random sampling approach, a total of 4562 older adults (mean age 67.68 years, SD 5.03 years; female proportion: 2544/4562, 55.8%) were recruited from the latest provincial health surveillance of Hubei China from July 25 to November 19, 2020. Measures included demographics, movement behaviors (PA, SB, and sleep), BMI, waist circumference, waist-hip ratio (WHR), percentage body fat (PBF), systolic and diastolic blood pressure, physical fitness, depressive symptoms, and loneliness. Generalized linear mixed models were employed to examine the associations between variables using SPSS 28.0 (IBM Corp). Results: Only 1.8% (83/4562) of participants met all 3 movement guidelines, while 32.1% (1466/4562), 3.4% (155/4562), and 66.4% (3031/4562) met the individual behavioral guidelines for PA, SB, and sleep, respectively. Participants who were older, were female, and lived in municipalities with lower economic levels were less likely to meet all 3 movement guidelines. Adhering to individual or combined movement guidelines was associated with greater physical fitness and lower values of BMI, waist circumference, WHR, PBF, depressive symptoms, and loneliness, with the exception of the relationship of SB+sleep guidelines with loneliness. Furthermore, only meeting SB guidelines or meeting both PA and SB guidelines was associated with lower systolic blood pressure. Conclusions: This is the first study to investigate adherence to 24-hour movement guidelines among Chinese older adults with regard to prevalence, correlates, and associations with physical and mental health outcomes. The findings emphasize the urgent need for promoting healthy movement behaviors among Chinese older adults. Future interventions to improve older adults’ physical and mental health should involve enhancing their overall movement behaviors and should consider demographic differences. %M 38869941 %R 10.2196/46072 %U https://publichealth.jmir.org/2024/1/e46072 %U https://doi.org/10.2196/46072 %U http://www.ncbi.nlm.nih.gov/pubmed/38869941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49482 %T Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis %A Pliannuom,Suphawita %A Pinyopornpanish,Kanokporn %A Buawangpong,Nida %A Wiwatkunupakarn,Nutchar %A Mallinson,Poppy Alice Carson %A Jiraporncharoen,Wichuda %A Angkurawaranon,Chaisiri %+ Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand, 66 53935462, kanokporn.pinyopo@cmu.ac.th %K home-based intervention %K digital health interventions %K postoperative care %K older adults %K hip fracture %D 2024 %7 12.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. Objective: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results: Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=–7.89; 95% CI –10.34 to –5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). Conclusions: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population. %M 38865706 %R 10.2196/49482 %U https://www.jmir.org/2024/1/e49482 %U https://doi.org/10.2196/49482 %U http://www.ncbi.nlm.nih.gov/pubmed/38865706 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53548 %T Sleep Duration and Functional Disability Among Chinese Older Adults: Cross-Sectional Study %A Luo,Minjing %A Dong,Yue %A Fan,Bingbing %A Zhang,Xinyue %A Liu,Hao %A Liang,Changhao %A Rong,Hongguo %A Fei,Yutong %+ Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No.11 Bei San Huan Dong Road, Chaoyang District, Beijing, 100026, China, 86 86 10 6428 6757, feiyt@bucm.edu.cn %K sleep duration %K functional disability %K activity of daily living disability %K instrumental activity of daily living %K older population %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The duration of sleep plays a crucial role in the development of physiological functions that impact health. However, little is known about the associations between sleep duration and functional disability among older adults in China. Objective: This study aimed to explore the associations between sleep duration and functional disabilities in the older population (aged≥65 years) in China. Methods: The data for this cross-sectional study were gathered from respondents 65 years and older who participated in the 2018 survey of the China Health and Retirement Longitudinal Study, an ongoing nationwide longitudinal investigation of Chinese adults. The duration of sleep per night was obtained through face-to-face interviews. Functional disability was assessed according to activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. The association between sleep duration and functional disability was assessed by multivariable generalized linear models. A restricted cubic-spline model was used to explore the dose-response relationship between sleep duration and functional disability. Results: In total, 5519 participants (n=2471, 44.77% men) were included in this study with a mean age of 73.67 years, including 2800 (50.73%) respondents with a functional disability, 1978 (35.83%) with ADL disability, and 2299 (41.66%) with IADL disability. After adjusting for potential confounders, the older adults reporting shorter (≤4, 5, or 6 hours) or longer (8, 9, or ≥10 hours) sleep durations per night exhibited a notably increased risk of functional disability compared to that of respondents who reported having 7 hours of sleep per night (all P<.05), which revealed a U-shaped association between sleep duration and dysfunction. When the sleep duration fell below 7 hours, increased sleep duration was associated with a significantly lower risk of functional disability (odds ratio [OR] 0.85, 95% CI 0.79-0.91; P<.001). When the sleep duration exceeded 7 hours, the risk of functional disability associated with a prolonged sleep duration increased (OR 1.16, 95% CI 1.05-1.29; P<.001). Conclusions: Sleep durations shorter and longer than 7 hours were associated with a higher risk of functional disability among Chinese adults 65 years and older. Future studies are needed to explore intervention strategies for improving sleep duration with a particular focus on functional disability. %M 38771907 %R 10.2196/53548 %U https://aging.jmir.org/2024/1/e53548 %U https://doi.org/10.2196/53548 %U http://www.ncbi.nlm.nih.gov/pubmed/38771907 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53020 %T Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study %A Mc Ardle,Ríona %A Taylor,Lynne %A Cavadino,Alana %A Rochester,Lynn %A Del Din,Silvia %A Kerse,Ngaire %K residential aged care facility %K cognitive dysfunction %K mobility limitation %K accelerometry %K physical activity %K aged residential care %D 2024 %7 4.6.2024 %9 %J JMIR Aging %G English %X Background: Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity. Objective: This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities. Methods: A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants’ cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large). Results: Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity. Conclusions: ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001827224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376298&isReview=true %R 10.2196/53020 %U https://aging.jmir.org/2024/1/e53020 %U https://doi.org/10.2196/53020 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53141 %T Three Perspectives on Older Adults’ Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study %A Cohen Elimelech,Ortal %A Rosenblum,Sara %A Tsadok-Cohen,Michal %A Meyer,Sonya %A Ferrante,Simona %A Demeter,Naor %K daily activity %K health %K technology use %K older adult %K qualitative study %K focus group %K COVID-19 %D 2024 %7 30.5.2024 %9 %J JMIR Aging %G English %X Background: During COVID-19 lockdowns, older adults’ engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults’ social environments—including their families and health professionals—in influencing their technology use, research into their unique perspectives is lacking. Objective: This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ≥65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults’ family members, and health professionals. Methods: Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods. Results: The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19–related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology’s transformative power, focusing on the need for technology to get engaged in daily activities. Conclusions: This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology’s uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults’ needs and preferences by focusing on motivational and preference-related activities. %R 10.2196/53141 %U https://aging.jmir.org/2024/1/e53141 %U https://doi.org/10.2196/53141 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49790 %T Relationship Between Physical Exercise and Cognitive Function Among Older Adults in China: Cross-Sectional Population-Based Study %A Wang,Fubaihui %A Gao,Changqing %A Wang,Yantao %A Li,Zhuo %A Zheng,Feiran %A Luo,Yanan %+ Department of Global Health, School of Public Health, Peking University, No 38 Xuyuan Road, Haidian District, Beijing, 100191, China, 86 18519621115, luoyanan@bjmu.edu.cn %K cognitive function %K exercise %K physical activity %K mindfulness %K cognitive exercise %K mind stimulation %K dementia treatment %K cognitive intervention %K cognitive treatment %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The existing literature reveals several significant knowledge gaps that hinder health care providers in formulating exercise prescriptions for cognitive health. Objective: This study endeavors to elucidate the relationship between the level of physical activity and cognitive function in older adults in China. Moreover, it seeks to explore the associations between distinct exercise behaviors—such as exercise types, the purpose motivating engagement in exercise, the accessibility of exercise fields, and the inclination toward exercise—and cognitive function. Methods: Using data from the China Longitudinal Aging Social Survey (CLASS conducted in 2016, cognitive function was meticulously assessed through the modified Chinese version of the Mini-Mental State Examination, encompassing measures of orientation, memory, and calculation. Using self-report structured questionnaires, a myriad of information about physical activity during leisure time, exercise engagement, exercise intensity, primary exercise types, reasons for exercise participation, availability of sports facilities, and exercise willingness was diligently gathered. Robust ordinary least squares regression models were then used to compute coefficients along with 95% CIs. Results: A discernible inverted U-shaped trend in cognitive scores emerged as the level of physical activity surpassed the threshold of 500 metabolic equivalents of task (MET) minutes per week. Notably, individuals with a physical activity level between 500 and 999 MET minutes per week exhibited a coefficient of 0.31 (95% CI 0.09 to 0.54), those with a physical activity level between 1000 and 1499 MET minutes per week displayed a coefficient of 0.75 (95% CI 0.52 to 0.97), and those with a physical activity level above 1500 MET minutes per week demonstrated a coefficient of 0.45 (95% CI 0.23 to 0.68). Older individuals engaging in exercise at specific MET levels showcased superior cognitive function compared to their inactive counterparts. Furthermore, individuals driven by exercise motivations aimed at enhancing physical fitness and health, as well as those using sports facilities or public spaces for exercise, exhibited notably higher cognitive function scores. Conclusions: The findings underscore the potential of exercise as a targeted intervention for the prevention and treatment of dementia or cognitive decline associated with aging in older individuals. Leveraging these insights to formulate informed exercise recommendations holds promise in addressing a significant public health challenge linked to aging populations. %M 38815262 %R 10.2196/49790 %U https://publichealth.jmir.org/2024/1/e49790 %U https://doi.org/10.2196/49790 %U http://www.ncbi.nlm.nih.gov/pubmed/38815262 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56184 %T Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial %A Tabira,Kento %A Oguma,Yuko %A Yoshihara,Shota %A Shibuya,Megumi %A Nakamura,Manabu %A Doihara,Natsue %A Hirata,Akihiro %A Manabe,Tomoki %+ Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-0061, Japan, 81 45 566 1090, yoguma@keio.jp %K physical activity %K physical function %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K digital peer support app %K mHealth %K mobile health %K app %K apps %K application %K applications %K eHealth %K peer support %K exercise %K mobile phone %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support–based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. Objective: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. Methods: We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. Results: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. Conclusions: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials. %M 38814686 %R 10.2196/56184 %U https://aging.jmir.org/2024/1/e56184 %U https://doi.org/10.2196/56184 %U http://www.ncbi.nlm.nih.gov/pubmed/38814686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53587 %T Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial %A Shashidhara,Y N %A Raghavendra,G %A P Kundapur,Poornima %A Binil,V %+ Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Madhava Nagar, Manipal, 576104, India, 91 9880328604, rag.wgsha@manipal.edu %K gerontechnology %K older adults %K awareness %K older people %K instrumental activities of daily living %K iADLs %K mobile apps %K mobile phone %K empowerment %D 2024 %7 13.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults’ quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. Objective: The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. Methods: This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults’ use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. Results: This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Conclusions: Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Trial Registration: Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977 International Registered Report Identifier (IRRID): DERR1-10.2196/53587 %M 38739442 %R 10.2196/53587 %U https://www.researchprotocols.org/2024/1/e53587 %U https://doi.org/10.2196/53587 %U http://www.ncbi.nlm.nih.gov/pubmed/38739442 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52575 %T Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study %A Kikkenborg,Julie %A Magelund,Emma %A Riise,Maria Silke %A Kayser,Lars %A Terp,Rikke %+ Section of Health Service Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth %K self-management %K fall prevention %K older adults %K physical activity %K nutritional intake %K Readiness and Enablement Index for Health Technology %K READHY %K social support %K support %K management %K fall %K nutrition %K diet %K qualitative study %K malnutrition %K physical inactivity %K injury %K injuries %K food %K food intake %K nutritional needs %K outpatient clinic %K social network %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: More than one-third of older adults (aged ≥65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults’ self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults’ needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. Objective: This qualitative study aims to explore older adults’ use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Methods: Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. Results: The qualitative data showed that the informants’ social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Conclusions: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals. %M 38717810 %R 10.2196/52575 %U https://humanfactors.jmir.org/2024/1/e52575 %U https://doi.org/10.2196/52575 %U http://www.ncbi.nlm.nih.gov/pubmed/38717810 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55211 %T Association of Rest-Activity Rhythm and Risk of Developing Dementia or Mild Cognitive Impairment in the Middle-Aged and Older Population: Prospective Cohort Study %A Haghayegh,Shahab %A Gao,Chenlu %A Sugg,Elizabeth %A Zheng,Xi %A Yang,Hui-Wen %A Saxena,Richa %A Rutter,Martin K %A Weedon,Michael %A Ibanez,Agustin %A Bennett,David A %A Li,Peng %A Gao,Lei %A Hu,Kun %+ Massachusetts General Hospital, 149 13th Street, 4th Floor, Boston, MA, 02129, United States, 1 5129543436, shaghayegh@mgh.harvard.edu %K circadian rhythm %K dementia %K actigraphy %K cognitive decline %K RAR %K rest-activity rhythms %K cognitive impairment %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The relationship between 24-hour rest-activity rhythms (RARs) and risk for dementia or mild cognitive impairment (MCI) remains an area of growing interest. Previous studies were often limited by small sample sizes, short follow-ups, and older participants. More studies are required to fully explore the link between disrupted RARs and dementia or MCI in middle-aged and older adults. Objective: We leveraged the UK Biobank data to examine how RAR disturbances correlate with the risk of developing dementia and MCI in middle-aged and older adults. Methods: We analyzed the data of 91,517 UK Biobank participants aged between 43 and 79 years. Wrist actigraphy recordings were used to derive nonparametric RAR metrics, including the activity level of the most active 10-hour period (M10) and its midpoint, the activity level of the least active 5-hour period (L5) and its midpoint, relative amplitude (RA) of the 24-hour cycle [RA=(M10-L5)/(M10+L5)], interdaily stability, and intradaily variability, as well as the amplitude and acrophase of 24-hour rhythms (cosinor analysis). We used Cox proportional hazards models to examine the associations between baseline RAR and subsequent incidence of dementia or MCI, adjusting for demographic characteristics, comorbidities, lifestyle factors, shiftwork status, and genetic risk for Alzheimer's disease. Results: During the follow-up of up to 7.5 years, 555 participants developed MCI or dementia. The dementia or MCI risk increased for those with lower M10 activity (hazard ratio [HR] 1.28, 95% CI 1.14-1.44, per 1-SD decrease), higher L5 activity (HR 1.15, 95% CI 1.10-1.21, per 1-SD increase), lower RA (HR 1.23, 95% CI 1.16-1.29, per 1-SD decrease), lower amplitude (HR 1.32, 95% CI 1.17-1.49, per 1-SD decrease), and higher intradaily variability (HR 1.14, 95% CI 1.05-1.24, per 1-SD increase) as well as advanced L5 midpoint (HR 0.92, 95% CI 0.85-0.99, per 1-SD advance). These associations were similar in people aged <70 and >70 years, and in non–shift workers, and they were independent of genetic and cardiovascular risk factors. No significant associations were observed for M10 midpoint, interdaily stability, or acrophase. Conclusions: Based on findings from a large sample of middle-to-older adults with objective RAR assessment and almost 8-years of follow-up, we suggest that suppressed and fragmented daily activity rhythms precede the onset of dementia or MCI and may serve as risk biomarkers for preclinical dementia in middle-aged and older adults. %M 38713911 %R 10.2196/55211 %U https://publichealth.jmir.org/2024/1/e55211 %U https://doi.org/10.2196/55211 %U http://www.ncbi.nlm.nih.gov/pubmed/38713911 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52898 %T Gait Features in Different Environments Contributing to Participation in Outdoor Activities in Old Age (GaitAge): Protocol for an Observational Cross-Sectional Study %A Rantakokko,Merja %A Matikainen-Tervola,Emmi %A Aartolahti,Eeva %A Sihvonen,Sanna %A Chichaeva,Julija %A Finni,Taija %A Cronin,Neil %+ Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, PO BOX 35 (viv), Jyväskylä, 40014, Finland, 358 503016860, merja.h.rantakokko@jyu.fi %K walking %K aging %K environment %K biomechanics %K kinematics %K spatiotemporal %K gait %K GaitAge %K observational cross-sectional study %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K health disparities %K health disparity %K assessment %K assessments %K physical test %K physical tests %K interview %K interviews %K biomechanic %K activities %K outdoor %K activity %K movement analysis %K analysis of walk %K posture %K free living %D 2024 %7 29.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ability to walk is a key issue for independent old age. Optimizing older peoples’ opportunities for an autonomous and active life and reducing health disparities requires a better understanding of how to support independent mobility in older people. With increasing age, changes in gait parameters such as step length and cadence are common and have been shown to increase the risk of mobility decline. However, gait assessments are typically based on laboratory measures, even though walking in a laboratory environment may be significantly different from walking in outdoor environments. Objective: This project will study alterations in biomechanical features of gait by comparing walking on a treadmill in a laboratory, level outdoor, and hilly outdoor environments. In addition, we will study the possible contribution of changes in gait between these environments to outdoor mobility among older people. Methods: Participants of the study were recruited through senior organizations of Central Finland and the University of the Third Age, Jyväskylä. Inclusion criteria were community-dwelling, aged 70 years and older, able to walk at least 1 km without assistive devices, able to communicate, and living in central Finland. Exclusion criteria were the use of mobility devices, severe sensory deficit (vision and hearing), memory impairment (Mini-Mental State Examination ≤23), and neurological conditions (eg, stroke, Parkinson disease, and multiple sclerosis). The study protocol included 2 research visits. First, indoor measurements were conducted, including interviews (participation, health, and demographics), physical performance tests (short physical performance battery and Timed Up and Go), and motion analysis on a treadmill in the laboratory (3D Vicon and next-generation inertial measurement units [NGIMUs]). Second, outdoor walking tests were conducted, including walking on level (sports track) and hilly (uphill and downhill) terrain, while movement was monitored via NGIMUs, pressure insoles, heart rate, and video data. Results: A total of 40 people (n=26, 65% women; mean age 76.3, SD 5.45 years) met the inclusion criteria and took part in the study. Data collection took place between May and September 2022. The first result is expected to be published in the spring of 2024. Conclusions: This multidisciplinary study will provide new scientific knowledge about how gait biomechanics are altered in varied environments, and how this influences opportunities to participate in outdoor activities for older people. International Registered Report Identifier (IRRID): RR1-10.2196/52898 %M 38684085 %R 10.2196/52898 %U https://www.researchprotocols.org/2024/1/e52898 %U https://doi.org/10.2196/52898 %U http://www.ncbi.nlm.nih.gov/pubmed/38684085 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e36154 %T Understanding Senior Adults’ Needs, Preferences, and Experiences of Commercial Exergames for Health: Usability Study %A Wang,Yu-Han %+ Department of Multimedia Design, National Taichung University of Science and Technology, No 129, Section 3, Sanmin Road, North District, Taichung City, 404336, Taiwan, 886 422196699, han@gm.nutc.edu.tw %K exergame %K senior user experience %K senior technology acceptance %K game technology %K psychological perception %K serious games %K exercise %K aging %K older adults %K physical activity %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many senior adults are at risk of mental and physical disorders due to a lack of sufficient exercise. Therefore, adherent exercise should be urgently promoted to improve senior adults’ muscle strength, preventing falls and conditions caused by physical and cognitive decline. However, off-the-shelf exercise games, so-called exergames, are mainly targeted at the younger generation or children, while senior adults are neglected, when this age group strongly needs exercise. Exergames could serve as a health intervention for promoting exercise. Objective: This study aimed to investigate senior adults’ experience, perceptions, and acceptance of game technology to promote exercise in order to suggest game design guidelines. Methods: In this usability study, participants engaged in playing Nintendo Switch and Xbox Kinect games, after which semistructured interviews were conducted. Before the gameplay, the participants provided their background information, exercise habits, and use of technology products. Next, all participants completed a workshop including 3 activities (brief instructions on how to play the games: 20 minutes; playing the selected exergames: 80 minutes; semistructured interviews: 20 minutes) for 2 hours a day for 3 days each. The participants played the latest Nintendo Switch games (eg, Just Dance, Boxing, Ring Fit Adventure) and Xbox Kinect games (eg, Kinect Adventures!, Mini Games). Just Dance, Zumba, and Boxing were played in activity 1; Ring Fit Adventure and Mini Games in activity 2; and Kinect Adventures! in activity 3. Reflexive thematic analysis was applied to identify the relative themes generated from the interviews. Results: In total, 22 participants (mean age 70.4, SD 6.1 years) were enrolled in the workshop in May 2021. The results of the generated themes included incomprehension of game instructions, psychological perception of game technology, and game art preferences. The subthemes generated from game art preferences included favorite game genres, characters, and scenes. Conclusions: There is a significant need for customized game tutorials considering senior adults’ cognitive and physical aging. Furthermore, the adventure game genre is preferable to other games. Humanlike game characters are preferable, especially those with a fit and healthy body shape. Nature scenes are more enjoyable than indoor stages or rooms. Furthermore, the game intensity design and playing time should be carefully planned to meet the World Health Organization’s criteria for physical activity in older adults. Intelligent recommendation systems might be helpful to support older adults with various health conditions. The guidelines suggested in this study might be beneficial for game design, exercise training, and game technology adoption of exergames for older adults to improve health. %M 38578674 %R 10.2196/36154 %U https://games.jmir.org/2024/1/e36154 %U https://doi.org/10.2196/36154 %U http://www.ncbi.nlm.nih.gov/pubmed/38578674 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51462 %T Development and Evaluation of a Community Health Program to Promote Physical Activity Among Vulnerable Community-Dwelling Older Adults: Protocol for a Prospective Cohort Study %A Auerswald,Tina %A Zwingmann,Katharina %A Schlesinger,Torsten %A Müller,Katrin %+ Institute of Human Movement Science and Health, Chemnitz University of Technology, Thüringer Weg 11, Chemnitz, 09126, Germany, 49 371 531 33, tina.auerswald@hsw.tu-chemnitz.de %K acceptance %K ageing %K aging %K cognitive %K cohort %K communal health promotion %K community based %K community dwelling %K community-dwelling older adults %K elder %K elderly %K exercise %K feasibility %K geriatric %K gerontology %K observational %K older adult %K older people %K older person %K physical activity %K psychosocial health %K psychosocial %K vulnerable %D 2024 %7 20.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vulnerable older adults have a high risk of morbidity and mortality. Regular physical activity (PA) can have a positive effect on the health and health-related behavior of this specific target group. However, evidence of the impact and feasibility of community-based PA promotion interventions for vulnerable older adults is still limited. Objective: The BeTaSen (Bewegungs-Tandems in den Lebenswelten Chemnitzer Seniorinnen und Senioren: ein Beitrag zur kommunalen Gesundheitsförderung) study aims to evaluate the (1) impact as well as the (2) feasibility, acceptance, and usefulness of a 12-month low-threshold PA intervention program for community-dwelling vulnerable older adults. Methods: For our population-based prospective observational cohort study, a total of 120 vulnerable older adults (aged 75 years or older) in the area of Chemnitz (Germany) will be recruited to participate in (1) weekly neighborhood-based low-threshold PA meetings with trained mentors (activity tandems) and (2) monthly exercise meetings led by trained exercise instructors. Within the intervention, participants will be encouraged to perform the PA independently. Participants will complete assessments, which will include questionnaires as well as objective measurements of their physical, cognitive, and psychosocial health at 3 different time points (baseline, 6 months after the start, and 6 months after the end of the intervention). Additionally, a process evaluation will be performed, including questionnaires and qualitative interviews, involving the participants, mentors, and municipal project partner representatives. Results: The BeTaSen project process began in October 2021, with the start of data collection and intervention in August 2022 in the first neighborhoods of the city of Chemnitz. A total of 86 participants were recruited at the time of submission of the manuscript. Longitudinal results are expected by 2025. Conclusions: This study’s results will provide insights on (1) the PA behavior of vulnerable older adults as well as the impact of PA interventions on health-related outcomes such as cognitive, physical, and psychosocial health, and (2) the feasible and useful components of community-based PA interventions. Thus, this pilot study contributes to future recommendations and provides a basis for further research, such as the development of feasible and sustainable target group–specific interventions in community settings. International Registered Report Identifier (IRRID): DERR1-10.2196/51462 %M 38376903 %R 10.2196/51462 %U https://www.researchprotocols.org/2024/1/e51462 %U https://doi.org/10.2196/51462 %U http://www.ncbi.nlm.nih.gov/pubmed/38376903 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53010 %T Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions %A Dawson,Rik %A Gilchrist,Heidi %A Pinheiro,Marina %A Nelson,Karn %A Bowes,Nina %A Sherrington,Cathie %A Haynes,Abby %+ Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, PO Box M179, Missenden Road, Missenden Road, Camperdown, 2050, Australia, 61 403895186, rik.dawson@sydney.edu.au %K physiotherapy %K telehealth %K telephysiotherapy %K exercise %K aged care %K qualitative methods %K behavior change %K technology %K virtual care %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. Objective: This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. Methods: A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders’ experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. Results: All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult–friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom’s convenience, use of tailored web-based exercise resources, and companionable local support. Conclusions: This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult–friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864 %M 38324369 %R 10.2196/53010 %U https://aging.jmir.org/2024/1/e53010 %U https://doi.org/10.2196/53010 %U http://www.ncbi.nlm.nih.gov/pubmed/38324369 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43366 %T Digital Group–Based Intervention for Physical Activity Promotion Among Thai Adults During the COVID-19 Lockdown: Randomized Controlled Trial %A Pomkai,Nanthawan %A Katewongsa,Piyawat %A Chamratrithirong,Aphichat %A Tharawan,Kanokwan %A Sakulsri,Teeranong %A Samutachak,Bhubate %A Widyastari,Dyah Anantalia %A Rasri,Niramon %A Wijarn,Boonyanuch %A Wongsawat,Yodchanan %+ Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Nakhon Pathom, 73170, Thailand, 66 875459998, piyawat.kat@mahidol.edu %K physical activity %K digital group–based activity %K collective action %K Thai adults %K COVID-19 pandemic %K COVID-19 %K design %K model %K effectiveness %K digital %K Thailand %K behavior %D 2024 %7 31.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic significantly diminished the physical activity (PA) level of Thai adults belonging to Generation Y (Gen Y). As a response to the global crisis, many individuals worldwide have turned to social community platforms, recognizing their potential in promoting PA during the pandemic. Gen Y, in particular, demonstrates exceptional proficiency in using social media platforms, showcasing a remarkable aptitude for swiftly accessing new information and knowledge. However, their proclivity for reckless behavior exposes them to various health risks, potentially leading to enduring adverse health consequences. Consequently, there arises a pressing need to develop a comprehensive model aimed at elevating the PA levels among individuals belonging to Gen Y. Objective: This research aimed to examine the effectiveness of a digital group–based activity in promoting PA among Gen Y in Thailand. Methods: This was a parallel 2-arm randomized controlled trial with single-blind allocation to experimental and control groups and pre- and posttest measurements. Measurements were administered on the web and were designed for respondents to complete by themselves. The sample comprised 100 Gen Y individuals who met the inclusion criteria. Both groups were matched for background characteristics. The two 8-week intervention activities were (1) two weeks of education and (2) six weeks of motivation by target groups that set goals for PA together (using the Zoom meeting application), with a time limit and group consensus as to when the goal was to be achieved. The intervention activities were implemented one by one at specified intervals and delivered daily through health apps and the official LINE account. Results: The intervention starts from August 22 to October 16, 2021. Of the 100 participants, 20 (20%) left the study, and the remaining 80 (80%) participated in the study (40 individuals each in the experimental and control groups). After participating in the experiment, a statistically significant difference in PA was found between the 2 groups (moderate to vigorous PA; 25/40, 63%; P=.03). Participants in the intervention group collected a higher cumulative minute of moderate to vigorous PA weekly (283 minutes) than those in the control group (164 minutes), and this was statistically significant (P=.03). For the transition to the fourth stage of behavior (ie, action), the improvement in the experimental group, after participating in the trial, was statistically significant compared to that of the control group (P=.01). Conclusions: Digital group–based activity showed its effectiveness in improving the PA of Gen Y individuals in the intervention group. It created a process-based intervention activity that corresponds to the stages of behavior changes, from contemplation to action. The digital community can also connect individuals to comparable groups locally and globally. Trial Registration: Thai Clinical Trials Registry TCTR20211101005; https://www.thaiclinicaltrials.org/show/TCTR20211101005 %M 38294853 %R 10.2196/43366 %U https://www.jmir.org/2024/1/e43366 %U https://doi.org/10.2196/43366 %U http://www.ncbi.nlm.nih.gov/pubmed/38294853 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46019 %T Effects of Physical Exercise on Telomere Length in Healthy Adults: Systematic Review, Meta-Analysis, and Meta-Regression %A Sánchez-González,Juan Luis %A Sánchez-Rodríguez,Juan Luis %A Varela-Rodríguez,Sergio %A González-Sarmiento,Rogelio %A Rivera-Picón,Cristina %A Juárez-Vela,Raúl %A Tejada-Garrido,Clara Isabel %A Martín-Vallejo,Javier %A Navarro-López,Víctor %+ Nursing Department, Faculty of Heatlh Sciences, University of La Rioja, C/Duquesa de la Victoria 88, Logroño, 26006, Spain, 34 941 299 062, clara-isabel.tejada@unirioja.es %K meta-analysis %K aging %K exercise %K older %K telomere length %D 2024 %7 9.1.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Physical exercise is one of the main nonpharmacological treatments for most pathologies. In addition, physical exercise is beneficial in the prevention of various diseases. The impact of physical exercise has been widely studied; however, existing meta-analyses have included diverse and heterogeneous samples. Therefore, to our knowledge, this is the first meta-analysis to evaluate the impact of different physical exercise modalities on telomere length in healthy populations. Objective: In this review, we aimed to determine the effect of physical exercise on telomere length in a healthy population through a meta-analysis of randomized controlled trials. Methods: A systematic review with meta-analysis and meta-regression of the published literature on the impact of physical exercise on telomere length in a healthy population was performed. PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. Methodological quality was evaluated using the Risk Of Bias In Nonrandomized Studies of Interventions and the risk-of-bias tool for randomized trials. Finally, the certainty of our findings (closeness of the estimated effect to the true effect) was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: We included 9 trials that met the inclusion criteria with fair methodological quality. Random-effects model analysis was used to quantify the difference in telomere length between the exercise and sham groups. Meta-analysis showed that exercise did not significantly increase telomere length compared with the control intervention (mean difference=0.0058, 95% CI −0.05 to 0.06; P=.83). Subgroup analysis suggested that high-intensity interventional exercise significantly increased telomere length compared with the control intervention in healthy individuals (mean difference=0.15, 95% CI 0.03-0.26; P=.01). Furthermore, 56% of the studies had a high risk of bias. Certainty was graded from low to very low for most of the outcomes. Conclusions: The findings of this systematic review and meta-analysis suggest that high-intensity interval training seems to have a positive effect on telomere length compared with other types of exercise such as resistance training or aerobic exercise in a healthy population. Trial Registration: PROSPERO CRD42022364518; http://tinyurl.com/4fwb85ff %M 38194261 %R 10.2196/46019 %U https://publichealth.jmir.org/2024/1/e46019 %U https://doi.org/10.2196/46019 %U http://www.ncbi.nlm.nih.gov/pubmed/38194261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47873 %T Sit-to-Stand Video Analysis–Based App for Diagnosing Sarcopenia and Its Relationship With Health-Related Risk Factors and Frailty in Community-Dwelling Older Adults: Diagnostic Accuracy Study %A Ruiz-Cárdenas,Juan D %A Montemurro,Alessio %A Martínez-García,María del Mar %A Rodríguez-Juan,Juan J %+ Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Avenida Los Jerónimos s/n 135, Murcia, 30107, Spain, 34 968278800, jdruiz@ucam.edu %K sarcopenia %K power %K calf circumference %K diagnosis %K screening %K affordable %K community dwelling %K older adults %K smartphone %D 2023 %7 8.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition. Objective: We aimed to create and validate a sit-to-stand video analysis–based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty. Methods: A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis–based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test. Results: Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2. Conclusions: The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings. Trial Registration: ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351 International Registered Report Identifier (IRRID): RR2-10.3390/s22166010 %M 38064268 %R 10.2196/47873 %U https://www.jmir.org/2023/1/e47873 %U https://doi.org/10.2196/47873 %U http://www.ncbi.nlm.nih.gov/pubmed/38064268 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44425 %T Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study %A Maes,Iris %A Mertens,Lieze %A Poppe,Louise %A Vetrovsky,Tomas %A Crombez,Geert %A De Backere,Femke %A Brondeel,Ruben %A Van Dyck,Delfien %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9 264 63 63, iris.maes@ugent.be %K ecological momentary assessment %K EMA %K associations %K emotions %K physical concerns %K intention %K self-efficacy %K older adult %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. Objective: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Methods: Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants’ PA. Multilevel regression analyses in R were performed to examine these within-person associations. Results: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Conclusions: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive. %M 37995131 %R 10.2196/44425 %U https://aging.jmir.org/2023/1/e44425 %U https://doi.org/10.2196/44425 %U http://www.ncbi.nlm.nih.gov/pubmed/37995131 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e42374 %T Comparison of Exergames Versus Conventional Exercises on the Health Benefits of Older Adults: Systematic Review With Meta-Analysis of Randomized Controlled Trials %A Chen,Xi %A Wu,Lina %A Feng,Hui %A Ning,Hongting %A Wu,Shuang %A Hu,Mingyue %A Jiang,Dian %A Chen,Yifei %A Jiang,Yu %A Liu,Xin %+ Department of General Practice, 921 Hospital of Joint Logistics Support Force, The Chinese People's Liberation Army, No.1 Hongshan Bridge, Changsha, 410008, China, 86 13308490423, 281039313@qq.com %K exergame %K exergaming %K older adult %K elder %K geriatric %K gerontology %K physical function %K mental health %K systematic review %K meta-analysis %K meta-analyses %K review methodology %K RCT %K randomized %K cognitive function %K depression %K QOL %K quality of life %D 2023 %7 22.6.2023 %9 Review %J JMIR Serious Games %G English %X Background: Conventional exercises (CEs) can provide health benefits for older adults, but the long-term exercise adherence rate is low. As an emerging, stimulating, and self-motivating strategy, exergames (EGs) are defined as combinations of exercises and games that users carry out through physical actions. They can promote exercise, but the health effects of EGs versus CEs on the physical function and mental health (cognitive function, depression, and quality of life) of older adults remain controversial. Objective: The aim of the study is to compare the health benefits of EGs versus those of CEs for the physical function and mental health of older adults. Methods: A comprehensive search was conducted from the earliest available date to February 2023 in the following 6 databases: PubMed, Web of Science, Embase, Cochrane, CINAHL, and PsycINFO. All English-language randomized controlled trials comparing the effects of EGs versus those of CEs on the physical function and mental health of older adults, with nearly same physical activity between the 2 interventions, were included. Risk of bias was independently evaluated by 2 authors using the Cochrane risk of bias in randomized trials tool. Two authors independently extracted data. We followed the Cochrane Handbook of Systematic Reviews of Interventions to process and analyze the data for meta-analysis. Standardized mean differences (SMDs) and 95% CIs were used for continuous data, and random models were used for analyses. Results: We included 12 studies consisting of 919 participants in total. Of these, 10 studies were eventually included in the meta-analysis. The results showed that EGs versus CEs exhibited no significant differences in physical (P=.13; τ2=0.31; χ26=26.6; I2=77%; SMD=0.37; 95% CI –0.11 to 0.86) or cognitive function (P=.63; τ2=0.01; χ23=3.1; I2=4%; SMD=0.09; 95% CI –0.27 to 0.44) effects. Conclusions: Our findings indicate no significant difference between EGs and CEs in improving the physical function and cognitive function of older adults. Future studies are required to compare the effects of EGs versus those of CEs on cognitive function according to cognitive status, quantify the “dose-effect” relationship between EGs and health benefits, and evaluate the effects of different types and devices of EGs with regard to the health benefits of older adults. Trial Registration: PROSPERO CRD42022322734; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322734 %M 37347534 %R 10.2196/42374 %U https://games.jmir.org/2023/1/e42374 %U https://doi.org/10.2196/42374 %U http://www.ncbi.nlm.nih.gov/pubmed/37347534 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43418 %T Testing Behavior Change Techniques to Increase Physical Activity in Middle-Aged and Older Adults: Protocol for a Randomized Personalized Trial Series %A Friel,Ciaran P %A Robles,Patrick L %A Butler,Mark %A Pahlevan-Ibrekic,Challace %A Duer-Hefele,Joan %A Vicari,Frank %A Chandereng,Thevaa %A Cheung,Ken %A Suls,Jerry %A Davidson,Karina W %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 140 East 59th Street, New York, NY, 10022, United States, 1 9172027729, cfriel@northwell.edu %K behavior change techniques %K N-of-1 %K personalized trials %K physical activity %K behavior change %K aging %K quality of life %K feasibility %K acceptability %K effectiveness %K web-based %K intervention %K text %K email %K survey %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Being physically active is critical to successful aging, but most middle-aged and older adults do not move enough. Research has shown that even small increases in activity can have a significant impact on risk reduction and improve quality of life. Some behavior change techniques (BCTs) can increase activity, but prior studies on their effectiveness have primarily tested them in between-subjects trials and in aggregate. These design approaches, while robust, fail to identify those BCTs most influential for a given individual. In contrast, a personalized, or N-of-1, trial design can assess a person’s response to each specific intervention. Objective: This study is designed to test the feasibility, acceptability, and preliminary effectiveness of a remotely delivered personalized behavioral intervention to increase low-intensity physical activity (ie, walking) in adults aged 45 to 75 years. Methods: The intervention will be administered over 10 weeks, starting with a 2-week baseline period followed by 4 BCTs (goal-setting, self-monitoring, feedback, and action planning) delivered one at a time, each for 2 weeks. In total, 60 participants will be randomized post baseline to 1 of 24 intervention sequences. Physical activity will be continuously measured by a wearable activity tracker, and intervention components and outcome measures will be delivered and collected by email, SMS text messages, and surveys. The effect of the overall intervention on step counts relative to baseline will be examined using generalized linear mixed models with an autoregressive model that accounts for possible autocorrelation and linear trends for daily steps across time. Participant satisfaction with the study components and attitudes and opinions toward personalized trials will be measured at the intervention's conclusion. Results: Pooled change in daily step count will be reported between baseline and individual BCTs and baseline versus overall intervention. Self-efficacy scores will be compared between baseline and individual BCTs and between baseline and the overall intervention. Mean and SD will be reported for survey measures (participant satisfaction with study components and attitudes and opinions toward personalized trials). Conclusions: Assessing the feasibility and acceptability of delivering a personalized, remote physical activity intervention for middle-aged and older adults will inform what steps will be needed to scale up to a fully powered and within-subjects experimental design remotely. Examining the effect of each BCT in isolation will allow for their unique impact to be assessed and support design of future behavioral interventions. In using a personalized trial design, the heterogeneity of individual responses for each BCT can be quantified and inform later National Institutes of Health stages of intervention development trials. Trial Registration: clinicaltrials.gov NCT04967313; https://clinicaltrials.gov/ct2/show/NCT04967313 International Registered Report Identifier (IRRID): RR1-10.2196/43418 %M 37314839 %R 10.2196/43418 %U https://www.researchprotocols.org/2023/1/e43418 %U https://doi.org/10.2196/43418 %U http://www.ncbi.nlm.nih.gov/pubmed/37314839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40953 %T Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members %A Kelly,Ryan M %A Xing,Yushan %A Baker,Steven %A Waycott,Jenny %+ School of Computing and Information Systems, University of Melbourne, 700 Swanston Street, Melbourne, 3010, Australia, 61 383442215, ryan.kelly@unimelb.edu.au %K aged care %K COVID-19 pandemic %K lockdowns %K older adults %K video calls %K videoconferencing %K mobile phone %K COVID-19 %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members’ experiences with video calling during lockdowns to ensure the effective use of this technology in the future. Objective: This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes. Methods: We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke. Results: We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents’ welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents’ unfamiliarity with video calling and their health conditions as further barriers to the continuation of care. Conclusions: This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context. %M 37191951 %R 10.2196/40953 %U https://aging.jmir.org/2023/1/e40953 %U https://doi.org/10.2196/40953 %U http://www.ncbi.nlm.nih.gov/pubmed/37191951 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 7 %N %P e42205 %T The Association of Sociodemographic Variables and Unhealthy Behaviors With Limitations in Activities of Daily Living Among Thai Older Adults: Cross-sectional Study and Projected Trends Over the Next 20 Years %A Nontarak,Jiraluck %A Bundhamcharoen,Kanitta %A Prasitsiriphon,Orawan %A Aekplakorn,Wichai %+ College of Population Studies, Chulalongkorn University, Visid Prajuabmoh Building, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand, 66 0654491942, orawan.pr@chula.ac.th %K ADL limitation %K National Health Examination Survey %K older adults %K activities of daily living %K physical activity %K disability %D 2023 %7 6.6.2023 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Extended life spans have led to an increase in the number of older people and an increase in the prevalence of disability among people older than 60 years of age. Objective: This study aims to investigate the association of sociodemographic variables and unhealthy behaviors with limitations in activities of daily living (ADL) among Thai older adults. The study also projects the number of older individuals likely to experience ADL limitations in the next 20 years. Methods: We performed sex-specific multinomial logistic regression analysis based on the 5th Thai National Health Examination Survey in 2014 to investigate the association between sociodemographic variables and health behaviors with ADL limitations among Thai older adults. Age- and sex-specific prevalence estimates of ADL limitations were obtained by applying the same models. These estimates were combined with population projections up to 2040 from the Office of the National Economic and Social Development Board, Thailand, to generate projections of older individuals with ADL limitations. Results: Age and physical activity were significant factors for both sexes, with age positively associated with the level of ADL limitations and low physical activity associated with an increased relative probability of mild or moderate to severe ADL limitations compared to individuals with no ADL limitation (1.2-2.2 times). Other variables such as education, marital status, diabetes, hypertension, smoking, alcohol consumption, and having a fruit- and vegetable-based diet showed significant associations, but the results varied regarding sex and levels of ADL limitations. This study also projected the number of older adults with mild and moderate to severe ADL limitations over the next 20 years from 2020 to 2040, revealing an increase of 3.2 and 3.1 times, respectively, along with a significant increase in men compared to that in women. Conclusions: This study identified age and physical activity as significant factors associated with ADL limitations in older adults, while other factors showed varying associations. Over the next 2 decades, projections suggest a significant increase in the number of older adults with ADL limitations, particularly men. Our findings emphasize the importance of interventions to reduce ADL limitations, and health care providers should consider various factors impacting them. %M 37279055 %R 10.2196/42205 %U https://apinj.jmir.org/2023/1/e42205 %U https://doi.org/10.2196/42205 %U http://www.ncbi.nlm.nih.gov/pubmed/37279055 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41810 %T Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study %A Stawarz,Katarzyna %A Liang,Ian Ju %A Alexander,Lyndsay %A Carlin,Angela %A Wijekoon,Anjana %A Western,Max J %+ School of Computer Science and Informatics, Cardiff University, Abacws, Senghennydd Road, Cardiff, CF24 4AG, United Kingdom, 44 029 2251 0037, stawarzk@cardiff.ac.uk %K physical activity %K older adults %K Internet of Things %K user-centered design %K qualitative research %K mobile phone %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Aging %G English %X 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. %M 37223992 %R 10.2196/41810 %U https://aging.jmir.org/2023/1/e41810 %U https://doi.org/10.2196/41810 %U http://www.ncbi.nlm.nih.gov/pubmed/37223992 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44682 %T The Effect of Activity Participation in Middle-Aged and Older People on the Trajectory of Depression in Later Life: National Cohort Study %A Gao,Yan %A Jia,Zhihao %A Zhao,Liangyu %A Han,Suyue %+ School of Physical Education, Shandong University, 17922 Jingshi Road, Lixia District, Jinan, Shandong, 250061, China, 86 18663709793, gaoyanluck@sdu.edu.cn %K activity participation %K middle-aged and older people %K depression %K cohort study %K developmental %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: More activity participation is an important means of handling depression and promoting positive aging, but the impact of changes in activity participation on the developmental trajectory of depression has not been fully studied. Objective: The purpose of this study is to study the relationship between current activity participation and depression in middle-aged and older people (≥45 years old) and the relationship between activity participation and the developmental trajectory of depression in later life in China. Methods: This study used data from the China Health and Retirement Longitudinal Study (CHARLS) across 7 years and included a total of 4818 middle-aged and older people (≥45 years old). Controlling for relevant control variables, the latent growth curve model and the cross-lag model were used to assess the effect of changes in activity participation on the depression trajectory in later life and the main lag relationship between activity participation and depression. Activity participation as well as depression were measured using the self-reported activity and health status based on the CHARLS questionnaire. Results: Among the 4818 respondents, the mean values of physical activity participation, social leisure activity participation, and depression ranged from 76.98 (SD 15.16) to 83.95 (SD 5.72), from 7.43 (SD 8.67) to 9.25 (SD 10.16), and from 7.61 (SD 5.72) to 8.82 (SD 6.51), respectively. Our findings revealed that activity participation could be related to depression. Physical activity participation predicted initial depression (β=–0.631, P<.001) and its trajectory (β=0.461, P<.001). However, social leisure activity participation predicted initial depression (β=–0.223, P<.001) but did not predict its trajectory (β=0.067, P=.159). Finally, cross-lag regression analysis further demonstrated the predictive effect of activity participation on depression. Conclusions: This study demonstrates the prediction of activity participation for future depression in the Chinese middle-aged and older populations. The data showed that activity participation is significantly associated with changes in depression and future depression among middle-aged and older people in China. The Chinese government should encourage middle-aged and older people to participate in various activities, which can effectively prevent the aggravation of depression and also have a positive significance for positive aging. %M 36951932 %R 10.2196/44682 %U https://publichealth.jmir.org/2023/1/e44682 %U https://doi.org/10.2196/44682 %U http://www.ncbi.nlm.nih.gov/pubmed/36951932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41685 %T Wrist Accelerometer Estimates of Physical Activity Intensity During Walking in Older Adults and People Living With Complex Health Conditions: Retrospective Observational Data Analysis Study %A Weber,Kyle S %A Godkin,F Elizabeth %A Cornish,Benjamin F %A McIlroy,William E %A Van Ooteghem,Karen %+ Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, kvanooteghem@uwaterloo.ca %K neurodegenerative disease %K aging %K older adults %K wearable sensors %K physical activity %K activity intensity %K activity monitoring %K exercise prescription %K accelerometry %K health technology %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application. Objective: The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates. Methods: A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking. Results: Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t16=4.24, P<.001) and had more variable wrist movement (t16=2.13, P=.049) compared to those in the lowest quartile. Conclusions: The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups. %M 36920452 %R 10.2196/41685 %U https://formative.jmir.org/2023/1/e41685 %U https://doi.org/10.2196/41685 %U http://www.ncbi.nlm.nih.gov/pubmed/36920452 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44274 %T The Bidirectional Association Between Cognitive Function and Gait Speed in Chinese Older Adults: Longitudinal Observational Study %A Li,Haibin %A Zhang,Jiajia %A Zou,Xinye %A Jia,Xiuqin %A Zheng,Deqiang %A Guo,Xiuhua %A Xie,Wuxiang %A Yang,Qi %+ Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Number 8, Gongti South Road, Chaoyang District, Beijing, 100020, China, 86 01085231928, yangyangqiqi@gmail.com %K aging %K cognitive function %K gait speed %K cross-lagged panel models %K longitudinal study %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cognitive and gait speed decline are common conditions in older adults and are often associated with future adverse consequences. Although an association between cognitive function and gait speed has been demonstrated, its temporal sequence remains unclear, especially in older Chinese adults. Clarifying this could help identify interventions to improve public health in older adults. Objective: This study aims to examine the longitudinal reciprocal association between gait speed and cognitive function and the possible temporal sequence of changes in both factors in a national longitudinal cohort. Methods: Data were derived from 2 waves (2011 baseline and 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants 60 years or older, without dementia or Parkinson disease at baseline, and with completed data on gait speed and cognition at both baseline and follow-up were included. Usual gait speed was measured over two 2.5-m walks. Mental intactness and episodic memory were used to assess global cognitive function. Cross-lagged panel models and linear mixed-effects models were used to examine the association between cognition and gait speed over time. Standardized coefficients were reported. Results: A total of 3009 participants (mean age 66.4 years, SD 5.4 years; 1422/3009, 47.26%, female participants) were eligible for inclusion in our analyses. Cross-lagged panel analyses revealed that after accounting for baseline gait speed, cognition, and potential confounders, baseline global cognition (β=.117, 95% CI 0.082-0.152; P<.001), mental intactness (β=.082, 95% CI 0.047-0.118; P<.001), and episodic memory (β=.102, 95% CI 0.067-0.137; P<.001) were associated with subsequent gait speed. Simultaneously, baseline gait speed was also associated with subsequent global cognition (β=.056, 95% CI 0.024-0.087; P=.001), mental intactness (β=.039, 95% CI 0.008-0.069; P=.01), and episodic memory (β=.057, 95% CI 0.023-0.092; P=.001). The comparison of standardized cross-lagged coefficients suggested that the effect size of baseline global cognition on subsequent gait speed was significantly larger than the reverse effect (χ12=6.50, P for difference=.01). However, the effects of both mental intactness and episodic memory on subsequent gait speed were not significantly stronger than those of the reverse pathway (χ12=3.33, P for difference=.07 and χ12=3.21, P for difference=.07). Linear mixed-effects analyses further supported these bidirectional relationships, revealing that lower baseline cognitive scores predicted steeper declines in gait speed trajectory, and slower baseline gait speed predicted more declines in cognitive trajectory over time. Conclusions: There is a longitudinal bidirectional association between usual gait speed and both global cognitive function and specific domains of mental intactness and episodic memory among Chinese older adults. Baseline global cognition is likely to have a stronger association with subsequent gait speed than the reverse pathway. This interlinkage is noteworthy and may have implications for public health. Maintaining normal cognitive function may be an important interventional strategy for mitigating age-related gait speed reduction. %M 36917163 %R 10.2196/44274 %U https://publichealth.jmir.org/2023/1/e44274 %U https://doi.org/10.2196/44274 %U http://www.ncbi.nlm.nih.gov/pubmed/36917163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42980 %T The Independent Walking for Brain Health Intervention for Older Adults: Protocol for a Pilot Randomized Controlled Trial %A Hays Weeks,Chelsea C %A Moore,Alison A %A Allison,Matthew %A Patrick,Kevin %A Bondi,Mark W %A Nebeker,Camille %A Liu,Thomas T %A Wing,David %A Higgins,Michael %A Hartman,Sheri J %A Rissman,Robert A %A Zlatar,Zvinka Z %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 858 822 7737, zzlatar@health.ucsd.edu %K older adults %K seniors %K real world %K real time %K digital health %K feasibility %K brain perfusion %K cognition %K adaptive intervention %K exercise %K clinical trial %K mechanisms %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Extensive research suggests that physical activity (PA) is important for brain and cognitive health and may help to delay or prevent Alzheimer's disease and related dementias. Most PA interventions designed to improve brain health in older adults have been conducted in laboratory, gym, or group settings that require extensive resources and travel to the study site or group sessions. Research is needed to develop novel interventions that leverage mobile health (mHealth) technologies to help older adults increase their engagement in PA in free-living environments, reducing participant burden and increasing generalizability of research findings. Moreover, promoting engagement in moderate-to-vigorous PA (MVPA) may be most beneficial to brain health; thus, using mHealth to help older adults increase time spent in MVPA in free-living environments may help to offset the burden of Alzheimer's disease and related dementias and improve quality of life in older age. Objective: We developed a novel PA intervention that leverages mHealth to help older adults achieve more minutes of MVPA independently. This pilot study was a 12-week randomized controlled trial to investigate the feasibility of providing just-in-time (JIT) feedback about PA intensity during free-living exercise sessions to help older adults meet current PA recommendations (150 minutes per week of MVPA). Methods: Participants were eligible if they were cognitively healthy English speakers aged between 65 and 80 years without major cardiovascular, neurologic, or mental health conditions; could ambulate independently; and undergo magnetic resonance imaging. Enrollment occurred from October 2017 to March 2020. Participants randomized to the PA condition received an individualized exercise prescription and an mHealth device that provided heart rate–based JIT feedback on PA intensity, allowing them to adjust their behavior in real time to maintain MVPA during exercise sessions. Participants assigned to the healthy aging education condition received a reading prescription consisting of healthy aging topics and completed weekly quizzes based on the materials. Results: In total, 44 participants were randomized to the intervention. A follow-up manuscript will describe the results of the intervention as well as discuss screening, recruitment, adverse events, and participants’ opinions regarding their participation in the intervention. Conclusions: The long-term goal of this intervention is to better understand how MVPA affects brain and cognitive health in the real world and extend laboratory findings to everyday life. This pilot randomized controlled trial was conducted to determine the feasibility of using JIT heart rate zone feedback to help older adults independently increase time spent in MVPA while collecting data on the plausible mechanisms of change (frontal and medial temporal cerebral blood flow and cardiorespiratory fitness) that may affect cognition (memory and executive function) to help refine a planned stage 2 behavioral trial. Trial Registration: ClinicalTrials.gov NCT03058146; https://clinicaltrials.gov/ct2/show/NCT03058146 International Registered Report Identifier (IRRID): DERR1-10.2196/42980 %M 36535765 %R 10.2196/42980 %U https://www.researchprotocols.org/2023/1/e42980 %U https://doi.org/10.2196/42980 %U http://www.ncbi.nlm.nih.gov/pubmed/36535765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39969 %T To Act or Not to Act—a Sense of Control Is Important for People With Chronic Obstructive Pulmonary Disease to Increase Physical Activity: Grounded Theory Study %A Marklund,Sarah %A Sörlin,Ann %A Stenlund,Tobias %A Wadell,Karin %A Nyberg,Andre %+ Section of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Linnaeus väg 9, Umeå, 90736, Sweden, 46 7869835, sarah.marklund@umu.se %K physical activity %K chronic obstructive pulmonary disease %K COPD %K eHealth %K interviews %K eHealth tools %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factors for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychological elements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites have shown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutions might be used to support positive changes in PA behavior in people with COPD. Objective: This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool among people with COPD. Methods: This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 13 (n=7, 54% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone. Results: The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question. Conclusions: The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending on other environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030788 %M 36735302 %R 10.2196/39969 %U https://formative.jmir.org/2023/1/e39969 %U https://doi.org/10.2196/39969 %U http://www.ncbi.nlm.nih.gov/pubmed/36735302 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42394 %T Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study %A Collombon,Eline H G M %A Peels,Denise A %A Bolman,Catherine A W %A de Bruijn,Gert-Jan %A Lechner,Lilian %+ Faculty of Psychology, Open Universiteit, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 455762888, Eline.Collombon@ou.nl %K prototype %K pilot test %K eHealth %K mHealth %K physical activity %K older adults %K development %K usability %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described. Objective: This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years. Methods: A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results. Results: The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation. Conclusions: During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/31677 %M 36696157 %R 10.2196/42394 %U https://formative.jmir.org/2023/1/e42394 %U https://doi.org/10.2196/42394 %U http://www.ncbi.nlm.nih.gov/pubmed/36696157 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42223 %T The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys %A Wang,Zixin %A Fang,Yuan %A Chan,Paul Shing-Fong %A Yu,Fuk Yuen %A Sun,Fenghua %+ Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K physical activity %K older adults %K barriers %K changes %K repeated random telephone survey %K China %K aging %K elderly population %K community-dwelling older adults %K health promotion %K telehealth %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the “postpandemic era.” Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the “postpandemic era.” Different factors influenced older adults’ PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. %M 36599172 %R 10.2196/42223 %U https://aging.jmir.org/2023/1/e42223 %U https://doi.org/10.2196/42223 %U http://www.ncbi.nlm.nih.gov/pubmed/36599172 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 7 %N %P e42195 %T Facilitators and Barriers of Tai Chi Practice in Community-Dwelling Older Adults: Qualitative Study %A Du,Yan %A Roberts,Penny %A Liu,Wei %+ School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 450 5329, duy@uthscsa.edu %K facilitators %K barriers %K older adults %K practice %K adherence %K Tai Chi %K qualitative study %K health outcomes %K martial arts %K exercise %K gerontology %K muscle strengthening %D 2023 %7 23.1.2023 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Numerous studies have documented the beneficial effects of Tai Chi on a variety of health outcomes, especially in older adults. However, only few studies have examined how to improve the practice and adherence of this Asian-originated exercise among older adults in Western countries. Objective: This study aimed to identify facilitators and barriers to Tai Chi practice and adherence in community-dwelling older adults. Methods: This study analyzed the qualitative data collected from 13 participants (mean age 62.0, SD 10.3) at the end of a 15-week randomized controlled trial conducted at a day activity senior center. Semistructured interviews were conducted, recorded, and transcribed; and the data were analyzed using inductive thematic analysis. Results: Four themes emerged: perceived benefit, threats, facilitators, and barriers. Perceived threats (eg, aging and side effects of medications) and perceived benefits of Tai Chi (eg, balance) inspired participants’ engagement in Tai Chi exercise. On the other hand, barriers to Tai Chi practice and adherence included instructor’s teaching style, the complexity of Tai Chi postures and movements, and existing health conditions (eg, hip problems). In essence, factors like Tai Chi class availability, family and peer support, as well as practicing Tai Chi with music may facilitate Tai Chi exercise adherence. Conclusions: The study findings could provide valuable information to health professionals, such as nurses and physical therapists, in developing and implementing effective Tai Chi programs in care plans. Considering health conditions, tailoring Tai Chi exercise instruction styles, encouraging social and peer support, and incorporating music may promote Tai Chi practice and adherence. %M 36720122 %R 10.2196/42195 %U https://apinj.jmir.org/2023/1/e42195 %U https://doi.org/10.2196/42195 %U http://www.ncbi.nlm.nih.gov/pubmed/36720122 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e39898 %T Feasibility, Safety, Enjoyment, and System Usability of Web-Based Aerobic Dance Exercise Program in Older Adults: Single-Arm Pilot Study %A Hyodo,Kazuki %A Kidokoro,Tetsuhiro %A Yamaguchi,Daisuke %A Iida,Michitaka %A Watanabe,Yuya %A Ueno,Aiko %A Noda,Takayuki %A Kawahara,Kenji %A Nishida,Sumiyo %A Kai,Yuko %A Arao,Takashi %+ Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tobuki 150, Hachioji, Tokyo, 192-0001, Japan, 81 42 691 1163, k-hyodo@my-zaidan.or.jp %K low-intensity exercise %K home exercise %K online exercise %K supervised exercise %K elderly %K COVID-19 %K smartphone %K tablet %K videoconferencing platform %D 2023 %7 16.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: During the COVID-19 epidemic, opportunities for social interaction and physical activity among older people are decreasing, which may have a negative impact on their health. As a solution, a web-based group exercise program provided through a videoconferencing platform would be useful. As a web-based exercise program that older adults can easily, safely, and enjoyably perform at home, we developed a short-duration, light-intensity aerobic dance exercise program. Before studying the effectiveness of this exercise program, its characteristics, such as feasibility, safety, enjoyment, and system usability, should be examined among older adults. Objective: This pilot study aimed to examine the feasibility, safety, and enjoyment of a web-based aerobic dance exercise program and the usability of a web-based exercise delivery system using a videoconferencing platform for older adults. Methods: This study was designed as a prospective single-arm pilot study. A total of 16 older adults participated in an 8-week web-based aerobic dance program held every morning (8:30 AM to 8:50 AM) on weekdays at home. Retention and adherence rates were measured for the program’s feasibility. Safety was assessed by the heart rate reserve, an index of exercise intensity calculated from heart rate, and the number of adverse events during exercise sessions. Enjoyment of this exercise program was assessed by an 11-point Likert scale ranging from 0 (not enjoyable at all) to 10 (extremely enjoyable) obtained through telephone interviews after the first-, third-, sixth-, and eighth-week intervention. For usability, the ease of the videoconferencing platform system was assessed through telephone interviews after the intervention. Results: A female participant with hypertension dropped out in the second week because of the continuously reported high blood pressure (≥180 mmHg) before attending the exercise session in the first week. Therefore, the retention rate was 93.8% (15/16). Among the remaining participants, the median (IQR) overall adherence rate was 97.4% (94.7-100). Regarding safety, the mean (SD) heart rate reserve during the aerobic dance exercise was 29.8% (6.8%), showing that the exercise was relatively safe with very light to light intensity. There were no adverse events during the exercise session. The enjoyment score (0-10 points) significantly increased from the first (6.7 [1.7]) to sixth (8.2 [1.3]) and eighth week (8.5 [1.3]). Regarding usability, 11 participants reported difficulties at the beginning, such as basic touch panel operations and the use of unfamiliar applications; however, all got accustomed to it and subsequently reported no difficulty. Conclusions: This study showed high feasibility, enjoyment, and safety of the web-based aerobic dance exercise program in older adults, and the web-based exercise delivery system may have areas for improvement, albeit without serious problems. Our web-based aerobic dance exercise program may contribute to an increase in physical and social activities among older adults. %M 36645705 %R 10.2196/39898 %U https://aging.jmir.org/2023/1/e39898 %U https://doi.org/10.2196/39898 %U http://www.ncbi.nlm.nih.gov/pubmed/36645705 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40969 %T Physical Activity Program for the Survival of Elderly Patients With Lymphoma: Study Protocol for Randomized Phase 3 Trial %A Dubu,Jonas %A Boyas,Sébastien %A Roland,Virginie %A Landry,Sébastien %A Septans,Anne-Lise %A Balavoine,Magali %A Bourgeois,Hugues %A Pointreau,Yoann %A Denis,Fabrice %A Letellier,Christophe %A Le Dû,Katell %+ ELSAN, Institut inter-regional de Cancerologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 769510938, j.dubu@ilcgroupe.fr %K diffuse large B-cell lymphoma %K adapted physical activity %K survival %K sarcopenia %D 2022 %7 25.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The practice of regular physical activity can reduce the incidence of certain cancers (colon, breast, and prostate) and improve overall survival after treatment by reducing fatigue and the risk of relapse. This impact on survival has only been demonstrated in active patients with lymphoma before and after treatment. As poor general health status reduces the chances of survival and these patients are most likely to also have sarcopenia, it is important to be able to improve their physical function through adapted physical activity (APA) as part of supportive care management. Unfortunately, APA is often saved for patients with advanced blood cancer. As a result, there is a lack of data regarding the impact of standardized regular practice of APA and concomitant chemotherapy as first-line treatment on lymphoma survival. Objective: This study aimed to assess the impact of a new and open rehabilitation program suitable for a frail population of patients treated for diffuse large B-cell lymphoma (DLBCL). Methods: PHARAOM (Physical Activity Program for the Survival of Elderly Patients with Lymphoma) is a phase 3 randomized (1:1) study focusing on a frail population of patients treated for DLBCL. The study will include 186 older adult patients with DLBCL (aged >65 years) receiving rituximab and chemotherapy. Overall, 50% (93/186) of patients (investigational group) will receive APA along with chemotherapy, and they will be supervised by a dedicated qualified kinesiologist. The APA program will include endurance and resistance training at moderate intensity 3 times a week during the 6 months of chemotherapy. The primary end point of this study will be event-free survival of the patients. The secondary end points will include the overall survival, progression-free survival, prevalence of sarcopenia and undernutrition, and patients’ quality of life. This study will be conducted in accordance with the principles of the Declaration of Helsinki. Results: Recruitment, enrollment, and data collection began in February 2021, and 4 participants have been enrolled in the study as of July 2022. Data analysis will begin after the completion of data collection. Future outcomes will be published in peer-reviewed health-related research journals and presented at national congress, and state professional meetings. This publication is based on protocol version 1.1, August 3, 2020. Conclusions: The PHARAOM study focuses on highlighting the benefits of APA intervention on survival during the period of first-line treatment of patients with DLBCL. This study could also contribute to our understanding of how an APA program can reduce complications such as sarcopenia in patients with lymphoma and improve their quality of life. By documenting the prevalence and relationship between sarcopenia and exercise load, we might be able to help physicians plan better interventions in the care of patients with DLBCL. Trial Registration: ClinicalTrials.gov NCT04670029; https://clinicaltrials.gov/ct2/show/NCT04670029 International Registered Report Identifier (IRRID): DERR1-10.2196/40969 %M 36427234 %R 10.2196/40969 %U https://www.researchprotocols.org/2022/11/e40969 %U https://doi.org/10.2196/40969 %U http://www.ncbi.nlm.nih.gov/pubmed/36427234 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e41255 %T Older Adults Living in Disadvantaged Areas: Protocol for a Mixed Methods Baseline Study on Homes, Quality of Life, and Participation in Transitioning Neighborhoods %A Granbom,Marianne %A Jönson,Håkan %A Kottorp,Anders %+ Department of Health Sciences, Lund University, Box 157, Lund, 221 00, Sweden, 46 725281362, marianne.granbom@med.lu.se %K aging %K housing %K neighborhood %K quality of life %K participation %K rural areas %K disadvantaged areas %K aging-in-place %K relocation %K socioeconomic status %K older adults %K elderly %K mental health %K physical health %K social participation %K health dynamics %D 2022 %7 12.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Swedish policy states that older adults should be able to age safely with continued independence and lead active lives. However, this plays out differently in different Swedish municipalities depending upon degree of demographic change, globalization, and urbanization. Internationally, older adults living in disadvantaged areas have worse physical and mental health, activity restrictions, and reduced life expectancy. In Sweden, research on how disadvantaged areas impact older adults’ quality of life is virtually nonexistent. We argue that disadvantaged areas exist in both urban and rural contexts. Objective: We aimed to investigate how older adults’ homes and neighborhoods influence their community participation, quality of life, identity, and belonging in urban and rural disadvantaged areas in Sweden, and how these person–context dynamics are experienced by older adults in transitioning neighborhoods. Methods: The study has a mixed methods design and includes 3 phases. Adults 65 years and older living in certain urban and rural disadvantaged areas in the south of Sweden will be included. Phase 1 is an interview study in which qualitative data are collected on neighborhood attachment, identity, and belonging through semistructured interviews and photo-elicitation interviews with 40 subjects. A variety of qualitative data analysis procedures are used. In phase 2, a survey study will be conducted to explore associations between observable and self-rated aspects of housing and neighborhood (physical, social, and emotional), participation, and quality of life; 400 subjects will be recruited and added to the 40 phase-1 subjects for a total of 440. The survey will include standardized measures and study-specific questions. Survey data will be analyzed with mainstream statistical analyses and structural equation modeling to understand the interactions between quality of life, home and neighborhood factors, and sociodemographic factors. In phase 3, the integration study, survey data from the 40 participants who participated in both data collections will be analyzed together with qualitative data with a mixed methods analysis approach. Results: As of the submission of this protocol (August 2022), recruitment for the interview study is complete (N=39), and 267 participants have been recruited and have completed data collection in the survey study. We expect recruitment and data collection to be finalized by December 2022. Conclusions: With an increasing proportion of older adults, an increasing number of disadvantaged areas, and an increasing dependency ratio in more than 50% of Swedish municipalities, these municipalities are transforming and becoming increasingly segregated. This study will add unique knowledge on what it is like to be older in a disadvantaged area and deepen knowledge on housing and health dynamics in later life. Further, the design of the current study will allow future follow-up studies to facilitate longitudinal analysis (if funding is granted) on aging in a transforming societal context. International Registered Report Identifier (IRRID): DERR1-10.2196/41255 %M 36222809 %R 10.2196/41255 %U https://www.researchprotocols.org/2022/10/e41255 %U https://doi.org/10.2196/41255 %U http://www.ncbi.nlm.nih.gov/pubmed/36222809 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38192 %T Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint %A Temprado,Jean-Jacques %A Torre,Marta Maria %+ Aix Marseille Université, Institut des Sciences du Mouvement, 163 Avenue de Luminy, BP 910, Marseille, 13288, France, 33 611837288, jean-jacques.temprado@univ-amu.fr %K aging %K older %K gerontology %K exergame %K physical activity %K cognition %K training %K intervention %K cognitive %K brain %K older adult %K motor skills %K exercise %K physical %K motor %K combined training %D 2022 %7 3.10.2022 %9 Viewpoint %J JMIR Serious Games %G English %X Combining physical, motor, and cognitive exercises is expected to be effective to attenuate age-related declines of brain and cognition in older adults. This can be achieved either by conventional interventions or by exergames. This paper aimed to determine whether conventional combined training and exergame interventions are two comparable ways for delivering combined training. In total, 24 studies on conventional training and 23 studies on exergames were selected and compared. A common framework was used to analyze both types of combined training interventions. Our analysis showed that conventional combined training interventions were more effective than separated physical and motor training to improve brain and cognition, while their superiority over cognitive training alone remains to be confirmed. Exergames scarcely led to cognitive benefits superior to those observed after physical, motor, or cognitive training alone. Thus, although both conventional training interventions and exergames allowed delivering combined training programs, they are not two facets of the same coin. Further studies that are more theoretically grounded are necessary to determine whether interventions delivered via exergames may lead to superior benefits compared to conventional separated and combined training interventions. %M 36190757 %R 10.2196/38192 %U https://games.jmir.org/2022/4/e38192 %U https://doi.org/10.2196/38192 %U http://www.ncbi.nlm.nih.gov/pubmed/36190757 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e34768 %T Digital Biomarkers for Well-being Through Exergame Interactions: Exploratory Study %A Petsani,Despoina %A Konstantinidis,Evdokimos %A Katsouli,Aikaterini-Marina %A Zilidou,Vasiliki %A Dias,Sofia B %A Hadjileontiadis,Leontios %A Bamidis,Panagiotis %+ Medical Physics and Digital Innovation Laboratory, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Medical Physics and Digital Innovation Laboratory, Thessaloniki, 54124, Greece, 30 2310999310, bamidis@med.auth.gr %K serious games %K machine learning %K physical well-being %K cognitive well-being %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Ecologically valid evaluations of patient states or well-being by means of new technologies is a key issue in contemporary research in health and well-being of the aging population. The in-game metrics generated from the interaction of users with serious games (SG) can potentially be used to predict or characterize a user’s state of health and well-being. There is currently an increasing body of research that investigates the use of measures of interaction with games as digital biomarkers for health and well-being. Objective: The aim of this paper is to predict well-being digital biomarkers from data collected during interactions with SG, using the values of standard clinical assessment tests as ground truth. Methods: The data set was gathered during the interaction with patients with Parkinson disease with the webFitForAll exergame platform, an SG engine designed to promote physical activity among older adults, patients, and vulnerable populations. The collected data, referred to as in-game metrics, represent the body movements captured by a 3D sensor camera and translated into game analytics. Standard clinical tests gathered before and after the long-term interaction with exergames (preintervention test vs postintervention test) were used to provide user baselines. Results: Our results showed that in-game metrics can effectively categorize participants into groups of different cognitive and physical states. Different in-game metrics have higher descriptive values for specific tests and can be used to predict the value range for these tests. Conclusions: Our results provide encouraging evidence for the value of in-game metrics as digital biomarkers and can boost the analysis of improving in-game metrics to obtain more detailed results. %M 36099000 %R 10.2196/34768 %U https://games.jmir.org/2022/3/e34768 %U https://doi.org/10.2196/34768 %U http://www.ncbi.nlm.nih.gov/pubmed/36099000 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38172 %T Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study %A Choudhury,Renoa %A Park,Joon-Hyuk %A Thiamwong,Ladda %A Xie,Rui %A Stout,Jeffrey R %+ Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816, United States, 1 407 823 1227, Joonpark@ucf.edu %K physical activity %K older women %K COVID-19 %K sedentary behavior %K wrist-worn accelerometers %K ActiGraph %K aging %K elderly population %K women's health %K digital health %K frail %K healthy lifestyle %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is vital for attenuating the aging-related physiological and functional declines in women aged 60 years or above. However, little is known about the objectively assessed PA behavior in older women during the COVID-19 pandemic and its association with sociodemographics, health and physical function, and COVID-19 related factors. Objective: This study aims to examine the objectively measured PA levels and associated factors among older US women who were living under the physical distancing guidelines during the second year of the pandemic. Methods: In this cross-sectional study, we collected free-living PA data from 94 community-dwelling older women aged between 60 and 96 years (mean age 75.1 years, SD 7.3) using wrist-worn ActiGraph GT9X accelerometers between February and August 2021. We examined whether their daily duration spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) varied by sociodemographic characteristics, health and physical function, and COVID-19 related factors. Results: On average, participants accumulated 12.4 (SD 1.9) hours/day in SB, 218.6 (SD 64.3) minutes/day in LPA, and 42.4 (SD 31.0) minutes/day in MVPA, exhibiting overall reduced PA levels than previously published pre–COVID-19 norms of older US women. Among participants aged ≥80 years, sedentary time was 7.5% (P=.003) higher and the time spent in LPA and MVPA was, respectively, 13.3% (P=.03) and 44.9% (P<.001) lower than those aged 60-79 years. More MVPA participation and a less sedentary lifestyle were observed in those who had a higher self-rated health score (MVPA: P=.001, SB: P=.04) and lower fear of falling (FOF; MVPA: P=.003, SB: P=.04). Poorer performance in the 30-second sit-to-stand (STS) test was independently associated with more SB (P=.01) and less LPA (P=.04) and MVPA (P=.001) time among participants. In addition, sedentary time was 5.0% higher (P=.03) in frail and prefrail participants than their healthy counterparts. Conclusions: During the pandemic, older women spent the majority of their waking time being sedentary, while LPA accounted for a larger portion of their daily PA. Therefore, replacing SB with LPA (rather than MVPA) might provide a more feasible PA target for older women, particularly those aged ≥80 years or who have reduced physical function. In addition, targeted interventions might be beneficial in promoting an active lifestyle for those who live alone, are prefrail or frail, and have a high FOF in older age. International Registered Report Identifier (IRRID): RR2-10.2196/27381 %M 35994346 %R 10.2196/38172 %U https://aging.jmir.org/2022/3/e38172 %U https://doi.org/10.2196/38172 %U http://www.ncbi.nlm.nih.gov/pubmed/35994346 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e32968 %T The Role of Depressive Symptoms and Physical Activity Levels in Mediating the Association Between HIV Status and Neurocognitive Functions Among Individuals Aged at Least 50 Years in China: Cross-sectional Study %A Qin,Pei %A He,Jianmei %A Yang,Xue %A Chen,Siyu %A Chen,Xi %A Jiang,Hui %A Fung,Ada Wai Tung %A Wang,Zixin %A Lau,Joseph Tak Fai %+ Affilliated Kangning Hospital of Wenzhou Medical University, Wenzhou Medical University, No. 1 Shengjin Road, Huanglong Residential Area, Wenzhou, 325000, China, 86 400 000 2120, jlau@cuhk.edu.hk %K neurocognitive performance %K HIV sero-status %K depressive symptoms %K level of physical activity %K mediation effects %K HIV %K depression %K physical activity %K neurocognitive %K mental health %K public health %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Neurocognitive impairments are prevalent among older people in China. It is more problematic among older people living with HIV. Objective: This study aims to compare neurocognitive performance between older people living with HIV and HIV-negative controls, and to explore whether the association between HIV status and neurocognitive performance was mediated by depressive symptoms and level of physical activity. Methods: A cross-sectional study was conducted in Yongzhou, China. All people living with HIV aged ≥50 years listed in the registry were invited. Frequency matching was used to sample HIV-negative controls from the general population according to the distribution of age, sex, and years of formal education of older people living with HIV. A total of 315 older people living with HIV and 350 HIV-negative controls completed the face-to-face interview and comprehensive neuropsychological assessment of seven domains (learning, memory, working memory, verbal fluency, processing speed, executive function, and motor skills). Results: As compared to HIV-negative controls, older people living with HIV performed worse in global score and all seven domains (P<.05). HIV infection was associated with higher depressive symptoms (P<.001) and lower level of physical activity (P<.001). Depressive symptoms and physical activity were negatively correlated (P<.001). Depressive symptoms and level of physical activity mediated the association between HIV status and global z-score and four domain z-scores of neurocognitive performance (learning, memory, verbal fluency, and processing speed). Conclusions: Change in mental health and physical activity after HIV infection may partially explain why older people living with HIV are more susceptible to neurocognitive impairment. Promoting mental health and physical activity are potential entry points to slow down the progress of neurocognitive impairment among older people living with HIV. %M 35984684 %R 10.2196/32968 %U https://publichealth.jmir.org/2022/8/e32968 %U https://doi.org/10.2196/32968 %U http://www.ncbi.nlm.nih.gov/pubmed/35984684 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e33845 %T A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study %A Boateng,George %A Petersen,Curtis L %A Kotz,David %A Fortuna,Karen L %A Masutani,Rebecca %A Batsis,John A %+ Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC, 27599, United States, 1 919 843 4096, john.batsis@gmail.com %K step tracking %K step counting %K pedometer %K wearable %K smartwatch %K older adults %K physical activity %K machine learning %K walking %K mHealth %K mobile health %K mobile app %K mobile application %K app %K uHealth %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings. Objective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time. Methods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions—one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics. Results: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet’s count was on average 3.2 (2.1%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669. Conclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults. %M 35947445 %R 10.2196/33845 %U https://aging.jmir.org/2022/3/e33845 %U https://doi.org/10.2196/33845 %U http://www.ncbi.nlm.nih.gov/pubmed/35947445 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36515 %T Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials %A Lippke,Sonia %A Ratz,Tiara %A Keller,Franziska Maria %A Juljugin,Dennis %A Peters,Manuela %A Pischke,Claudia %A Voelcker-Rehage,Claudia %+ Psychology & Methods, Jacobs University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K physical activity %K older adults %K intervention %K loneliness %K depression %K eHealth %K mobile health %K mHealth %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods: Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09). Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID): RR2-10.2196/15168 %M 35943790 %R 10.2196/36515 %U https://aging.jmir.org/2022/3/e36515 %U https://doi.org/10.2196/36515 %U http://www.ncbi.nlm.nih.gov/pubmed/35943790 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e39192 %T Intervention in Older Urban-Dwelling Veterans With Dysmobility: Protocol for a Pilot Feasibility Clinical Trial %A Robbins,Ronna N %A Serra,Monica C %A Kilpela,Lisa S %A Parker,Elizabeth A %A Jiwani,Rozmin %A Addison,Odessa %+ San Antonio Geriatric, Research, Education, and Clinic Center, South Texas Veterans Health Care System, 4700 Merton Minter Blvd., GRECC-182, San Antonio, TX, 78229, United States, 1 210 617 5300 ext 15986, r.robbins@utexas.edu %K peer-led %K veterans %K dysmobility %K lifestyle modification programs %D 2022 %7 13.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The majority of older veterans do not meet the minimum healthy diet or physical activity recommendations despite known benefits. Identifying ways to increase adherence to programs that improve dietary quality and physical activity may reduce the risk of disability in older veterans. Peer-based interventions may be one method for facilitating lasting behavior change because peers often share a common culture and knowledge regarding problems their community experiences. Objective: This study aims to develop, pilot, and evaluate a theory-driven, 12-week, peer-led nutrition and exercise intervention that targets older veterans with dysmobility and assess its feasibility in 2 diverse urban areas with underrepresented populations. Methods: Community-dwelling veterans aged >65 years with self-reported dysmobility (defined as difficulty in at least 1 of the following: walking quickly across a street, walking a mile, ascending a flight of stairs, rising from a chair without the use of arms, or a fear of falling) from 2 Department of Veterans Affairs Geriatric Research, Education, and Clinic Centers (Baltimore, Maryland, and San Antonio, Texas) will be eligible to participate. First, this study will use validated mixed methods via web-based surveys (n=50 per site) to assess potential physical, social or environmental, and behavioral or lifestyle barriers that affect physical activity and dietary quality (phase 1). Next, we will use knowledge gained from these assessments and feedback from a focus group (n=10 per site) to adapt established Department of Veterans Affairs diet and exercise program materials to develop peer-led intervention materials and train peer leaders (n=3 per site). Finally, we will determine the feasibility and acceptability of the intervention to assess reach (recruitment and retention), adoption (satisfaction, perceived utility, attendance, and engagement), and implementation (fidelity of intervention), as well as the estimated magnitude and potential impact on selected outcomes (ie, diet quality and mobility) in 20 older veterans with dysmobility (n=10 per site). Results: The study was funded on January 1, 2022, with a projected data collection period of June 1, 2022, to December 31, 2023. Conclusions: This study offers an innovative approach to identifying strategies that increase long-term adherence to lifestyle modification programs that improve dietary quality and physical activity in older veterans with dysmobility. Trial Registration: ClinicalTrials.gov NCT04994938; https://clinicaltrials.gov/ct2/show/NCT04994938 International Registered Report Identifier (IRRID): PRR1-10.2196/39192 %M 35830251 %R 10.2196/39192 %U https://www.researchprotocols.org/2022/7/e39192 %U https://doi.org/10.2196/39192 %U http://www.ncbi.nlm.nih.gov/pubmed/35830251 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e31677 %T Adding Mobile Elements to Online Physical Activity Interventions Targeted at Adults Aged 50 Years and Older: Protocol for a Systematic Design %A Collombon,Eline H G M %A Bolman,Catherine A W %A Peels,Denise A %A de Bruijn,Gert-Jan %A de Groot,Renate H M %A Lechner,Lilian %+ Faculty of Psychology, Open Universiteit, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 045 5762888, Eline.Collombon@ou.nl %K mHealth %K eHealth %K physical activity %K older adults %K design protocol %D 2022 %7 12.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) can increase mental and physical health in adults aged 50 years and older. However, it has been shown that PA guidelines are often not met within this population. Therefore, our research group developed 2 computer-tailored intervention programs in the last decade to stimulate PA: Active Plus and I Move. Although these programs were proven effective, positive effects diminished over time and attrition rates were relatively high. To respond to this, we will integrate 3 interactive mobile elements into the existing programs: activity tracker, ecological momentary intervention program, and virtual coach app. Objective: The goal of the research is to define systematic and evidence-based steps for extending our online computer-based PA intervention programs with 3 interactive mobile elements. Methods: Components often included in other (eHealth) design models were identified as key components and served as a base for the definition of systematic steps: exploration of context, involvement of the target population, prototype and intervention testing, and implementation. Based on these key components, 10 systematic steps were defined. The initial step is a literature search, with the results serving as a base for development of the low-fidelity prototypes in step 2. The pilot phase comprises the 3rd to 6th steps and includes semistructured interviews, pilot tests, and adaptations of the prototypes with intensive involvement of the target population of adults aged 50 years and older, where particular attention will be paid to lower educated persons. The 7th step is an effect evaluation in the form of a randomized controlled trial. During the 8th step, the most effective intervention programs will be selected and reinforced. These reinforced intervention programs will be used during the design of an implementation plan in the 9th step and the subsequent field study in the 10th step. Results: The project will be executed from December 2019 to December 2023. During this period, the systematic approach presented will be practically executed according to the methodological procedures described. Conclusions: Based on the 4 identified key components, we were able to design an evidence-based systematic design approach for separately adding 3 mobile elements to our existing online PA intervention programs. The 10 steps are presented as a useful approach to guide future eHealth design studies. International Registered Report Identifier (IRRID): DERR1-10.2196/31677 %M 35819820 %R 10.2196/31677 %U https://www.researchprotocols.org/2022/7/e31677 %U https://doi.org/10.2196/31677 %U http://www.ncbi.nlm.nih.gov/pubmed/35819820 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e32288 %T Physical Activity and Fall Prevention in Geriatric Inpatients in an Acute Care Unit (AGIR Study): Protocol for a Usability Study %A Noublanche,Frédéric %A Simon,Romain %A Ben-Sadoun,Grégory %A Annweiler,Cédric %+ Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, 4, rue Larrey, Angers, 49 933 Angers Cedex 9, France, 33 2 41 35 36 37, gregory.ben-sadoun@unicaen.fr %K fall prevention %K physical activity %K older patients %K geriatric acute care unit %D 2022 %7 11.7.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Falls are one of the world’s top 10 risks associated with disability in people older than 60 years. They also represent more than two-thirds of adverse events in hospitals, mainly affecting patients older than 65 years. Physical activity is a central intervention in fall prevention for older people. Whatever the details of the prevention strategy that is adopted (ie, how a mono- or multifactorial intervention is evaluated, the category of person the intervention targets, and where it is used), it is important to ensure that the proposed intervention is feasible and usable for the patient and the health care team. Objective: The primary objective is to study the usability of carrying out a physical activity intervention, including 3 types of exercises, in older patients hospitalized in a geriatric acute care unit and categorized according to 3 fall risk levels: low, moderate, and high. The secondary objectives are to determine the difficulty of the physical exercise for patients with different fall risk levels, to study the health care team’s perceptions of the intervention’s feasibility, and to study the benefits for patients. Methods: This is an open-label, unicenter, nonrandomized, usability prospective clinical trial. The intervention tested is a daily physical activity program. It consists of 3 types of physical exercise: staying out of bed for at least 3 hours, performing balance exercises while standing for 2 minutes, and the Five Times Sit to Stand transfer exercise. These exercises are carried out under the supervision of the health care team. Fall risk in the patients is classified with the Brief Geriatric Assessment tool. The exercise program starts on the second day of hospitalization after inclusion in the study. Patient assessment continues until the last day of hospitalization or the 20th day of hospitalization, whichever is earlier. For each fall-risk group and each type of exercise, the intervention will be defined as usable if at least 80% of the participants complete 75% or more of the exercises (ie, the ratio between the number of days when the patient completes a type of exercise and the total number of hospitalization days). The perceived feasibility by the health care team is measured with 2 scales, measuring perceived difficulty and time spent with the patient. The intervention benefit is evaluated using the performance of the Five Times Sit to Stand test before and after the intervention. Results: The first patient was recruited on March 16, 2015. The study enrolled 266 patients, including 75 with low fall risk, 105 with moderate risk, and 85 with high risk. Conclusions: We have not yet analyzed the results, but our observations suggest that the usability of each type of exercise for a given patient will depend on their fall risk level. Trial Registration: ClinicalTrials.gov NCT02393014; https://clinicaltrials.gov/ct2/show/NCT02393014 International Registered Report Identifier (IRRID): DERR1-10.2196/32288 %M 35816381 %R 10.2196/32288 %U https://www.researchprotocols.org/2022/7/e32288 %U https://doi.org/10.2196/32288 %U http://www.ncbi.nlm.nih.gov/pubmed/35816381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e26196 %T Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study %A Nogueira,Mª Nilza %A Silva,Joana %A Nogueira,Isabel %A Pacheco,Maria Neto %A Lopes,Joana %A Araújo,Fátima %+ Escola Superior de Enfermagem do Porto, Centro de Investigação em Tecnologias e Serviços de Saúde, Escola Superior de Enfermagem do Porto, Porto, 4200-072, Portugal, 351 225 073 500, nilza@esenf.pt %K functional tests %K fall assessment %K exercices %K older adults: games %K technology %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools. Objective: The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting. Methods: This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed. Results: A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors. Conclusions: In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results. %M 35767321 %R 10.2196/26196 %U https://formative.jmir.org/2022/6/e26196 %U https://doi.org/10.2196/26196 %U http://www.ncbi.nlm.nih.gov/pubmed/35767321 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e34796 %T A Case Management Program at Home to Reduce Fall Risk in Older Adults (the MAGIC Study): Protocol for a Single-Blind Randomized Controlled Trial %A Alberto,Silsam Napolitano %A Ansai,Juliana Hotta %A Janducci,Ana Luísa %A Florido,João Vitor Businaro %A Novaes,Areta Dames Cachapuz %A Caetano,Maria Joana Duarte %A Rossi,Paulo Giusti %A Tavares,Larissa Riani Costa %A Lord,Stephen Ronald %A Gramani-Say,Karina %+ Department of Gerontology, Federal University of São Carlos, Rodovia Washington Luís, Km 235, São Carlos, Postal 676, Zip Code 13565-905, Brazil, 55 16 3306 6745, jhansai@ufscar.br %K accidental falls %K risk management %K aged %K fall prevention %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. Objective: This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). Methods: Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. Results: Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. Conclusions: This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. Trial Registration: Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd International Registered Report Identifier (IRRID): DERR1-10.2196/34796 %M 35700005 %R 10.2196/34796 %U https://www.researchprotocols.org/2022/6/e34796 %U https://doi.org/10.2196/34796 %U http://www.ncbi.nlm.nih.gov/pubmed/35700005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31352 %T The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial %A Alley,Stephanie J %A van Uffelen,Jannique %A Schoeppe,Stephanie %A Parkinson,Lynne %A Hunt,Susan %A Power,Deborah %A Waterman,Natasha %A Waterman,Courtney %A To,Quyen G %A Duncan,Mitch J %A Schneiders,Anthony %A Vandelanotte,Corneel %+ Physical Activity Research Group, Appleton Institute, Central Queensland University, Building 7, Bruce Hwy, Rockhampton, 4701, Australia, 61 749232263, s.alley@cqu.edu.au %K internet %K online %K activity trackers %K activity monitors %K wearables %K physical activity %K mobile phone %D 2022 %7 12.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. Objective: The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. Methods: Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants’ Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)–measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. Results: A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI –24% to 40%) or the tailoring-only group (–4%, 95% CI –24% to 30%); however, a significant decline was seen in the control group (–35%, 95% CI –52% to –11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). Conclusions: A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246 %M 35552166 %R 10.2196/31352 %U https://www.jmir.org/2022/5/e31352 %U https://doi.org/10.2196/31352 %U http://www.ncbi.nlm.nih.gov/pubmed/35552166 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e36768 %T Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study %A Kleschnitzki,Jana Marina %A Grossmann,Inga %A Beyer,Reinhard %A Beyer,Luzi %+ Institute of Psychology, Faculty of Human Sciences, Humboldt-University of Berlin, Rudower Chaussee 18, Berlin, 12489, Germany, 49 15231964606, janakleschnitzki@posteo.de %K serious games %K motor skills %K motor %K long-term care %K exercise %K movement %K coronavirus effects %K eHealth %K seniors %K older adult %K elder %K senior population %K aged %K care home %K intervention effects analysis %K COVID-19 %K pandemic %K digital game %K digital health %K physical activity %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial η2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn’t reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial η2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial η²=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px %M 35536610 %R 10.2196/36768 %U https://games.jmir.org/2022/2/e36768 %U https://doi.org/10.2196/36768 %U http://www.ncbi.nlm.nih.gov/pubmed/35536610 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28222 %T Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study %A Puthusseryppady,Vaisakh %A Morrissey,Sol %A Aung,Min Hane %A Coughlan,Gillian %A Patel,Martyn %A Hornberger,Michael %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7139, m.hornberger@uea.ac.uk %K Alzheimer disease %K dementia %K spatial disorientation %K getting lost %K outdoor navigation %K risk factors %K environmental %K GPS tracking %K community %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients’ right to safety and autonomy when making outings alone in the community. %M 35451965 %R 10.2196/28222 %U https://aging.jmir.org/2022/2/e28222 %U https://doi.org/10.2196/28222 %U http://www.ncbi.nlm.nih.gov/pubmed/35451965 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e35511 %T A Photography-based, Social Media Walking Intervention Targeting Autonomous Motivations for Physical Activity: Semistructured Interviews With Older Women %A Robertson,Michael C %A Swartz,Maria Chang %A Christopherson,Ursela %A Bentley,Jason R %A Basen-Engquist,Karen M %A Thompson,Debbe %A Volpi,Elena %A Lyons,Elizabeth J %+ Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 2575, ellyons@utmb.edu %K physical activity %K walking %K exercise %K fitness %K social media %K health %K intervention %K behavior %K behavior mechanism %K psychological theory %K serious games %K gamification %K older women %K older adults %K behavior change %K behavioral interventions %K mobile phone %K photography %K patient perspective %K patient attitude %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. Objective: The objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. Methods: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. Results: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. Conclusions: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women. %M 35436205 %R 10.2196/35511 %U https://games.jmir.org/2022/2/e35511 %U https://doi.org/10.2196/35511 %U http://www.ncbi.nlm.nih.gov/pubmed/35436205 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33165 %T The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study %A Ho,Vanda %A Merchant,Reshma A %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Rd, Tower Block Level 10, Division of Geriatric Medicine, Singapore, 119228, Singapore, 65 6779 5555, reshmaa@nuhs.edu.sg %K senior %K telehealth %K digital exercise %K acceptability %K telemedicine %K elderly %K older adults %K outcome %K isolation %K decline %K function %K adoption %K perception %K exercise %K physical activity %K questionnaire %K COVID-19 %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ≥60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14% (n=6), 12% (n=5), and 24% (n=10) of participants, respectively. Of the participants, 29% (n=12) had possible sarcopenia and 14% (n=6) were prefrail. Around 24% (n=10) were at risk of social isolation. Most of the participants (n=38, 91%) agreed that technology is good, and 79% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79%) agreed that they have the necessary knowledge, and 91% (n=38) had technological assistance available. However, 57% (n=24) were still apprehensive about using technology. Despite 71% (n=30) of older adults owning their devices, 36% (n=15) felt finances were limiting. Through digital HAPPY, 45% (n=19) of participants reported feeling stronger, 48% (n=20) had improved spirits, and 40% (n=17) and 38% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. %M 35294921 %R 10.2196/33165 %U https://aging.jmir.org/2022/2/e33165 %U https://doi.org/10.2196/33165 %U http://www.ncbi.nlm.nih.gov/pubmed/35294921 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e37127 %T The Moderating Effects of Disability on Mobile Internet Use Among Older Adults: Population-Based Cross-sectional Study %A Yang,Eunjin %A Lee,Kyung Hee %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3321, kyungheelee@yuhs.ac %K older adults %K people with disabilities %K digital divide %K mobile phone use %D 2022 %7 4.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The preferred devices to access the internet are changing from personal computers to mobile devices, and the number of older adults with or without disabilities is rapidly increasing in an aging society. However, little is known about the moderating effects of disability on mobile internet use among older adults. Objective: This study aimed to examine the levels of mobile internet use and factors associated with this use among older adults according to their disabilities. In addition, moderating effects of disability on mobile internet use were investigated. Methods: This study consisted of a secondary data analysis using the 2020 Digital Divide Survey conducted in South Korea. The single inclusion criterion was participants being aged 55 years or older; accordingly, 2243 people without disabilities and 1386 people with disabilities were included in the study. Multiple regression analyses considering complex sample designs were conducted to identify mobile internet use factors and to test the moderating effects of disability on mobile internet use. Results: Older adults with disabilities used mobile internet less than older adults without disabilities. However, disability status had moderating effects on the relationships between mobile internet use and (1) operational skills regarding mobile devices (B=0.31, P=.004), (2) internet use skills (B=1.46, P<.001), (3) motivation to use digital devices (B=0.46, P=.01), and (4) attitude toward new technology (B=0.50, P=.002). The results revealed that these positive relationships were stronger among older adults with disabilities than among adults without disabilities. Conclusions: Although older adults and people with disabilities are considered vulnerable populations regarding technology adoption, disability creates a stronger association between several determinants and actual mobile internet use. Therefore, policy makers and practitioners should pay attention to older adults with disabilities to deliver appropriate information-literacy education. Older adults with disabilities could be the primary beneficiaries of mobile services and new technology. %M 35377329 %R 10.2196/37127 %U https://www.jmir.org/2022/4/e37127 %U https://doi.org/10.2196/37127 %U http://www.ncbi.nlm.nih.gov/pubmed/35377329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e32212 %T Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial %A Pischke,Claudia R %A Voelcker-Rehage,Claudia %A Ratz,Tiara %A Peters,Manuela %A Buck,Christoph %A Meyer,Jochen %A von Holdt,Kai %A Lippke,Sonia %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany, 49 211 81 ext 08599, ClaudiaRuth.Pischke@med.uni-duesseldorf.de %K physical activity %K older adults %K eHealth %K print-based intervention %K web-based intervention %K physical activity promotion %K healthy aging %K preferences %K randomized trial %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fewer than half of older German adults engage in the recommended levels of endurance training. Objective: The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial. Methods: Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups. Results: Of the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (βtime=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: βgroup*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: βgroup*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2. Conclusions: There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time. Trial Registration: German Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073 %M 35319484 %R 10.2196/32212 %U https://mhealth.jmir.org/2022/3/e32212 %U https://doi.org/10.2196/32212 %U http://www.ncbi.nlm.nih.gov/pubmed/35319484 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32683 %T One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study %A Dimet-Wiley,Andrea %A Golovko,George %A Watowich,Stanley J %+ Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0645, United States, 1 832 613 5356, watowich@xray.utmb.edu %K hip %K fracture %K mortality %K aging %K older adults %K elderly %K mortality risk %K electronic health record %K EHR %K survival probability %K postfracture mortality rate %K fall %K bone %K injury %K dementia %K diabetes %K type 2 diabetes %K trauma %K treatment %K comorbidity %K mobility %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies but is critical to determining current unmet needs for therapeutic intervention. Objective: This study examined whether hip fracture increases the 1-year postfracture mortality rate relative to several other fracture types and determined whether dementia or type 2 diabetes (T2D) exacerbates postfracture mortality risk. Methods: TriNetX Diamond Network data were used to identify patients with a single event of fracture of the hip, the upper humerus, or several regions near and distal to the hip occurring from 60 to 89 years of age from 2010 to 2019. Propensity score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year postfracture mortality rates in elderly populations with dementia or T2D were established. Results: One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were significantly lower in the hip fracture groups, even after propensity score matching was performed on cohorts for a variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate the 1-year mortality risk. T2D did not exacerbate the 1-year mortality risk beyond mere additive effects. Conclusions: Elderly patients with hip fracture have a significantly decreased survival probability. Greatly increased 1-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, postfracture treatments or diagnoses, restoration of prefracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations for these 2 comorbidities. Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia. %M 35293865 %R 10.2196/32683 %U https://aging.jmir.org/2022/1/e32683 %U https://doi.org/10.2196/32683 %U http://www.ncbi.nlm.nih.gov/pubmed/35293865 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31404 %T A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study %A Beltran-Alacreu,Hector %A Navarro-Fernández,Gonzalo %A Godia-Lledó,Daniela %A Graell-Pasarón,Lucas %A Ramos-González,Álvaro %A Raya,Rafael %A Martin-Pintado Zugasti,Aitor %A Fernandez-Carnero,Josue %+ Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Avenida de Monteprincipe s/n Boadilla del Monte, Madrid, 28668, Spain, 34 91 3724700 ext 14635, martinpintado.a@gmail.com %K video games %K neck pain %K aged %K virtual reality %K exercise therapy %K physical therapy modalities %K technology %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective: The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods: A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane’s trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results: A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and “real” in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions: The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology. %M 35103608 %R 10.2196/31404 %U https://games.jmir.org/2022/1/e31404 %U https://doi.org/10.2196/31404 %U http://www.ncbi.nlm.nih.gov/pubmed/35103608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26652 %T Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal %A Domingos,Célia %A Costa,Patrício %A Santos,Nadine Correia %A Pêgo,José Miguel %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Largo do Paço, Braga, 4710-057, Portugal, 351 253 604 800, jmpego@med.uminho.pt %K user experience %K Technology Acceptance Model %K health monitoring %K fitness trackers %K aging %K seniors %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. Objective: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. Methods: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. Results: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high—perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=–.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. Conclusions: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults. %M 35080503 %R 10.2196/26652 %U https://www.jmir.org/2022/1/e26652 %U https://doi.org/10.2196/26652 %U http://www.ncbi.nlm.nih.gov/pubmed/35080503 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29987 %T Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic %A Muñoz,John %A Mehrabi,Samira %A Li,Yirou %A Basharat,Aysha %A Middleton,Laura E %A Cao,Shi %A Barnett-Cowan,Michael %A Boger,Jennifer %+ Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, john.munoz.hci@uwaterloo.ca %K virtual reality %K exergames %K persons living with dementia %K physical activity %K head mounted displays %K participatory design %K co-development %K gaming %K older adults %K elderly %K design %K dementia %K VR %K user-centered %K physical activity %K exercise %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. %M 35044320 %R 10.2196/29987 %U https://games.jmir.org/2022/1/e29987 %U https://doi.org/10.2196/29987 %U http://www.ncbi.nlm.nih.gov/pubmed/35044320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29153 %T Internet Search Results for Older Adult Physical Activity Guidelines: Scoping Review %A Harden,Samantha M %A Murphy,Anna %A Ratliff,Kathryn %A Balis,Laura E %+ Physical Activity Research and Community Implementation Laboratory, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, Blacksburg, VA, 24060, United States, 1 540 231 9960, harden.samantha@vt.edu %K dissemination %K information seeking %K health communication %K elderly %D 2022 %7 13.1.2022 %9 Review %J JMIR Form Res %G English %X Background: Older adults seek health-related information through casual internet searches. Yet, researchers focus on peer-reviewed journals and conference presentations as primary dissemination strategies. Representatives of mass media are alerted (passive diffusion) of new studies or recommendations, but the veracity of the information shared is not often analyzed, and when it is, the analysis is often not comprehensive. However, most older adults do not have access to peer-reviewed journal articles or paid subscription services for more reputable media outlets. Objective: We aimed to determine what information was readily available (ie, open access) to older adults who may casually search the internet for physical activity recommendations. Methods: We performed a 6-part scoping review to determine the research question and available evidence, and extract data within open-access top hits using popular online search engines. Results were categorized by a dissemination model that has categories of sources, channels, audience, and messages. Results: After the iterative search process, 92 unique articles were included and coded. Only 5 (5%) cited physical activity guidelines, and most were coded as promoting healthy aging (82/92, 89%) and positive framing (84/92, 91%). Most articles were posed as educational, but the authors’ credentials were rarely reported (ie, 22% of the time). Muscle strengthening and balance components of the physical activity guidelines for older adults were rarely reported (72/92, 78% and 80/92, 87%, respectively) or inaccurately reported (3/92, 3% and 3/92, 3%, respectively). Conclusions: Inconsistent messages lead to mistrust of science and public health representatives. This work highlights the lack of evidence within existing open-access resources. Further efforts are needed to ensure evidence-based public health messages are in the sources and channels older adults are using to inform their knowledge and behaviors. %M 35023847 %R 10.2196/29153 %U https://formative.jmir.org/2022/1/e29153 %U https://doi.org/10.2196/29153 %U http://www.ncbi.nlm.nih.gov/pubmed/35023847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30558 %T A Digital Health Fall Prevention Program for Older Adults: Feasibility Study %A Jacobson,Claire L %A Foster,Lauren C %A Arul,Hari %A Rees,Amanda %A Stafford,Randall S %+ Age Bold Inc, Los Angeles, CA, United States, 1 6503811395, lauren@agebold.com %K older adults %K accidental falls %K fall prevention %K digital health %K technology %K exercise %K longevity and healthy aging %K program evaluation %K aging %K elderly %K health strategy %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective: We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. Methods: Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results: The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. Conclusions: The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults. %M 34837492 %R 10.2196/30558 %U https://formative.jmir.org/2021/12/e30558 %U https://doi.org/10.2196/30558 %U http://www.ncbi.nlm.nih.gov/pubmed/34837492 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27645 %T Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study %A Gell,Nancy %A Hoffman,Elise %A Patel,Kushang %+ Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA, 98195-6540, United States, 1 2066168052, kvpatel@uw.edu %K tele-exercise %K technology %K older adults %K adult learning theory %K knee osteoarthritis %K mobile phone %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. %M 34889743 %R 10.2196/27645 %U https://aging.jmir.org/2021/4/e27645 %U https://doi.org/10.2196/27645 %U http://www.ncbi.nlm.nih.gov/pubmed/34889743 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29964 %T Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study %A Robertson,Michael C %A Baranowski,Tom %A Thompson,Debbe %A Basen-Engquist,Karen M %A Swartz,Maria Chang %A Lyons,Elizabeth J %+ Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 2578, ellyons@utmb.edu %K physical activity %K video games %K eHealth %K intervention %K behavior and behavior mechanisms %K psychological theory %K serious games %K gamification %K older women %K older adults %K behavior change %K behavioral interventions %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. %M 34870604 %R 10.2196/29964 %U https://games.jmir.org/2021/4/e29964 %U https://doi.org/10.2196/29964 %U http://www.ncbi.nlm.nih.gov/pubmed/34870604 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27208 %T Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial %A Bisson,Alycia N %A Sorrentino,Victoria %A Lachman,Margie E %+ Psychiatry Department, Brigham and Women’s Hospital, Room 394, 221 Longwood Ave, Boston, MA, 02115, United States, 1 5082598151, alyciansullivan@brandeis.edu %K physical activity %K fitness technology %K intervention %K behavioral science %K aging %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity. Objective: The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy. Methods: The participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels. Results: Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants. Conclusions: Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537 %M 34855609 %R 10.2196/27208 %U https://mhealth.jmir.org/2021/12/e27208 %U https://doi.org/10.2196/27208 %U http://www.ncbi.nlm.nih.gov/pubmed/34855609 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33589 %T Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study %A Cabral,Danylo F %A Hinchman,Carrie A %A Nunez,Christina %A Rice,Jordyn %A Loewenstein,David A %A Cahalin,Lawrence P %A Rundek,Tatjana %A Pascual-Leone,Alvaro %A Gomes-Osman,Joyce %+ Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St #609, Miami, FL, United States, 1 305 243 6732, j.gomes@miami.edu %K exercise %K neuroplasticity %K cognition %K brain health %K cardiorespiratory fitness %K cardiovascular function %K trophic factors %K telehealth %K aging adult %D 2021 %7 23.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 %M 34817393 %R 10.2196/33589 %U https://www.researchprotocols.org/2021/11/e33589 %U https://doi.org/10.2196/33589 %U http://www.ncbi.nlm.nih.gov/pubmed/34817393 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e30332 %T Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counseling Intervention: Qualitative Study Using a Relational Ethics Lens %A Leese,Jenny %A MacDonald,Graham %A Backman,Catherine L %A Townsend,Anne %A Nimmon,Laura %A Li,Linda C %+ Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada, 1 604 207 4020, lli@arthritisresearch.ca %K relational ethics %K physical activity %K wearable %K arthritis %K qualitative %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. However, recent evidence also identifies some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ethically aware ways. Objective: Using an ethics lens, we aimed to describe a range of experiences from persons with knee OA who used a wearable during a physical activity counseling intervention study. Methods: This is a secondary analysis of qualitative interviews nested within a randomized controlled trial. Guided by phenomenography, we explored the experiences of persons with knee OA following participation in a physical activity counseling intervention that involved using a Fitbit Flex and biweekly phone calls with a study physiotherapist (PT) in an 8-week period. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. Results: Interviews with 21 participants (12 females and 9 males) aged 40 to 82 years were analyzed. Education levels ranged from high school graduates (4/21, 19%) to bachelor’s degrees or above (11/21, 52%). We identified 3 categories of description: (1) participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; (2) some participants felt a sense of accomplishment from seeing progress in their wearable data, which fueled their motivation; (3) for some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. However, they also expressed there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. Conclusions: Findings provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in a randomized controlled trial to support physical activity. To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation. %M 34766912 %R 10.2196/30332 %U https://mhealth.jmir.org/2021/11/e30332 %U https://doi.org/10.2196/30332 %U http://www.ncbi.nlm.nih.gov/pubmed/34766912 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e15220 %T Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment %A Elavsky,Steriani %A Klocek,Adam %A Knapova,Lenka %A Smahelova,Martina %A Smahel,David %A Cimler,Richard %A Kuhnova,Jitka %+ Department of Human Movement Studies, University of Ostrava, Varenska 40a, Ostrava, 70200, Czech Republic, 420 553462588, steriani.elavsky@osu.cz %K mHealth %K mobile phone %K older adults %K health behavior %K physical activity %K Fitbit %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants’ perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. %M 34757317 %R 10.2196/15220 %U https://aging.jmir.org/2021/4/e15220 %U https://doi.org/10.2196/15220 %U http://www.ncbi.nlm.nih.gov/pubmed/34757317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28634 %T Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study %A Herkert,Cyrille %A Graat-Verboom,Lidwien %A Gilsing-Fernhout,Judith %A Schols,Manon %A Kemps,Hareld Marijn Clemens %+ Department of Cardiology, Máxima Medical Center, Dominee Theodor Fliednerstraat 1, Eindhoven, 5631 BM, Netherlands, 31 408888220, cyrille.herkert@mmc.nl %K home-based exercise %K cardiac diseases %K pulmonary diseases %K comorbidities %K elderly %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 %M 34751655 %R 10.2196/28634 %U https://formative.jmir.org/2021/11/e28634 %U https://doi.org/10.2196/28634 %U http://www.ncbi.nlm.nih.gov/pubmed/34751655 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29044 %T Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial %A Radhakrishnan,Kavita %A Julien,Christine %A Baranowski,Tom %A O'Hair,Matthew %A Lee,Grace %A Sagna De Main,Atami %A Allen,Catherine %A Viswanathan,Bindu %A Thomaz,Edison %A Kim,Miyong %+ School of Nursing, The University of Texas Austin, 1710 Red River St, Austin, TX, 78701, United States, 1 512 471 7936, Kradhakrishnan@mail.nur.utexas.edu %K heart failure %K digital game %K sensor %K self-management %K older adults %K weight monitoring %K physical activity %K behaviors %K mobile phone %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants’ knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results: A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983 %M 34747701 %R 10.2196/29044 %U https://games.jmir.org/2021/4/e29044 %U https://doi.org/10.2196/29044 %U http://www.ncbi.nlm.nih.gov/pubmed/34747701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e28554 %T Effectiveness of a Walking Football Program for Middle-Aged and Older Men With Type 2 Diabetes: Protocol for a Randomized Controlled Trial %A Barbosa,Ana %A Brito,João %A Figueiredo,Pedro %A Seabra,André %A Mendes,Romeu %+ EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, Porto, 4050-600, Portugal, 351 222061820, romeuduartemendes@gmail.com %K type 2 diabetes %K cardiovascular risk factors %K physical activity %K exercise %K football %K soccer %K walking %K randomized controlled trial %D 2021 %7 3.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Studies on walking football have found positive effects on health; however, there are still several research gaps when applying walking football programs for patients with type 2 diabetes. Objective: This study aims to test the effectiveness of a walking football exercise program on glycemic control and cardiovascular risk factors in middle-aged and older men with type 2 diabetes. Methods: The study will be run as a randomized controlled trial with a 6-month duration in Portugal. Eligible participants will be randomized using a 1:1 ratio for intervention or control groups and compared using an intention-to-treat analysis. The intervention will consist of a walking football exercise program. The control group will continue with usual care in primary health care units. The primary outcome will be the mean difference in glycated hemoglobin between intervention and control groups after 6 months. Secondary outcomes include the mean differences in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index, waist circumference, fat-free mass, and fat mass. Additionally, secondary outcomes include the incidence of exercise-related injuries and adverse events and the walking football exercise program’s cost-utility. Results: The study protocol is being prepared to be submitted to the Health Ethics Committee of the Northern Regional Health Administration, Portugal. After approval, participant recruitment will start in primary health care units in Porto's metropolitan area by family medicine doctors. Conclusions: Walking football might have the potential to be effective in improving glycemic control and cardiovascular risk factors, with a low rate of exercise-related injuries and adverse events and a good cost-utility ratio. Therefore, walking football may be a sustainable intervention strategy for type 2 diabetes management. International Registered Report Identifier (IRRID): PRR1-10.2196/28554 %M 34730549 %R 10.2196/28554 %U https://www.researchprotocols.org/2021/11/e28554 %U https://doi.org/10.2196/28554 %U http://www.ncbi.nlm.nih.gov/pubmed/34730549 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29188 %T Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study %A Yin,Zenong %A Martinez,Cristina E %A Li,Shiyu %A Martinez,Martha %A Peng,Kezhi %A Land,William M %A Ullevig,Sarah L %A Cantu,Adelita %A Falk,Sharon %A Hernández,Arthur E %A Ortega,Catherine %A Parra-Medina,Deborah %A Simmonds,Maureen J %+ Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, United States, 1 210 458 5650, zenong.yin@utsa.edu %K mHealth %K community-based participatory research %K five animal play %K wuqinxi %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse. Objective: This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults. Methods: This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks. Results: Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3% participant retention, 79.4% of the participants completed at least 70% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest. Conclusions: FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137 %M 34723824 %R 10.2196/29188 %U https://aging.jmir.org/2021/4/e29188 %U https://doi.org/10.2196/29188 %U http://www.ncbi.nlm.nih.gov/pubmed/34723824 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e27848 %T An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study %A Kamnardsiri,Teerawat %A Phirom,Kochaphan %A Boripuntakul,Sirinun %A Sungkarat,Somporn %+ Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, 9th Floor, Faculty of Associated Medical Sciences, 110 Intawaroros Rd, Sripoom, Chiang Mai, 50200, Thailand, 66 53936042, somporn.sungkarat@cmu.ac.th %K digital game %K interactive game-based training %K physical-cognitive training %K exergaming %K Kinect sensors %K older adults %K falls %K PACES %K user-centered design %K game-based exercise %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. Objective: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. Methods: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants’ characteristics and PACES scores. Results: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. Conclusions: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined. %M 34704953 %R 10.2196/27848 %U https://games.jmir.org/2021/4/e27848 %U https://doi.org/10.2196/27848 %U http://www.ncbi.nlm.nih.gov/pubmed/34704953 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32729 %T Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study %A Henrique,Patrícia Paula Bazzanello %A Perez,Fabrízzio Martin Pelle %A Becker,Osvaldo Henrique Cemin %A Bellei,Ericles Andrei %A Biduski,Daiana %A Korb,Arthiese %A Pochmann,Daniela %A Dani,Caroline %A Elsner,Viviane Rostirola %A De Marchi,Ana Carolina Bertoletti %+ Institute of Exact Sciences and Geosciences, University of Passo Fundo, B5 Building, São José, Highway BR-285, Km 292, Passo Fundo, 99052-900, Brazil, 55 5433168354, 168729@upf.br %K elderly women %K exergame %K epigenome %K cognition %K kinesiotherapy %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women’s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 %M 34643543 %R 10.2196/32729 %U https://www.researchprotocols.org/2021/10/e32729 %U https://doi.org/10.2196/32729 %U http://www.ncbi.nlm.nih.gov/pubmed/34643543 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32085 %T Noisy Galvanic Vestibular Stimulation Combined With a Multisensory Balance Program in Older Adults With Moderate to High Fall Risk: Protocol for a Feasibility Study for a Randomized Controlled Trial %A McLaren,Ruth %A Smith,Paul F %A Lord,Sue %A Kaur,Preet Kamal %A Zheng,Yiwen %A Taylor,Denise %+ Rehabilitation Innovation Centre, School of Clinical Sciences, Auckland University of Technology, AA115, AA Building, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 9 9210 9680, denise.taylor@aut.ac.nz %K older adult %K balance %K rehabilitation %K noisy galvanic vestibular stimulation %K nGVS %K brain stimulation %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reduced mobility and falls are common among older adults. Balance retraining programs are effective in reducing falls and in improving balance and mobility. Noisy galvanic vestibular stimulation is a low-level electrical stimulation used to reduce the threshold for the firing of vestibular neurons via a mechanism of stochastic resonance. Objective: This study aims to determine the feasibility of using noisy galvanic vestibular stimulation to augment a balance training program for older adults at risk of falls. We hypothesize that noisy galvanic vestibular stimulation will enhance the effects of balance retraining in older adults at risk of falls Methods: In this 3-armed randomized controlled trial, community dwelling older adults at risk of falling will be randomly assigned to a noisy galvanic vestibular stimulation plus balance program (noisy galvanic vestibular stimulation group), sham plus balance program (sham group), or a no treatment group (control). Participants will attend the exercise group twice a week for 8 weeks with assessment of balance and gait pretreatment, posttreatment, and at 3 months postintervention. Primary outcome measures include postural sway, measured by center of pressure velocity, area and root mean square, and gait parameters such as speed, step width, step variability, and double support time. Spatial memory will also be measured using the triangle completion task and the 4 Mountains Test. Results: Recruitment began in November 2020. Data collection and analysis are expected to be completed by December 2022. Conclusions: This study will evaluate the feasibility of using noisy galvanic vestibular stimulation alongside balance retraining in older adults at risk of falls and will inform the design of a fully powered randomized controlled trial. Trial Registration: New Zealand Clinical Trials Registry (ACTRN12620001172998); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379944 International Registered Report Identifier (IRRID): DERR1-10.2196/32085 %M 34609323 %R 10.2196/32085 %U https://www.researchprotocols.org/2021/10/e32085 %U https://doi.org/10.2196/32085 %U http://www.ncbi.nlm.nih.gov/pubmed/34609323 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31137 %T Exploring Associations of Housing, Relocation, and Active and Healthy Aging in Sweden: Protocol for a Prospective Longitudinal Mixed Methods Study %A Zingmark,Magnus %A Björk,Jonas %A Granbom,Marianne %A Gefenaite,Giedre %A Nordeström,Frida %A Schmidt,Steven M %A Rantanen,Taina %A Slaug,Björn %A Iwarsson,Susanne %+ Department of Health Sciences, Lund University, Margaretavägen 1B, PO Box 157, Lund, 222 40, Sweden, 46 462221940, susanne.iwarsson@med.lu.se %K accessibility %K activity %K age-friendly housing %K aging-in-place %K housing preferences %K life-space %K mobility %K moving expectations %K neighborhood %K participation %D 2021 %7 21.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging. Objective: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation. Methods: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants’ deepened experience over time in terms of fulfilled expectations and relocation experiences. Results: As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021. Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels. Trial Registration: ClinicalTrials.gov NCT04765696; https://clinicaltrials.gov/ct2/show/NCT04765696 International Registered Report Identifier (IRRID): DERR1-10.2196/31137 %M 34546172 %R 10.2196/31137 %U https://www.researchprotocols.org/2021/9/e31137 %U https://doi.org/10.2196/31137 %U http://www.ncbi.nlm.nih.gov/pubmed/34546172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26871 %T A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study %A Gomes,Luís Antunes %A Gregório,Maria João %A Iakovleva,Tatiana A %A Sousa,Rute Dinis de %A Bessant,John %A Oliveira,Pedro %A Branco,Jaime C %A Canhão,Helena %A Rodrigues,Ana Maria %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Pólo de Investigação, NMS, UNL. Edifício Amarelo, Piso 2. Rua do Instituto Bacteriológico, nº5, Lisbon, Portugal, 351 218 803 000, ana.m.rodrigues@nms.unl.pt %K food insecurity %K eHealth %K television app %K elderly people %K vulnerable population %K cognitive behavioral strategy %K health innovation %K multidisciplinary program %D 2021 %7 31.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. Objective: This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. Methods: A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). Results: A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean −3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean −0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean −1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. Conclusions: The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants’ fatigue and physical function. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6626 %M 34463638 %R 10.2196/26871 %U https://www.jmir.org/2021/8/e26871 %U https://doi.org/10.2196/26871 %U http://www.ncbi.nlm.nih.gov/pubmed/34463638 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e24665 %T Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study %A Lapierre,Nolwenn %A Um Din,Nathavy %A Igout,Manuella %A Chevrier,Joël %A Belmin,Joël %+ Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris, AP-HP.Sorbonne Université, 7 Av de la République, Ivry-Sur-Seine, 94200, France, 33 0149594571, nolwennlapierre@gmail.com %K older adult %K fall %K fear of falling %K exergame %K randomized controlled trial %K psychomotor therapy %K rehabilitation %K fear %K risk %K elderly %K protocol %K therapy %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comité de Protection des Personnes Nord-Ouest I–Université de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 %M 34435968 %R 10.2196/24665 %U https://www.researchprotocols.org/2021/8/e24665 %U https://doi.org/10.2196/24665 %U http://www.ncbi.nlm.nih.gov/pubmed/34435968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24015 %T eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability %A Kraaijkamp,Jules J M %A van Dam van Isselt,Eléonore F %A Persoon,Anke %A Versluis,Anke %A Chavannes,Niels H %A Achterberg,Wilco P %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 610599869, J.J.M.Kraaijkamp@lumc.nl %K geriatric rehabilitation %K eHealth %K mHealth %K digital health %K effectiveness %K feasibility %K usability %K systematic review %D 2021 %7 19.8.2021 %9 Review %J J Med Internet Res %G English %X Background: eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. Objective: The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. Methods: We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. Results: In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. Conclusions: eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation. %M 34420918 %R 10.2196/24015 %U https://www.jmir.org/2021/8/e24015 %U https://doi.org/10.2196/24015 %U http://www.ncbi.nlm.nih.gov/pubmed/34420918 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e16846 %T Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study %A Humphry,Nia Angharad %A Wilson,Thomas %A Cox,Michael Christian %A Carter,Ben %A Arkesteijn,Marco %A Reeves,Nicola Laura %A Brakenridge,Scott %A McCarthy,Kathryn %A Bunni,John %A Draper,John %A Hewitt,Jonathan %+ School of Medicine, Cardiff University, 9th Floor Neuadd Meirionydd, University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom, 44 7815913222, HumphryNA1@cardiff.ac.uk %K sarcopenia %K frailty %K nutritional status %K urine metabolomics %K surgery %K geriatric medicine %D 2021 %7 17.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/16846 %M 34402798 %R 10.2196/16846 %U https://www.researchprotocols.org/2021/8/e16846 %U https://doi.org/10.2196/16846 %U http://www.ncbi.nlm.nih.gov/pubmed/34402798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e25781 %T A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study %A Araújo,Fátima %A Nogueira,Maria Nilza %A Silva,Joana %A Rego,Sílvia %+ Escola Superior de Enfermagem do Porto (ESEP), Inovação e Desenvolvimento em Enfermagem, Centro de Investigação em Tecnologias e Serviços de Saúde, Rua Dr. António Bernardino, 830, 844, 856, Porto, 4200-072, Portugal, 351 00351 225 073 5, araujo@esenf.pt %K fall prevention %K technological platform %K elderly %K Otago Exercise Program %D 2021 %7 12.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. Objective: This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. Methods: A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. Results: This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. Conclusions: The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. Trial Registration: ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163 International Registered Report Identifier (IRRID): PRR1-10.2196/25781 %M 34387557 %R 10.2196/25781 %U https://www.researchprotocols.org/2021/8/e25781 %U https://doi.org/10.2196/25781 %U http://www.ncbi.nlm.nih.gov/pubmed/34387557 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e28400 %T Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Liu,Justina Yat Wa %A Fong,Kenneth Nai Kuen %A Qin,Jing %A Leung,Philip Kwok-Yuen %A Sin,Olive Suk Kan %A Hon,Pik Yuen %A Suen,Lydia W %A Tse,Man-Kei %A Lai,Claudia KY %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, GH502, Hung Hom, Kowloon, Hong Kong, , China (Hong Kong), 852 2766 6546, rick.kwan@polyu.edu.hk %K virtual reality %K motor-cognitive training %K cognitive frailty %K game %K feasibility %K VR %K training %K older adults %K frail %K pilot study %K randomized controlled trial %D 2021 %7 6.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. Objective: We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. Methods: A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. Results: Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=–2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=–1.19, P=.24). The reduction in physical frailty in the intervention group (Z=–1.73, P=.08) was similar to that in the control group (Z=–1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=–0.16, P=.11) and greater in the control group (Z=–2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. Conclusions: This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial Registration: ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216 %M 34383662 %R 10.2196/28400 %U https://games.jmir.org/2021/3/e28400 %U https://doi.org/10.2196/28400 %U http://www.ncbi.nlm.nih.gov/pubmed/34383662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e30709 %T Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults’ Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial %A Beauchamp,Mark R %A Hulteen,Ryan M %A Ruissen,Geralyn R %A Liu,Yan %A Rhodes,Ryan E %A Wierts,Colin M %A Waldhauser,Katrina J %A Harden,Samantha H %A Puterman,Eli %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 604 822 4864, mark.beauchamp@ubc.ca %K COVID-19 %K randomized trial %K mental health %K physical activity %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults. Objective: The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. Methods: The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial’s primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms. Results: The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271). Conclusions: There were no intervention effects for the trial’s primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343 %M 34328433 %R 10.2196/30709 %U https://www.jmir.org/2021/7/e30709 %U https://doi.org/10.2196/30709 %U http://www.ncbi.nlm.nih.gov/pubmed/34328433 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26235 %T Older Adults’ Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory %A Pettersson,Beatrice %A Janols,Rebecka %A Wiklund,Maria %A Lundin-Olsson,Lillemor %A Sandlund,Marlene %+ Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, 90187, Sweden, 46 907865224, beatrice.pettersson@umu.se %K accidental falls %K aged %K exercise %K qualitative research %K eHealth %K self-management %K fall prevention %K behavior change %K self-determination theory %K classification of motivation and behavior change techniques %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory. Objective: This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users. Methods: The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed. Results: In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program. Conclusions: In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented. Trial Registration: ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849 %M 34328438 %R 10.2196/26235 %U https://www.jmir.org/2021/7/e26235 %U https://doi.org/10.2196/26235 %U http://www.ncbi.nlm.nih.gov/pubmed/34328438 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e27884 %T The Effects of Exergaming on Sensory Reweighting and Mediolateral Stability of Women Aged Over 60: Usability Study %A Sápi,Mariann %A Fehér-Kiss,Anna %A Csernák,Krisztina %A Domján,Andrea %A Pintér,Sándor %+ Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Temesvári krt. 31, Szeged, 6726, Hungary, 36 62 54 6411, domjan.andrea.agnes@szte.hu %K exergaming %K sensory reweighting %K older women %K mediolateral sway %K vestibular %D 2021 %7 21.7.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Older adults tend to experience difficulties in switching quickly between various reliable sensory inputs, which ultimately may contribute to an increased risk of falls and injuries. Sideward falls are the most frequent cause of hip fractures among older adults. Recently, exergame programs have been confirmed as beneficial tools for enhancing postural control, which can reduce the risk of falls. However, studies to explore more precisely which mechanism of exergaming directly influences older women’s ability to balance are still needed. Objective: Our aim was to evaluate, in a single-group pretest/posttest/follow-up usability study, whether Kinect exergame balance training might have a beneficial impact on the sensory reweighting in women aged over 60. Methods: A total of 14 healthy women (mean age 69.57 [SD 4.66] years, mean body mass index 26.21 [SD 2.6] kg/m2) participated in the study. The volunteers trained with the commercially available games of Kinect for Xbox 360 console 3 times (30 minutes/session) a week over a 6-week period (total of 18 visits). Participants’ postural sway in both the anteroposterior (AP) and mediolateral (ML) directions was recorded with NeuroCom Balance Master 6.0. To assess and measure postural sensory reweighting, the Modified Clinical Test of Sensory Interaction in Balance was used, where volunteers were exposed to various changes in visual (eyes open or eyes closed) and surface conditions (firm or foam surface). Results: In the ML direction, the Kinect exergame training caused a significant decrease in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P=.001), and on the foam surface with the eyes open (P=.001) and eyes closed (P<.001) conditions compared with baseline data. The follow-up measurements when compared with the baseline data showed a significant change in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P<.001) conditions, as well as on the foam surface with the eyes open (P=.003) and eyes closed (P<.001) conditions. Besides, on the firm surface, there were no significant differences in sway path values in the AP direction between the baseline and the posttraining measurements (eyes open: P=.49; eyes closed: P=.18). Likewise, on the foam surface, there were no significant differences in sway path values in the AP direction under both eyes open (P=.24) and eyes closed (P=.84) conditions. Conclusions: The improved posturography measurements of the sway path in the ML direction might suggest that the Kinect exergame balance training may have effects on sensory reweighting, and thus on the balance of women aged over 60. Based on these results, Kinect exergaming may provide a safe and potentially useful tool for improving postural stability in the crucial ML direction, and thus it may help reduce the risk of falling. %M 34287215 %R 10.2196/27884 %U https://games.jmir.org/2021/3/e27884 %U https://doi.org/10.2196/27884 %U http://www.ncbi.nlm.nih.gov/pubmed/34287215 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29013 %T Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial %A Fanning,Jason %A Brooks,Amber K %A Hsieh,Katherine L %A Kershner,Kyle %A Furlipa,Joy %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC, United States, 1 336 758 5042, fanninjt@wfu.edu %K aging %K physical activity %K sedentary behavior %K weight loss %K chronic pain %K mHealth %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. Objective: The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods: The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results: Recruitment is ongoing as of January 2021. Conclusions: Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration: ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID): PRR1-10.2196/29013 %M 34279241 %R 10.2196/29013 %U https://www.researchprotocols.org/2021/7/e29013 %U https://doi.org/10.2196/29013 %U http://www.ncbi.nlm.nih.gov/pubmed/34279241 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e24553 %T Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study %A Rouzaud Laborde,Charlotte %A Cenko,Erta %A Mardini,Mamoun T %A Nerella,Subhash %A Kheirkhahan,Matin %A Ranka,Sanjay %A Fillingim,Roger B %A Corbett,Duane B %A Weber,Eric %A Rashidi,Parisa %A Manini,Todd %+ Department of Pharmacy, University of Toulouse, Hopital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse, 31059, France, 33 625088692, charlotte.laborde@yahoo.fr %K ehealth %K mobile health %K ecological momentary assessment %K real-time online assessment and mobility monitor %K ROAMM %K older adults %K compliance %K personal satisfaction %K usability %K smartwatch %K knee osteoarthritis %K pain %K fatigue %K wearable electronic device %K mobile application %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night’s sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54%) and would consider wearing it as their personal watch (11/24, 46%). Most participants were satisfied with its battery charging system (20/26, 77%). A majority of participants (19/26, 73%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88% vs 16/26, 71%) and among those who found the text too small to read (4/26, 86% vs 22/26, 60%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. %M 34259638 %R 10.2196/24553 %U https://aging.jmir.org/2021/3/e24553 %U https://doi.org/10.2196/24553 %U http://www.ncbi.nlm.nih.gov/pubmed/34259638 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e15641 %T A Smart Shoe Insole to Monitor Frail Older Adults’ Walking Speed: Results of Two Evaluation Phases Completed in a Living Lab and Through a 12-Week Pilot Study %A Piau,Antoine %A Steinmeyer,Zara %A Charlon,Yoann %A Courbet,Laetitia %A Rialle,Vincent %A Lepage,Benoit %A Campo,Eric %A Nourhashemi,Fati %+ Gerontopole, University Hospital of Toulouse, 24 rue du pont St Pierre, Toulouse, 31400, France, 33 561323010, antoinepiau@hotmail.com %K frail older adults %K walking speed %K outpatient monitoring %K activity tracker %K shoe insert %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent World Health Organization reports propose wearable devices to collect information on activity and walking speed as innovative health indicators. However, mainstream consumer-grade tracking devices and smartphone apps are often inaccurate and require long-term acceptability assessment. Objective: Our aim is to assess the user acceptability of an instrumented shoe insole in frail older adults. This device monitors participants’ walking speed and differentiates active walking from shuffling after step length calibration. Methods: A multiphase evaluation has been designed: 9 older adults were evaluated in a living lab for a day, 3 older adults were evaluated at home for a month, and a prospective randomized trial included 35 older adults at home for 3 months. A qualitative research design using face-to-face and phone semistructured interviews was performed. Our hypothesis was that this shoe insole was acceptable in monitoring long-term outdoor and indoor walking. The primary outcome was participants' acceptability, measured by a qualitative questionnaire and average time of insole wearing per day. The secondary outcome described physical frailty evolution in both groups. Results: Living lab results confirmed the importance of a multiphase design study with participant involvement. Participants proposed insole modifications. Overall acceptability had mixed results: low scores for reliability (2.1 out of 6) and high scores for usability (4.3 out of 6) outcomes. The calibration phase raised no particular concern. During the field test, a majority of participants (mean age 79 years) were very (10/16) or quite satisfied (3/16) with the insole's comfort at the end of the follow-up. Participant insole acceptability evolved as follows: 63% (12/19) at 1 month, 50% (9/18) at 2 months, and 75% (12/16) at 3 months. A total of 9 participants in the intervention group discontinued the intervention because of technical issues. All participants equipped for more than a week reported wearing the insole every day at 1 month, 83% (15/18) at 2 months, and 94% (15/16) at 3 months for 5.8, 6.3, and 5.1 hours per day, respectively. Insole data confirmed that participants effectively wore the insole without significant decline during follow-up for an average of 13.5 days per 4 months and 5.6 hours per day. For secondary end points, the change in frailty parameters or quality of life did not differ for those randomly assigned to the intervention group compared to usual care. Conclusions: Our study reports acceptability data on an instrumented insole in indoor and outdoor walking with remote monitoring in frail older adults under real-life conditions. To date, there is limited data in this population set. This thin instrumentation, including a flexible battery, was a technical challenge and seems to provide an acceptable solution over time that is valued by participants. However, users still raised certain acceptability issues. Given the growing interest in wearable health care devices, these results will be useful for future developments. Trial Registration: ClinicalTrials.gov NCT02316600; https://clinicaltrials.gov/ct2/show/NCT02316600 %M 36260404 %R 10.2196/15641 %U https://mhealth.jmir.org/2021/7/e15641 %U https://doi.org/10.2196/15641 %U http://www.ncbi.nlm.nih.gov/pubmed/36260404 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e27972 %T The Effect of Mixed Reality Technologies for Falls Prevention Among Older Adults: Systematic Review and Meta-analysis %A Nishchyk,Anna %A Chen,Weiqin %A Pripp,Are Hugo %A Bergland,Astrid %+ Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, PO Box 4, St Olavs plass, Oslo, 0130, Norway, 47 45128733, annani@oslomet.no %K falls %K fall prevention %K mixed reality %K augmented reality %K virtual reality %K physical exercise %D 2021 %7 30.6.2021 %9 Review %J JMIR Aging %G English %X Background: Falling is one of the most common and serious age-related issues, and falls can significantly impair the quality of life of older adults. Approximately one-third of people over 65 experience a fall annually. Previous research has shown that physical exercise could help reduce falls among older adults and improve their health. However, older adults often find it challenging to follow and adhere to physical exercise programs. Interventions using mixed reality (MR) technology could help address these issues. MR combines artificial augmented computer-generated elements with the real world. It has frequently been used for training and rehabilitation purposes. Objective: The aim of this systematic literature review and meta-analysis was to investigate the use of the full spectrum of MR technologies for fall prevention intervention and summarize evidence of the effectiveness of this approach. Methods: In our qualitative synthesis, we analyzed a number of features of the selected studies, including aim, type of exercise, technology used for intervention, study sample size, participant demographics and history of falls, study design, involvement of health professionals or caregivers, duration and frequency of the intervention, study outcome measures, and results of the study. To systematically assess the results of the selected studies and identify the common effect of MR interventions, a meta-analysis was performed. Results: Seven databases were searched, and the initial search yielded 5838 results. With the considered inclusion and exclusion criteria, 21 studies were included in the qualitative synthesis and 12 were included in meta-analysis. The majority of studies demonstrated a positive effect of an MR intervention on fall risk factors among older participants. The meta-analysis demonstrated a statistically significant difference in Berg Balance Scale score between the intervention and control groups (ES: 0.564; 95% CI 0.246-0.882; P<.001) with heterogeneity statistics of I2=54.9% and Q=17.74 (P=.02), and a statistical difference in Timed Up and Go test scores between the intervention and control groups (ES: 0.318; 95% CI 0.025-0.662; P<.001) with heterogeneity statistics of I2=77.6% and Q=44.63 (P<.001). The corresponding funnel plot and the Egger test for small-study effects (P=.76 and P=.11 for Berg Balance Scale and Timed Up and Go, respectively) indicate that a minor publication bias in the studies might be present in the Berg Balance Scale results. Conclusions: The literature review and meta-analysis demonstrate that the use of MR interventions can have a positive effect on physical functions in the elderly. MR has the potential to help older users perform physical exercises that could improve their health conditions. However, more research on the effect of MR fall prevention interventions should be conducted with special focus given to MR usability issues. %M 34255643 %R 10.2196/27972 %U https://aging.jmir.org/2021/2/e27972 %U https://doi.org/10.2196/27972 %U http://www.ncbi.nlm.nih.gov/pubmed/34255643 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28684 %T Interrupting Sitting Time in Postmenopausal Women: Protocol for the Rise for Health Randomized Controlled Trial %A Hartman,Sheri J %A Dillon,Lindsay W %A LaCroix,Andrea Z %A Natarajan,Loki %A Sears,Dorothy D %A Owen,Neville %A Dunstan,David W %A Sallis,James F %A Schenk,Simon %A Allison,Matthew %A Takemoto,Michelle %A Herweck,Alexandra M %A Nguyen,Bao %A Rosenberg,Dori E %+ Hebert Wertheim School of Public Health, University of California, San Diego, 3855 Health Sciences Drive, Mail Code 0901, La Jolla, CA, , United States, 1 858 534 9235, sjhartman@ucsd.edu %K sedentary behavior %K cardiometabolic health %K older adults %K physical function %K cognitive function %K biomarkers %D 2021 %7 13.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many older adults spend the majority of their waking hours sitting, which increases their risk of chronic diseases. Given the challenges that many older adults face when engaging in moderate-to-vigorous physical activity, understanding the health benefits of decreasing sitting time and increasing the number of sit-to-stand transitions is needed to address this growing public health concern. Objective: The aim of this 3-arm randomized controlled trial is to investigate how changes in sitting time and brief sit-to-stand transitions impact biomarkers of healthy aging and physical, emotional, and cognitive functioning compared with a healthy attention control arm. Methods: Sedentary and postmenopausal women (N=405) will be recruited and randomly assigned to 1 of the 3 study conditions for 3 months: healthy living attention control (Healthy Living), reduce sitting time (Reduce Sitting), and increase sit-to-stand transitions (Increase Transitions). Assessments conducted at baseline and 3 months included fasting blood draw, blood pressure, anthropometric measurements, physical functioning, cognitive testing, and 7 days of a thigh-worn accelerometer (activPAL) and a hip-worn accelerometer (ActiGraph). Blood-based biomarkers of healthy aging included those associated with glycemic control (glycated hemoglobin, fasting plasma insulin and glucose, and homeostatic model assessment of insulin resistance). Results: Recruitment began in May 2018. The intervention is ongoing, with data collection expected to continue through the end of 2022. Conclusions: The Rise for Health study is designed to test whether 2 different approaches to interrupting sitting time can improve healthy aging in postmenopausal women. Results from this study may inform the development of sedentary behavior guidelines and interventions to reduce sitting time in older adults. Trial Registration: ClinicalTrials.gov NCT03473145; https://clinicaltrials.gov/ct2/show/NCT03473145 International Registered Report Identifier (IRRID): DERR1-10.2196/28684 %M 33983131 %R 10.2196/28684 %U https://www.researchprotocols.org/2021/5/e28684 %U https://doi.org/10.2196/28684 %U http://www.ncbi.nlm.nih.gov/pubmed/33983131 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26387 %T Exploring Breaks in Sedentary Behavior of Older Adults Immediately After Receiving Personalized Haptic Feedback: Intervention Study %A Compernolle,Sofie %A Van Dyck,Delfien %A Cardon,Greet %A Brondeel,Ruben %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 92646323, sofie.compernolle@ugent.be %K tactile feedback %K sitting behavior %K sedentary behavior %K older adults %K mHealth intervention %K self-monitoring %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: “Push” components of mobile health interventions may be promising to create conscious awareness of habitual sedentary behavior; however, the effect of these components on the near-time, proximal outcome, being breaks in sedentary behavior immediately after receiving a push notification, is still unknown, especially in older adults. Objective: The aims of this study are to examine if older adults break their sedentary behavior immediately after receiving personalized haptic feedback on prolonged sedentary behavior and if the percentage of breaks differs depending on the time of the day when the feedback is provided. Methods: A total of 26 Flemish older adults (mean age 64.4 years, SD 3.8) wore a triaxial accelerometer (Activator, PAL Technologies Ltd) for 3 weeks. The accelerometer generated personalized haptic feedback by means of vibrations each time a participant sat for 30 uninterrupted minutes. Accelerometer data on sedentary behavior were used to estimate the proximal outcome, which was sedentary behavior breaks immediately (within 1, 3, and 5 minutes) after receiving personalized haptic feedback. Generalized estimating equations were used to investigate whether or not participants broke up their sedentary behavior immediately after receiving haptic feedback. A time-related variable was added to the model to investigate if the sedentary behavior breaks differed depending on the time of day. Results: A total of 2628 vibrations were provided to the participants during the 3-week intervention period. Of these 2628 vibrations, 379 (14.4%), 570 (21.7%), and 798 (30.4%) resulted in a sedentary behavior break within 1, 3 and 5 minutes, respectively. Although the 1-minute interval did not reveal significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided, the 3- and 5-minute intervals did show significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided. Concretely, the percentage of sedentary behavior breaks was significantly higher if personalized haptic feedback was provided between noon and 3 PM compared to if the feedback was provided between 6 and 9 AM (odds ratio 1.58, 95% CI 1.01-2.47, within 3 minutes; odds ratio 1.78, 95% CI 1.11-2.84, within 5 minutes). Conclusions: The majority of haptic vibrations, especially those in the morning, did not result in a break in the sedentary behavior of older adults. As such, simply bringing habitual sedentary behavior into conscious awareness seems to be insufficient to target sedentary behavior. More research is needed to optimize push components in interventions aimed at the reduction of the sedentary behavior of older adults. Trial Registration: ClinicalTrials.gov NCT04003324; https://clinicaltrials.gov/ct2/show/NCT04003324 %M 33970109 %R 10.2196/26387 %U https://mhealth.jmir.org/2021/5/e26387 %U https://doi.org/10.2196/26387 %U http://www.ncbi.nlm.nih.gov/pubmed/33970109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e20966 %T Usability and Accuracy of a Smartwatch for the Assessment of Physical Activity in the Elderly Population: Observational Study %A Martinato,Matteo %A Lorenzoni,Giulia %A Zanchi,Tommaso %A Bergamin,Alessia %A Buratin,Alessia %A Azzolina,Danila %A Gregori,Dario %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Via Leonardo Loredan, 18, Padova, , Italy, 39 049 827 5384, dario.gregori@unipd.it %K wearable devices %K elderly %K physical activity %K smartwatches %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity (PA) contributes to the primary and secondary prevention of several chronic diseases and reduces the risk of premature death. Physical inactivity is a modifiable risk factor for cardiovascular disease and a variety of chronic disorders such as diabetes, obesity, hypertension, bone and joint diseases (eg, osteoporosis and osteoarthritis), depression, and colon and breast cancer. Population aging and the related increase in chronic diseases have a major impact on the health care systems of most Western countries and will produce an even more significant effect in the future. Monitoring PA is a valuable method of determining whether people are performing enough PA so as to prevent chronic diseases or are showing early symptoms of those diseases. Objective: The aim of this study was to estimate the accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting. Methods: Participants aged 70 to 90 years with the ability to walk safely without any walking aid for at least 300 meters, who had no walking disabilities or episodes of falling while walking in the last 12 months, were asked to walk 150 meters at their preferred pace wearing a vívoactive HR device (Garmin Ltd) and actual steps were monitored and tallied by a researcher using a hand-tally counter to assess the performance of the device at a natural speed. A Bland-Altman plot was used to analyze the difference between manually counted steps and wearable device–measured steps. The intraclass correlation coefficient (ICC) was computed (with a 95% confidence interval) between step measurements. The generalized linear mixed-model (GLMM) ICCs were estimated, providing a random effect term (random intercept) for the individual measurements (gold standard and device). Both adjusted and conditional ICCs were computed for the GLMM models considering separately the effect of age, sex, BMI, and obesity. Analyses were performed using R software (R Foundation for Statistical Computing) with the rms package. Results: A total of 23 females and 26 males were enrolled in the study. The median age of the participants was 75 years. The Bland-Altman plot revealed that, excluding one observation, all differences across measurements were in the confidence bounds, demonstrating the substantial agreement between the step count measurements. The results were confirmed by an ICC equal to .98 (.96-.99), demonstrating excellent agreement between the two sets of measurements. Conclusions: The level of accuracy of wearable devices in quantifying the PA of elderly people in a real-life setting that was found in this study supports the idea of considering wrist-wearable nonmedical devices (widely available in nonspecialized stores) as reliable tools. Both health care professionals and informal caregivers could monitor the level of PA of their patients. %M 33949953 %R 10.2196/20966 %U https://mhealth.jmir.org/2021/5/e20966 %U https://doi.org/10.2196/20966 %U http://www.ncbi.nlm.nih.gov/pubmed/33949953 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e23681 %T The Effect of Sensor Placement and Number on Physical Activity Recognition and Energy Expenditure Estimation in Older Adults: Validation Study %A Davoudi,Anis %A Mardini,Mamoun T %A Nelson,David %A Albinali,Fahd %A Ranka,Sanjay %A Rashidi,Parisa %A Manini,Todd M %+ Department of Biomedical Engineering, University of Florida, M542, Stetson Medical Science Building, 1345 Center Dr, Gainesville, FL, 32610, United States, 1 352 294 5086, anisdavoudi@ufl.edu %K human activity recognition %K machine learning %K wearable accelerometers %K mobile phone %D 2021 %7 3.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has shown the feasibility of human activity recognition using wearable accelerometer devices. Different studies have used varying numbers and placements for data collection using sensors. Objective: This study aims to compare accuracy performance between multiple and variable placements of accelerometer devices in categorizing the type of physical activity and corresponding energy expenditure in older adults. Methods: In total, 93 participants (mean age 72.2 years, SD 7.1) completed a total of 32 activities of daily life in a laboratory setting. Activities were classified as sedentary versus nonsedentary, locomotion versus nonlocomotion, and lifestyle versus nonlifestyle activities (eg, leisure walk vs computer work). A portable metabolic unit was worn during each activity to measure metabolic equivalents (METs). Accelerometers were placed on 5 different body positions: wrist, hip, ankle, upper arm, and thigh. Accelerometer data from each body position and combinations of positions were used to develop random forest models to assess activity category recognition accuracy and MET estimation. Results: Model performance for both MET estimation and activity category recognition were strengthened with the use of additional accelerometer devices. However, a single accelerometer on the ankle, upper arm, hip, thigh, or wrist had only a 0.03-0.09 MET increase in prediction error compared with wearing all 5 devices. Balanced accuracy showed similar trends with slight decreases in balanced accuracy for the detection of locomotion (balanced accuracy decrease range 0-0.01), sedentary (balanced accuracy decrease range 0.05-0.13), and lifestyle activities (balanced accuracy decrease range 0.04-0.08) compared with all 5 placements. The accuracy of recognizing activity categories increased with additional placements (accuracy decrease range 0.15-0.29). Notably, the hip was the best single body position for MET estimation and activity category recognition. Conclusions: Additional accelerometer devices slightly enhance activity recognition accuracy and MET estimation in older adults. However, given the extra burden of wearing additional devices, single accelerometers with appropriate placement appear to be sufficient for estimating energy expenditure and activity category recognition in older adults. %M 33938809 %R 10.2196/23681 %U https://mhealth.jmir.org/2021/5/e23681 %U https://doi.org/10.2196/23681 %U http://www.ncbi.nlm.nih.gov/pubmed/33938809 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e18819 %T A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial %A Blair,Cindy K %A Harding,Elizabeth %A Wiggins,Charles %A Kang,Huining %A Schwartz,Matthew %A Tarnower,Amy %A Du,Ruofei %A Kinney,Anita Y %+ Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, United States, 1 5059257907, CiBlair@salud.unm.edu %K light-intensity physical activity %K physical activity %K sedentary behavior %K mobile health %K cancer survivors %K consumer wearable %K activity monitor %K mobile phone %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective: This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods: Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results: Participants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008). Conclusions: A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration: ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694 %M 33847588 %R 10.2196/18819 %U https://cancer.jmir.org/2021/2/e18819 %U https://doi.org/10.2196/18819 %U http://www.ncbi.nlm.nih.gov/pubmed/33847588 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e18777 %T Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial %A Smith,Cassandra %A Lin,Xuzhu %A Scott,David %A Brennan-Speranza,Tara C %A Al Saedi,Ahmed %A Moreno-Asso,Alba %A Woessner,Mary %A Bani Hassan,Ebrahim %A Eynon,Nir %A Duque,Gustavo %A Levinger,Itamar %+ Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, Australia, 61 399195343, itamar.levinger@vu.edu.au %K acute exercise %K clinical trial %K bone %K adult %K aging %K osteocalcin %K muscles %K sarcopenia %K progenitor cells %K stem cells %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism. Objective: The proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality. Methods: A total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function. Results: The trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019. Conclusions: This study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925. International Registered Report Identifier (IRRID): DERR1-10.2196/18777 %M 33835038 %R 10.2196/18777 %U https://www.researchprotocols.org/2021/4/e18777 %U https://doi.org/10.2196/18777 %U http://www.ncbi.nlm.nih.gov/pubmed/33835038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27381 %T Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study %A Thiamwong,Ladda %A Stout,Jeffrey R %A Park,Joon-Hyuk %A Yan,Xin %+ College of Nursing, University of Central Florida, 12201 Research Parkway, Orlando, FL, 32826, United States, 1 4072830470, ladda.thiamwong@ucf.edu %K body composition %K falls %K risk assessment %K technology %K wearable devices %K accidental falls %K fear %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity. Objective: This study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings. Methods: This cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures. Results: Ethical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022. Conclusions: Accurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings. International Registered Report Identifier (IRRID): PRR1-10.2196/27381 %M 33825688 %R 10.2196/27381 %U https://www.researchprotocols.org/2021/4/e27381 %U https://doi.org/10.2196/27381 %U http://www.ncbi.nlm.nih.gov/pubmed/33825688 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24455 %T The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II to Assess the Use of the Apple Watch in Older Emergency Department Patients With Falls: Protocol for a Mixed Methods Study %A Strauss,Daniel H %A Davoodi,Natalie M %A Healy,Margaret %A Metts,Christopher L %A Merchant,Roland C %A Banskota,Swechya %A Goldberg,Elizabeth M %+ Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street, Second Floor, Room 203, Providence, RI, 02903, United States, 1 401 527 1740, elizabeth_goldberg@brown.edu %K fall intervention %K geriatric care %K Apple Watch %K wearable technology %D 2021 %7 1.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed; the device could also be used to objectively collect data on gait, fitness, and falls as part of clinical trials. However, little is known about the ease of use of this technology among older adult ED patients, a population at high risk of recurrent falls. Objective: The goal of this study—the Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II—is to examine the feasibility, acceptability, and usability of the Apple Watch Series 4 paired with the iPhone and our research app Rhode Island FitTest (RIFitTest) among older adult ED patients seeking care for falls. Methods: We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically, with or without telephone assistance from the research staff, to assess gait, fitness, and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semistructured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics. Results: Recruitment began in December 2019 and was on pause from April 2020 until September 2020 due to the COVID-19 pandemic. Study recruitment will continue until 30 participants are enrolled. This study has been approved by the Rhode Island Hospital Institutional Review Board (approval 1400781-16). Conclusions: GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology: older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs. Trial Registration: ClinicalTrials.gov NCT04304495; https://clinicaltrials.gov/ct2/show/NCT04304495 International Registered Report Identifier (IRRID): DERR1-10.2196/24455 %M 33792553 %R 10.2196/24455 %U https://www.researchprotocols.org/2021/4/e24455 %U https://doi.org/10.2196/24455 %U http://www.ncbi.nlm.nih.gov/pubmed/33792553 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e25779 %T Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study %A Daly,Jessica R %A Depp,Colin %A Graham,Sarah A %A Jeste,Dilip V %A Kim,Ho-Cheol %A Lee,Ellen E %A Nebeker,Camille %+ Research Center for Optimal Digital Ethics in Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 8585347786, nebeker@eng.ucsd.edu %K aging %K quarantine %K mental health %K physical health %K social isolation %K COVID-19 pandemic %K continued care senior housing community %K CCSHC %K qualitative research %K videoconferencing %K older adults %K gerontechnology %K loneliness %K housing for the elderly %K independent living %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting “Stay-at-Home” order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the “stay-at-home” mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. %M 33690146 %R 10.2196/25779 %U https://aging.jmir.org/2021/1/e25779 %U https://doi.org/10.2196/25779 %U http://www.ncbi.nlm.nih.gov/pubmed/33690146 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e22370 %T Exergaming Platform for Older Adults Residing in Long-Term Care Homes: User-Centered Design, Development, and Usability Study %A Chu,Charlene H %A Biss,Renée K %A Cooper,Lara %A Quan,Amanda My Linh %A Matulis,Henrique %+ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada, 1 416 946 0217, charlene.chu@utoronto.ca %K user-centered design %K aged %K long-term care %K nursing homes %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Older adults (OAs) residing in long-term care (LTC) homes are often unable to engage in adequate amounts of physical activity because of multiple comorbidities, including frailty and severe cognitive impairments. This level of physical inactivity is associated with declines in cognitive and functional abilities and can be further compounded by social isolation. Exergaming, defined as a combination of exercise and gaming, has the potential to engage OAs in exercise and encourage social interaction. However, previously used systems such as the Nintendo Wii are no longer commercially available, and the physical design of other exergames is not suitable for OAs (ie, fall risks, accessibility issues, and games geared toward a younger population) with diverse physical and cognitive impairments. Objective: This study aims to design and develop a novel, user-centered, evidence-based exergaming system for use among OAs in LTC homes. In addition, we aim to identify facilitators and barriers to the implementation of our exergaming intervention, the MouvMat, into LTC homes according to staff input. Methods: This study used a user-centered design (UCD) process that consisted of 4 rounds of usability testing. The exergame was developed and finalized based on existing evidence, end user and stakeholder input, and user testing. Semistructured interviews and standardized and validated scales were used iteratively to evaluate the acceptability, usability, and physical activity enjoyment of the MouvMat. Results: A total of 28 participants, 13 LTC residents, and 15 staff and family members participated in the UCD process for over 18 months to design and develop the novel exergaming intervention, the MouvMat. The iterative use of validated scales (System Usability Scale, 8-item Physical Activity Enjoyment Scale, and modified Treatment Evaluation Inventory) indicated an upward trend in the acceptability, usability, and enjoyment scores of MouvMat over 4 rounds of usability testing, suggesting that identified areas for refinement and improvement were appropriately addressed by the team. A qualitative analysis of semistructured interview data found that residents enjoyed engaging with the prototype and appreciated the opportunity to increase their PA. In addition, staff and stakeholders were drawn to MouvMat’s ability to increase residents’ autonomous PA. The intended and perceived benefits of MouvMat use, that is, improved physical and cognitive health, were the most common facilitators of its use identified by study participants. Conclusions: This study was successful in applying UCD to collaborate with LTC residents, despite the high number of physical and sensory impairments that this population experiences. By following a UCD process, an exergaming intervention that meets diverse requirements (ie, hardware design features and motivation) and considers environmental barriers and residents’ physical and cognitive needs was developed. The effectiveness of MouvMat in improving physical and cognitive abilities should be explored in future multisite randomized controlled trials. %M 33687337 %R 10.2196/22370 %U https://games.jmir.org/2021/1/e22370 %U https://doi.org/10.2196/22370 %U http://www.ncbi.nlm.nih.gov/pubmed/33687337 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e19859 %T Using Consumer-Grade Physical Activity Trackers to Measure Frailty Transitions in Older Critical Care Survivors: Exploratory Observational Study %A Kim,Ben %A Hunt,Miranda %A Muscedere,John %A Maslove,David M %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K frailty %K frail elderly %K wearable electronic devices %K fitness trackers %K activity trackers %K heart rate %K sleep monitoring %K critical care outcomes %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Critical illness has been suggested as a sentinel event for frailty development in at-risk older adults. Frail critical illness survivors are affected by increased adverse health outcomes, but monitoring the recovery after intensive care unit (ICU) discharge is challenging. Clinicians and funders of health care systems envision an increased role of wearable devices in monitoring clinically relevant measures, as sensor technology is advancing rapidly. The use of wearable devices has also generated great interest among older patients, and they are the fastest growing group of consumer-grade wearable device users. Recent research studies indicate that consumer-grade wearable devices offer the possibility of measuring frailty. Objective: This study aims to examine the data collected from wearable devices for the progression of frailty among critical illness survivors. Methods: An observational study was conducted with 12 older survivors of critical illness from Kingston General Hospital in Canada. Frailty was measured using the Clinical Frailty Scale (CFS) at ICU admission, hospital discharge, and 4-week follow-up. A wearable device was worn between hospital discharge and 4-week follow-up. The wearable device collected data on step count, physical activity, sleep, and heart rate (HR). Patient assessments were reviewed, including the severity of illness, cognition level, delirium, activities of daily living, and comorbidity. Results: The CFS scores increased significantly following critical illness compared with the pre-ICU frailty level (P=.02; d=−0.53). Survivors who were frail over the 4-week follow-up period had significantly lower daily step counts than survivors who were not frail (P=.02; d=1.81). There was no difference in sleep and HR measures. Daily step count was strongly correlated with the CFS at 4-week follow-up (r=−0.72; P=.04). The average HR was strongly correlated with the CFS at hospital discharge (r=−0.72; P=.046). The HR SD was strongly correlated (r=0.78; P=.02) with the change in CFS from ICU admission to 4-week follow-up. No association was found between the CFS and sleep measures. The pattern of increasing step count over the 4-week follow-up period was correlated with worsening of frailty (r=.62; P=.03). Conclusions: This study demonstrated an association between frailty and data generated from a consumer-grade wearable device. Daily step count and HR showed a strong association with the frailty progression of the survivors of critical illness over time. Understanding this association could unlock a new avenue for clinicians to monitor and identify a vulnerable subset of the older adult population that might benefit from an early intervention. %M 33620323 %R 10.2196/19859 %U https://aging.jmir.org/2021/1/e19859 %U https://doi.org/10.2196/19859 %U http://www.ncbi.nlm.nih.gov/pubmed/33620323 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e23423 %T A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers %A Da Silva Júnior,Jorge Luiz Andrade %A Biduski,Daiana %A Bellei,Ericles Andrei %A Becker,Osvaldo Henrique Cemin %A Daroit,Luciane %A Pasqualotti,Adriano %A Tourinho Filho,Hugo %A De Marchi,Ana Carolina Bertoletti %+ Institute of Exact Sciences and Geosciences, University of Passo Fundo, B5 Building, São José, Highway BR285, Km 292, Passo Fundo, 99052900, Brazil, 55 5433168354, 168729@upf.br %K functional status %K elderly %K virtual reality therapy %K user-centered design %K software design %K video games %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. Objective: In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants’ adherence to and enjoyment of exercise; (2) test the participants’ functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. Methods: We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants’ General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. Results: We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. Conclusions: The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants. %M 33512319 %R 10.2196/23423 %U http://games.jmir.org/2021/1/e23423/ %U https://doi.org/10.2196/23423 %U http://www.ncbi.nlm.nih.gov/pubmed/33512319 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19244 %T Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study %A Sturge,Jodi %A Meijering,Louise %A Jones,C Allyson %A Garvelink,Mirjam %A Caron,Danielle %A Nordin,Susanna %A Elf,Marie %A Légaré,France %+ VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Department of Family Medicine and Emergency Medicine, Université Laval, Pavillon Landry-Poulin, door A-1-2, room A-4574, 2525, chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada, 1 418 663 5713, France.Legare@fmed.ulaval.ca %K aging in place %K co-design %K cross-country comparison %K electronic decision support intervention %K housing decisions %K memory problems %K mixed methods %K mobility patterns %K shared decision making %K technology %D 2021 %7 21.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users’ mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults’ autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 %M 33475512 %R 10.2196/19244 %U http://www.researchprotocols.org/2021/1/e19244/ %U https://doi.org/10.2196/19244 %U http://www.ncbi.nlm.nih.gov/pubmed/33475512 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e22488 %T Habit Formation in Wearable Activity Tracker Use Among Older Adults: Qualitative Study %A Peng,Wei %A Li,Lin %A Kononova,Anastasia %A Cotten,Shelia %A Kamp,Kendra %A Bowen,Marie %+ College of Communication Arts and Sciences, Michigan State University, 404 Wilson Room 409, East Lansing, MI, 48824, United States, 1 5174328235, pengwei@msu.edu %K habits %K action planning %K coping planning %K activity trackers %K fitness trackers %K continued use %K mobile phone %K older adults %K health behavior %K mHealth %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers are popular devices used to motivate behavior change. Wearable activity trackers are especially beneficial for encouraging light physical activity such as walking, which is an ideal behavior for older adults or individuals who cannot be physically active at moderate and vigorous levels. A common problem is that people do not continue to use these wearable devices, with initial behavioral change gains eroding as people disengage. Limited research is available regarding the continued use of wearable activity trackers. The habit formation literature may provide insights into the long-term use of wearables and other health informatics devices. Objective: This study aims to uncover the mechanism underlying the long-term continued use of wearable devices among older adults through the theoretical lens of habit formation. Methods: In-depth interviews were conducted with 20 participants who were aged 65 years or older and had used wearable activity trackers for more than 6 months to understand their experiences and the strategies they employed to support continued use. Results: Thematic analysis of data revealed 8 themes related to habit formation, including aspects in initiation and goal setting, use of contextual cues, action planning, and coping planning. Long-term users tended to have meaningful initiation of wearable activity trackers. They usually started with a small behavioral change goal and gradually increased it. They used consistent time and locational cues to make the use of wearable activity trackers routine. Long-term users also used creative contextual cues and reminders to facilitate action planning, engaged in coping planning to deal with anticipated problems, and had a positive mindset and inventive strategies for managing unfulfillment and lapses. Conclusions: The results of this qualitative study of long-term users of wearable activity trackers suggest specific ways to enhance long-term habit formation among older adults. These best practices by long-term users can inform the future design of technology-based behavior interventions. %M 33464216 %R 10.2196/22488 %U http://mhealth.jmir.org/2021/1/e22488/ %U https://doi.org/10.2196/22488 %U http://www.ncbi.nlm.nih.gov/pubmed/33464216 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21094 %T Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study %A Daly,Robin M %A Gianoudis,Jenny %A Hall,Travis %A Mundell,Niamh L %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 392446040, rmdaly@deakin.edu.au %K home exercise %K multicomponent exercise %K mobile health %K musculoskeletal %K adherence %K usability %K older adults %K physical activity enjoyment %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many older adults choose and prefer to exercise at home, but to attain the greatest benefits, the correct type and dose of exercise 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 any time. Objective: The aim of this study was to evaluate the feasibility, usability, and enjoyment of a web-based exercise prescription app as a platform for exercise professionals to remotely deliver and monitor an individually tailored, home-based multicomponent 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 owned a tablet computer (tablet owners) and 10 did not own tablets (tablet nonowners). 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 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 the participants' experiences and perceptions of the exercise program and web-based app were also included. Results: A total of 19 participants (mean age, 70 years) completed the study (19/20, 95%), and mean adherence to the exercise program was 84% (95% CI 70%-97%). There were 2 minor adverse events in 2 participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes (95% CI 0-156, P=.049) and moderate-to-vigorous physical activity time by 41 minutes (95% CI –8 to 90, P=.09). For SPPB scores, there was a 0.3 point (95% CI –0.1 to 0.7, P=.17) modest sized (effect size, d=0.42) improvement after 8 weeks. Mean (SD) system usability was high (86 [10] with 100 best imaginable). There was no change in the overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the web-based 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 nonowners. Conclusions: This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multicomponent exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app. %M 33439147 %R 10.2196/21094 %U http://mhealth.jmir.org/2021/1/e21094/ %U https://doi.org/10.2196/21094 %U http://www.ncbi.nlm.nih.gov/pubmed/33439147 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e19690 %T One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study %A Hawley-Hague,Helen %A Tacconi,Carlo %A Mellone,Sabato %A Martinez,Ellen %A Chiari,Lorenzo %A Helbostad,Jorunn %A Todd,Chris %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 7810358568, Helen.Hawley-Hague@manchester.ac.uk %K aged %K postural balance %K telerehabilitation %K patient compliance %K accidental falls %K mobile phone %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Falls have implications for the health of older adults. Strength and balance interventions significantly reduce the risk of falls; however, patients seldom perform the dose of exercise that is required based on evidence. Health professionals play an important role in supporting older adults as they perform and progress in their exercises. Teleconferencing could enable health professionals to support patients more frequently, which is important in exercise behavior. Objective: This study aims to examine the overall concept and acceptability of teleconferencing for the delivery of falls rehabilitation with health care professionals and older adults and to examine the usability, acceptability, and feasibility of teleconferencing delivery with health care professionals and patients. Methods: There were 2 stages to the research: patient and public involvement workshops and usability and feasibility testing. A total of 2 workshops were conducted, one with 5 health care professionals and the other with 8 older adults from a community strength and balance exercise group. For usability and feasibility testing, we tested teleconferencing both one-to-one and in small groups on a smartphone with one falls service and their patients for 3 weeks. Semistructured interviews and focus groups were used to explore acceptability, usability, and feasibility. Focus groups were conducted with the service that used teleconferencing with patients and 2 other services that received only a demonstration of how teleconferencing works. Qualitative data were analyzed using the framework approach. Results: In the workshops, the health care professionals thought that teleconferencing provided an opportunity to save travel time. Older adults thought that it could enable increased support. Safety is of key importance, and delivery needs to be carefully considered. Both older adults and health care professionals felt that it was important that technology did not eliminate face-to-face contact. There were concerns from older adults about the intrusiveness of technology. For the usability and feasibility testing, 7 patients and 3 health care professionals participated, with interviews conducted with 6 patients and a focus group with the health care team. Two additional teams (8 health professionals) took part in a demonstration and focus group. Barriers and facilitators were identified, with 5 barriers around reliability due to poor connectivity, cost of connectivity, safety concerns linked to positioning of equipment and connectivity, intrusiveness of technology, and resistance to group teleconferencing. Two facilitators focused on the positive benefits of increased support and monitoring and positive solutions for future improvements. Conclusions: Teleconferencing as a way of delivering fall prevention interventions can be acceptable to older adults, patients, and health care professionals if it works effectively. Connectivity, where there is no Wi-Fi provision, is one of the largest issues. Therefore, local infrastructure needs to be improved. A larger usability study is required to establish whether better equipment for delivery improves usability. %M 33433398 %R 10.2196/19690 %U http://rehab.jmir.org/2021/1/e19690/ %U https://doi.org/10.2196/19690 %U http://www.ncbi.nlm.nih.gov/pubmed/33433398 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e16458 %T Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial %A Santos,Luciano Henrique De Oliveira %A Okamoto,Kazuya %A Otsuki,Ryo %A Hiragi,Shusuke %A Yamamoto,Goshiro %A Sugiyama,Osamu %A Aoyama,Tomoki %A Kuroda,Tomohiro %+ Department of Social Informatics, Graduate School of Informatics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 75 366 7701, lhsantos@kuhp.kyoto-u.ac.jp %K aged %K physical activity %K pervasive games %K social interaction %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players’ lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior. Objective: The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity. Methods: Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6% (SE 7.2%) (week 2), 591.5 (SE 2414.5)/2.4% (SE 4.7%) (week 3), and −1041.8 (SE 1992.7)/0.6% (SE 4.4%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0% (SE 8.7%) (week 2), 9567.3 (SE 2631.5)/23.0% (SE 5.1%) (week 3), and 7648.7 (SE 3900.9)/13.9% (SE 8.0%) (week 4). The result of the analysis of the group effect was significant (absolute change: η2=0.31, P=.04; proportional change: η2=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95% CI 0.32 to 0.77; proportional change: r=0.39, 95% CI 0.08 to 0.64). Conclusions: The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy) %M 33404507 %R 10.2196/16458 %U https://games.jmir.org/2021/1/e16458 %U https://doi.org/10.2196/16458 %U http://www.ncbi.nlm.nih.gov/pubmed/33404507 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22201 %T Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews %A McGarrigle,Lisa %A Todd,Chris %+ School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613067865, chris.todd@manchester.ac.uk %K physical activity %K mHealth %K eHealth %K app %K accelerometer %K pedometer %K technology %K COVID-19 %D 2020 %7 29.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. Objective: The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. Methods: We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. Results: Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. Conclusions: There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support. %M 33372894 %R 10.2196/22201 %U http://www.jmir.org/2020/12/e22201/ %U https://doi.org/10.2196/22201 %U http://www.ncbi.nlm.nih.gov/pubmed/33372894 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20061 %T Integrating Key User Characteristics in User-Centered Design of Digital Support Systems for Seniors’ Physical Activity Interventions to Prevent Falls: Protocol for a Usability Study %A Revenäs,Åsa %A Johansson,Ann-Christin %A Ehn,Maria %+ Center for Clinical Research, Region Västmanland-Uppsala University, Hospital of Västmanland Västerås, Västerås Hospital, Entrance 29, Västerås, 72189, Sweden, 46 764959223, asa.revenas@regionvastmanland.se %K eHealth %K mobile health %K internet-based interventions %K physical activity %K exercise %K older adults %K gender %K user feedback %K user involvement %K user-centered design %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The goal of user-centered design (UCD) is to understand the users’ perspective and to use that knowledge to shape more effective solutions. The UCD approach provides insight into users’ needs and requirements and thereby improves the design of the developed services. However, involving users in the development process does not guarantee that feedback from different subgroups of users will shape the development in ways that will make the solutions more useful for the entire target user population. Objective: The aim of this study was to describe a protocol for systematic analysis and prioritization of feedback from user subgroups in the usability testing of a digital motivation support for fall-preventive physical activity (PA) interventions in seniors (aged 65 years and older). This protocol can help researchers and developers to systematically exploit feedback from relevant user subgroups in UCD. Methods: Gender, PA level, and level of technology experience have been identified in the literature to influence users’ experience and use of digital support systems for fall-preventive PA interventions in seniors. These 3 key user characteristics were dichotomized and used to define 8 (ie, 23) possible user subgroups. The presented method enables systematic tracking of the user subgroups’ contributions in iterative development. The method comprises (1) compilation of difficulties and deficiencies in the digital applications identified in usability testing, (2) clustering of the identified difficulties and deficiencies, and (3) prioritization of deficiencies to be rectified. Tracking user subgroup representation in the user feedback ensures that the development process is prioritized according to the needs of different subgroups. Mainly qualitative data collection methods are used. Results: A protocol was developed to ensure that feedback from users representing all possible variants of 3 selected key user characteristics (gender, PA level, and level of technology experience) is considered in the iterative usability testing of a digital support for seniors’ PA. The method was applied in iterative usability testing of two digital applications during spring/summer 2018. Results from the study on the users’ experiences and the iterative modification of the digital applications are expected to be published during 2021. Conclusions: Methods for systematic collection, analysis, and prioritization of feedback from user subgroups might be particularly important in heterogenous user groups (eg, seniors). This study can contribute to identifying and improving the understanding of potential differences between user subgroups of seniors in their use and experiences of digital support for fall-preventive PA interventions. This knowledge may be relevant for developing digital support systems that are appropriate, useful, and attractive to users and for enabling the design of digital support systems that target specific user subgroups (ie, tailoring of the support). The protocol needs to be further used and investigated in order to validate its potential value. International Registered Report Identifier (IRRID): RR1-10.2196/20061 %M 33346732 %R 10.2196/20061 %U http://www.researchprotocols.org/2020/12/e20061/ %U https://doi.org/10.2196/20061 %U http://www.ncbi.nlm.nih.gov/pubmed/33346732 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e19527 %T Age and Attitudes Towards an Internet-Mediated, Pedometer-Based Physical Activity Intervention for Chronic Obstructive Pulmonary Disease: Secondary Analysis %A Robinson,Stephanie A %A Wan,Emily S %A Shimada,Stephanie L %A Richardson,Caroline R %A Moy,Marilyn L %+ Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Building 70, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 4776, stephanie.robinson5@va.gov %K aging %K COPD %K chronic conditions %K physical activity %K eHealth %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic obstructive pulmonary disease (COPD) is prevalent among older adults. Promoting physical activity and increasing exercise capacity are recommended for all individuals with COPD. Pulmonary rehabilitation is the standard of care to improve exercise capacity, although there are barriers that hinder accessibility. Technology has the potential to overcome some of these barriers, but it is unclear how aging adults with a chronic disease like COPD perceive technology-based platforms to support their disease self-management. Objective: Guided by the unified theory of acceptance and use of technology, the current retrospective secondary analysis explores if age moderates multiple factors that influence an individual with COPD’s openness toward an internet-mediated, pedometer-based physical activity intervention. Methods: As part of an efficacy study, participants with COPD (N=59) were randomly assigned to use an internet-mediated, pedometer-based physical activity intervention for 12 weeks. At completion, they were asked about their experience with the intervention using a survey, including their performance expectancy and effort expectancy, facilitating conditions (ie, internet use frequency and ability), and use of the intervention technology. Logistic regression and general linear modeling examined the associations between age and these factors. Results: Participants ranged in age from 49 to 89 years (mean 68.66, SD 8.93). Disease severity was measured by forced expiratory volume in the first second percent predicted (mean 60.01, SD 20.86). Nearly all participants (54/59) believed the intervention was useful. Regarding effort expectancy, increasing age was associated with reporting that it was easy to find the time to engage in the intervention. Regarding facilitating conditions, approximately half of the participants believed the automated step count goals were too high (23/59) and many did not feel comfortable reaching their goals (22/59). The probability of these perceptions increased with age, even after accounting for disease severity. Age was not associated with other facilitating conditions or use of the technology. Conclusions: Age does not influence performance expectancy or use of technology with an internet-mediated, pedometer-based physical activity intervention. Age is associated with certain expectations of effort and facilitating conditions. Consideration of age of the user is needed when personalizing step count goals and time needed to log in to the website. Trial Registration: ClinicalTrials.gov NCT01772082; https://clinicaltrials.gov/ct2/show/NCT01772082 %M 32902390 %R 10.2196/19527 %U http://aging.jmir.org/2020/2/e19527/ %U https://doi.org/10.2196/19527 %U http://www.ncbi.nlm.nih.gov/pubmed/32902390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19732 %T Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study %A Kim,Ben %A McKay,Sandra M %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K frailty %K mobile health %K wearables %K physical activity %K home care %K prediction %K predictive modeling, older adults %K activities of daily living, sleep %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective: The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods: From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results: A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions: We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services. %M 32880582 %R 10.2196/19732 %U https://www.jmir.org/2020/9/e19732 %U https://doi.org/10.2196/19732 %U http://www.ncbi.nlm.nih.gov/pubmed/32880582 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e20834 %T Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study %A Blair,Cindy K %A Harding,Elizabeth %A Herman,Carla %A Boyce,Tawny %A Demark-Wahnefried,Wendy %A Davis,Sally %A Kinney,Anita Y %A Pankratz,Vernon S %+ Department of Internal Medicine, University of New Mexico, MSC07-4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131, United States, 1 5059257907, CiBlair@salud.unm.edu %K physical function %K physical performance %K older adults %K remote assessment %K videoconferencing %K cancer survivors %K cancer %K elderly %K physical activity %K telehealth %D 2020 %7 1.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. Objective: This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. Methods: To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ≥60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. Results: Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. Conclusions: This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. Trial Registration: ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959 International Registered Report Identifier (IRRID): DERR1-10.2196/20834 %M 32769075 %R 10.2196/20834 %U https://www.researchprotocols.org/2020/9/e20834 %U https://doi.org/10.2196/20834 %U http://www.ncbi.nlm.nih.gov/pubmed/32769075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16596 %T Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick YC %A Lee,Deborah %A Lee,Paul H %A Tse,Mimi %A Cheung,Daphne SK %A Thiamwong,Ladda %A Choi,Kup-Sze %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Hong Kong (China), 852 27666546 ext 6546, rick.kwan@polyu.edu.hk %K cognitive frailty %K brisk walking %K smartphone %K moderate-to-vigorous physical activity %K older people %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756 %M 32735218 %R 10.2196/16596 %U https://mhealth.jmir.org/2020/7/e16596 %U https://doi.org/10.2196/16596 %U http://www.ncbi.nlm.nih.gov/pubmed/32735218 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e18008 %T Inferring Destinations and Activity Types of Older Adults From GPS Data: Algorithm Development and Validation %A Bayat,Sayeh %A Naglie,Gary %A Rapoport,Mark J %A Stasiulis,Elaine %A Chikhaoui,Belkacem %A Mihailidis,Alex %+ Institute of Biomaterials and Biomedical Engineering, University of Toronto, 550 University Avenue, Toronto, ON, Canada, 1 416 597 3422 ext 7345, sayeh.bayat@mail.utoronto.ca %K outdoor mobility %K older adults %K GPS %K life space %K activity types %K machine learning %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Outdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and characterizes older adults’ outdoor mobility based on its semantic aspects (ie, mobility intentions and motivations) by integrating geographic and domain knowledge. Objective: This study assesses the feasibility of using GPS to determine semantic dimensions of older adults’ outdoor mobility, including destinations and activity types. Methods: A total of 5 healthy individuals, aged 65 years or older, carried a GPS device when traveling outside their homes for 4 weeks. The participants were also given a travel diary to record details of all excursions from their homes, including date, time, and destination information. We first designed and implemented an algorithm to extract destinations and infer activity types (eg, food, shopping, and sport) from the GPS data. We then evaluated the performance of the GPS-derived destination and activity information against the traditional diary method. Results: Our results detected the stop locations of older adults from their GPS data with an F1 score of 87%. On average, the extracted home locations were within a 40.18-meter (SD 1.18) distance of the actual home locations. For the activity-inference algorithm, our results reached an F1 score of 86% for all participants, suggesting a reasonable accuracy against the travel diary recordings. Our results also suggest that the activity inference’s accuracy measure differed by neighborhood characteristics (ie, Walk Score). Conclusions: We conclude that GPS technology is accurate for determining semantic dimensions of outdoor mobility. However, further improvements may be needed to develop a robust application of this system that can be adopted in clinical practice. %M 32720647 %R 10.2196/18008 %U http://aging.jmir.org/2020/2/e18008/ %U https://doi.org/10.2196/18008 %U http://www.ncbi.nlm.nih.gov/pubmed/32720647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16380 %T Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study %A Mehra,Sumit %A van den Helder,Jantine %A Visser,Bart %A Engelbert,Raoul H H %A Weijs,Peter J M %A Kröse,Ben J A %+ Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Wibautstraat 3b, Amsterdam, 1091 GH, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K evaluation %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. %M 32459652 %R 10.2196/16380 %U http://www.jmir.org/2020/7/e16380/ %U https://doi.org/10.2196/16380 %U http://www.ncbi.nlm.nih.gov/pubmed/32459652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15339 %T Using Geocaching to Promote Active Aging: Qualitative Study %A Fornasini,Silvia %A Dianti,Marco %A Bacchiega,Alessandro %A Forti,Stefano %A Conforti,Diego %+ Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461 314140, s.fornasini@fbk.eu %K geocaching %K active ageing %K elderly empowerment %K qualitative methods %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the past few years, the development of technologies supporting active aging has been increasing. Among the activities that promote physical exercise by using technologies is geocaching—a treasure hunt of sorts in which participants use a receiver GPS to hide or find real or virtual objects. Although this activity is particularly suited to the promotion of healthy lifestyles in older people, geocaching remains to be unexplored in this area. Objective: This study aimed to investigate the effectiveness of activities combining geocaching and self-tracking technologies to promote active aging, evaluate the usability of technologies, and explore the ways in which technologies have been integrated in the organizational context under examination to determine the user experience of participants. Methods: A group of individuals aged 65 years and older (N=14) attending a senior center managed by a social cooperative was involved in the study. Some of them created the geocaching contents, and others, split into 2 teams, participated in the game. Each participant was given a pedometer bracelet and the geocaching app. The steps taken by individual participants along with the number of caches found by each group translated into team scores. Results: The main results of the study were as follows: (1) activities in favor of active aging that involve the use of new technologies can foster the participation of elderly people; in particular, adding gamification to self-tracking can be a valid strategy to promote physical exercise among the elderly; (2) for this to happen, involvement of older people firsthand is crucial, and there must be a focus on their active involvement and empowerment in every phase of the project; and (3) the mediation of conflicts and competition that arise from the gamification could only take place because of the strong support of the organization in the form of social workers. Conclusions: The results show that promoting active aging through technologies requires more effort than simply using these tools; it requires a wider process that involves an articulated organizational network with heterogeneous actors, technologies, and relations. %M 32525486 %R 10.2196/15339 %U http://www.jmir.org/2020/6/e15339/ %U https://doi.org/10.2196/15339 %U http://www.ncbi.nlm.nih.gov/pubmed/32525486 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16000 %T Development and Preliminary Usability Evaluation of a Somatosensory Square Dance System for Older Chinese Persons: Mixed Methods Study %A Yu,Chin-Wen %A Rau,Pei-Luen Patrick %A Liu,Xueqian %+ Department of Industrial Engineering, Tsinghua University, Shunde Building, 5th floor, Beijing, 100084, China, 86 62776664, rpl@tsinghua.edu.cn %K older persons %K chinese square dance %K somatosensory games %K somatosensory square dance system %K physical exercise %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Chinese square dancing, known as guangchang wu in Chinese, is a well-known public fitness activity that provides an entertaining way for older Chinese women to improve their flexibility, lower extremity strength, overall coordination, and balance. However, injuries, noise conflicts, and lack of space are challenging aspects of this activity. Somatosensory games (SG) are an increasingly popular physical fitness approach to enhance the selective attention of older persons with indoor engagement and exercises. Objective: The objectives of this study were to develop a newly designed somatosensory square dance system for older Chinese people and to evaluate its usability. Methods: This is a mixed methods study. The newly designed somatosensory square dance system is a somatic training tool that provides adequate Chinese square dance fitness training based on Laban Movement Analysis (LMA) and design guidelines established in a previous stage. The usability evaluation involved a questionnaire and interviews. Twelve participants were interviewed before and after experiencing the 15-minute dancing and learning process within the program. In addition, participants scored their experience satisfaction in psychological, physiological, and relaxation sections on a scale of 1 to 5 using a questionnaire. Qualitative content analysis and quantitative analysis of the satisfaction scores supported understanding of usability problems. Results: Based on the interview results, 6/12 (50%) of the participants thought the system could help them correct their dancing movements indoors without being affected by poor outdoor weather. Among the participants, 3/12 (25%) indicated that this indoor system could enable them to enjoy fitness activities in a private space. Moreover, 3/12 participants (25%) stated that this system could promote family relationships by providing easy dancing movements. All participants were highly satisfied with the relaxation aspect of the system (4.45/5). The participants were all psychologically satisfied and interested in the novel features of the system, with an average score of 4.16/5. Physiologically, participants affirmed that the system could help them maintain good health (4.91/5). Conclusions: The results of this study suggest that the somatosensory square dance system can be used as an indoor fitness tool to improve older Chinese square dancers’ health conditions with reasonable dance training. Noise and space conflicts can be addressed. The Laban Elated Square Dance system, which was modified by therapists based on LMA and square dance design guidelines, was highly approved by dancers because it decreased the possibility of injuries, falls, and joint damage by considering the physical and psychological difficulties of older persons. Different features will be considered in the next stage, such as greater selection of exercises and difficulty level settings. Users’ social needs will also be explored in subsequent stages. %M 32463376 %R 10.2196/16000 %U http://games.jmir.org/2020/2/e16000/ %U https://doi.org/10.2196/16000 %U http://www.ncbi.nlm.nih.gov/pubmed/32463376 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e19007 %T Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study %A Goethals,Luc %A Barth,Nathalie %A Guyot,Jessica %A Hupin,David %A Celarier,Thomas %A Bongue,Bienvenu %+ Autonomic Nervous System Research Laboratory, University of Jean Monnet, 10 Rue Tréfilerie, Saint-Etienne, France, 33 0699222119, luc.goethals@univ-st-etienne.fr %K older adults %K physical activity %K COVID-19 %K social marketing %D 2020 %7 7.5.2020 %9 Short Paper %J JMIR Aging %G English %X Background: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults. Objective: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle. Methods: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews. Results: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context. Conclusions: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home. %M 32356777 %R 10.2196/19007 %U http://aging.jmir.org/2020/1/e19007/ %U https://doi.org/10.2196/19007 %U http://www.ncbi.nlm.nih.gov/pubmed/32356777 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e15168 %T Implementation and Effects of Information Technology-Based and Print-Based Interventions to Promote Physical Activity Among Community-Dwelling Older Adults: Protocol for a Randomized Crossover Trial %A Pischke,Claudia R %A Voelcker-Rehage,Claudia %A Peters,Manuela %A Ratz,Tiara %A Pohlabeln,Hermann %A Meyer,Jochen %A von Holdt,Kai %A Lippke,Sonia %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany, 49 49 211 81 ext 08599, claudiaruth.pischke@med.uni-duesseldorf.de %K physical activity %K older adults %K eHealth %K print intervention %K IT-based intervention %K physical activity promotion %K healthy aging %K preferences %K randomized trial %D 2020 %7 27.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the known health benefits of physical activity (PA), less than half and less than one-third of older adults in Germany reach the PA recommendations for endurance training and strength training, respectively, of the World Health Organization. The aim of this study is to investigate the implementation and effectiveness over the course of 9 months of two interventions (information technology [IT]-based vs print-based) for PA promotion among initially inactive older adults in a randomized, crossover trial. This study is part of a large research consortium (2015-2021) investigating different aspects of PA promotion. The IT-based intervention was previously developed and refined, while the print-based intervention was newly developed during this funding phase. Objective: We aim to compare the effectiveness and examine the preferences of study participants regarding both delivery modes. Methods: Our target sample size was 390 initially inactive community-dwelling older adults aged ≥60 years at baseline (3-month follow-up [T1]: expected n=300; 9-month follow-up [T2]: expected n=240) who were randomized to one of two interventions for self-monitoring PA: IT-based (50%) or print-based (50%) intervention. In addition, 30% of the IT-based intervention group received a PA tracker. At T1, participants in both groups could choose whether they prefered to keep their assigned intervention or cross over to the other group for the following 6 months (T2). Participants’ intervention preferences at baseline were collected retrospectively to run a post hoc matched-mismatched analysis. During the initial 3-month intervention period, both intervention groups were offered weekly group sessions that were continued monthly between T1 and T2. A self-administered questionnaire and 3D accelerometers were employed to assess changes in PA between baseline, T1, and T2. Adherence to PA recommendations, attendance at group sessions, and acceptance of the interventions were also tracked. Results: The funding period started in February 2018 and ends in January 2021. We obtained institutional review board approval for the study from the Medical Association in Bremen on July 3, 2018. Data collection was completed on January 31, 2020, and data cleaning and analysis started in February 2020. We expect to publish the first results by the end of the funding period. Conclusions: Strategies to promote active aging are of particular relevance in Germany, as 29% of the population is projected to be ≥65 years old by 2030. Regular PA is a key contributor to healthy aging. This study will provide insights into the acceptance and effectiveness of IT-based vs print-based interventions to promote PA in initially inactive individuals aged ≥60 years. Results obtained in this study will improve the existing evidence base on the effectiveness of community-based PA interventions in Germany and will inform efforts to anchor evidence-based PA interventions in community structures and organizations via an allocation of permanent health insurance funds. Trial Registration: German Registry of Clinical Trials DRKS00016073; https://tinyurl.com/y983586m International Registered Report Identifier (IRRID): DERR1-10.2196/15168 %M 32338622 %R 10.2196/15168 %U https://www.researchprotocols.org/2020/4/e15168 %U https://doi.org/10.2196/15168 %U http://www.ncbi.nlm.nih.gov/pubmed/32338622 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15704 %T Comparing the Usability and Acceptability of Wearable Sensors Among Older Irish Adults in a Real-World Context: Observational Study %A Keogh,Alison %A Dorn,Jonas F %A Walsh,Lorcan %A Calvo,Francesc %A Caulfield,Brian %+ Insight Centre for Data Analytics, UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, O'Brien Centre for Science, Science Centre East, Belfield, Dublin, 4, Ireland, 353 863762075, Alison.keogh@ucd.ie %K wearable technology %K usability %K mixed methods %K user satisfaction %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable devices are valuable assessment tools for patient outcomes in contexts such as clinical trials. To be successfully deployed, however, participants must be willing to wear them. Another concern is that usability studies are rarely published, often fail to test devices beyond 24 hours, and need to be repeated frequently to ensure that contemporary devices are assessed. Objective: This study aimed to compare multiple wearable sensors in a real-world context to establish their usability within an older adult (>50 years) population. Methods: Eight older adults wore seven devices for a minimum of 1 week each: Actigraph GT9x, Actibelt, Actiwatch, Biovotion, Hexoskin, Mc10 Biostamp_RC, and Wavelet. Usability was established through mixed methods using semistructured interviews and three questionnaires, namely, the Intrinsic Motivation Inventory (IMI), the System Usability Scale (SUS), and an acceptability questionnaire. Quantitative data were reported descriptively and qualitative data were analyzed using deductive content analysis. Data were then integrated using triangulation. Results: Results demonstrated that no device was considered optimal as all scored below average in the SUS (median, IQR; min-max=57.5, 12.5; 47.5-63.8). Hexoskin was the lowest scored device based on the IMI (3.6; 3.4-4.5), while Biovotion, Actibelt, and Mc10 Biostamp_RC achieved the highest median results on the acceptability questionnaire (3.6 on a 6-point Likert scale). Qualitatively, participants were willing to accept less comfort, less device discretion, and high charging burdens if the devices were perceived as useful, namely through the provision of feedback for the user. Participants agreed that the purpose of use is a key enabler for long-term compliance. These views were particularly noted by those not currently wearing an activity-tracking device. Participants believed that wrist-worn sensors were the most versatile and easy to use, and therefore, the most suitable for long-term use. In particular, Actiwatch and Wavelet stood out for their comfort. The convergence of quantitative and qualitative data was demonstrated in the study. Conclusions: Based on the results, the following context-specific recommendations can be made: (1) researchers should consider their device selection in relation to both individual and environmental factors, and not simply the primary outcome of the research study; (2) if researchers do not wish their participants to have access to feedback from the devices, then a simple, wrist-worn device that acts as a watch is preferable; (3) if feedback is allowed, then it should be made available to help participants remain engaged; this is likely to apply only to people without cognitive impairments; (4) battery life of 1 week should be considered as a necessary feature to enhance data capture; (5) researchers should consider providing additional information about the purpose of devices to participants to support their continued use. %M 32310149 %R 10.2196/15704 %U http://mhealth.jmir.org/2020/4/e15704/ %U https://doi.org/10.2196/15704 %U http://www.ncbi.nlm.nih.gov/pubmed/32310149 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e14182 %T Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation %A Brauner,Philipp %A Ziefle,Martina %+ Human-Computer-Interaction Center, RWTH Aachen University, Campus Boulevard 57, Aachen, 52074, Germany, 49 02418049237, brauner@comm.rwth-aachen.de %K serious games %K exercise game %K health care %K pain %K ambient assisted living %K technology acceptance %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift. Objective: This study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation. Methods: We developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance. Results: Both games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: −55%, P=.002; game 2: −66%, P=.01). Conclusions: Serious exercise games outside and inside AAL environments can contribute to individuals’ health and well-being and to the stability of health care systems. %M 32234703 %R 10.2196/14182 %U https://games.jmir.org/2020/2/e14182 %U https://doi.org/10.2196/14182 %U http://www.ncbi.nlm.nih.gov/pubmed/32234703 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15125 %T Impact of a Knowledge Translation Intervention on Physical Activity and Mobility in Older Adults (the Move4Age Study): Randomized Controlled Trial %A Neil-Sztramko,Sarah %A Smith-Turchyn,Jenna %A Richardson,Julie %A Dobbins,Maureen %+ School of Nursing, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada, 1 9055259140 ext 20459, neilszts@mcmaster.ca %K physical activity %K mobility limitation %K aging %K knowledge translation %K randomized controlled trial %D 2020 %7 11.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The McMaster Optimal Aging Portal (the Portal) was launched in 2014 as a knowledge translation (KT) tool to increase access to evidence-based health information. Objective: The purpose of this study was to understand if and how dissemination of mobility information through the Portal impacts physical activity (PA) in older adults. Methods: In this randomized controlled trial, participants (n=510) were assigned to a 12-week mobility-focused KT intervention or self-serve control group. The intervention included weekly email alerts and a study-specific social media hashtag linking to mobility-focused Portal materials. The control group was able to access the Portal on their own but did not receive targeted KT strategies. Participants completed questionnaires (including the Rapid Assessment of Physical Activity to quantify PA) at baseline, end of the study, and 3-month follow-up. Results: Participants were predominantly female (430/510, 84.3%), mean age 64.7 years, with no baseline differences between groups. Over half (277/510, 54.3%) of the participants were classified as “active” at baseline. There was no significant between-group difference in the PA category. Overall, both groups increased their PA with improvements maintained at 3-month follow-up (P<.001). In planned subgroup analyses, the KT intervention had a significant effect for those with poor or fair baseline self-rated health (P=.03). Conclusions: No differences were found between those who received the targeted intervention and a control group with self-serve access to the Portal, except in subgroups with low self-rated health. Both groups did report increases in PA that were sustained beyond participation in a research study. Findings suggest that different KT strategies may be needed for different types of users, with more intense interventions being most impactful for certain groups (ie, those with lower self-rated health). Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/NCT02947230 %M 32044750 %R 10.2196/15125 %U https://www.jmir.org/2020/2/e15125 %U https://doi.org/10.2196/15125 %U http://www.ncbi.nlm.nih.gov/pubmed/32044750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14343 %T Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis %A Yerrakalva,Dharani %A Yerrakalva,Dhrupadh %A Hajna,Samantha %A Griffin,Simon %+ Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge, , United Kingdom, 44 1223 330300, dharaniyerrakalva@googlemail.com %K sedentary behavior %K physical activity %K physical fitness %K aged %K mHealth %K mobile apps %D 2019 %7 28.11.2019 %9 Review %J J Med Internet Res %G English %X Background: High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. Objective: We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. Methods: We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. Results: Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. Conclusions: mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects. %M 31778121 %R 10.2196/14343 %U http://www.jmir.org/2019/11/e14343/ %U https://doi.org/10.2196/14343 %U http://www.ncbi.nlm.nih.gov/pubmed/31778121 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15191 %T Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial %A Mueller,Arne %A Hoefling,Holger Alfons %A Muaremi,Amir %A Praestgaard,Jens %A Walsh,Lorcan C %A Bunte,Ola %A Huber,Roland Martin %A Fürmetz,Julian %A Keppler,Alexander Martin %A Schieker,Matthias %A Böcker,Wolfgang %A Roubenoff,Ronenn %A Brachat,Sophie %A Rooks,Daniel S %A Clay,Ieuan %+ Novartis Institutes for BioMedical Research, Campus St Johan, Basel, Switzerland, 41 61 324 1111, ieuan.clay@novartis.com %K gait %K walking speed %K mobility limitation %K accelerometry %K clinical trials %K frailty %K wearable electronic devices %K algorithms %K open source data %K data collection %K dataset %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies and advanced analytics have drastically improved our ability to capture and interpret health-relevant data from patients. However, only limited data and results have been published that demonstrate accuracy in target indications, real-world feasibility, or the validity and value of these novel approaches. Objective: This study aimed to establish accuracy, feasibility, and validity of continuous digital monitoring of walking speed in frail, elderly patients with sarcopenia and to create an open source repository of raw, derived, and reference data as a resource for the community. Methods: Data described here were collected as a part of 2 clinical studies: an independent, noninterventional validation study and a phase 2b interventional clinical trial in older adults with sarcopenia. In both studies, participants were monitored by using a waist-worn inertial sensor. The cross-sectional, independent validation study collected data at a single site from 26 naturally slow-walking elderly subjects during a parcours course through the clinic, designed to simulate a real-world environment. In the phase 2b interventional clinical trial, 217 patients with sarcopenia were recruited across 32 sites globally, where patients were monitored over 25 weeks, both during and between visits. Results: We have demonstrated that our approach can capture in-clinic gait speed in frail slow-walking adults with a residual standard error of 0.08 m per second in the independent validation study and 0.08, 0.09, and 0.07 m per second for the 4 m walk test (4mWT), 6-min walk test (6MWT), and 400 m walk test (400mWT) standard gait speed assessments, respectively, in the interventional clinical trial. We demonstrated the feasibility of our approach by capturing 9668 patient-days of real-world data from 192 patients and 32 sites, as part of the interventional clinical trial. We derived inferred contextual information describing the length of a given walking bout and uncovered positive associations between the short 4mWT gait speed assessment and gait speed in bouts between 5 and 20 steps (correlation of 0.23) and longer 6MWT and 400mWT assessments with bouts of 80 to 640 steps (correlations of 0.48 and 0.59, respectively). Conclusions: This study showed, for the first time, accurate capture of real-world gait speed in slow-walking older adults with sarcopenia. We demonstrated the feasibility of long-term digital monitoring of mobility in geriatric populations, establishing that sufficient data can be collected to allow robust monitoring of gait behaviors outside the clinic, even in the absence of feedback or incentives. Using inferred context, we demonstrated the ecological validity of in-clinic gait assessments, describing positive associations between in-clinic performance and real-world walking behavior. We make all data available as an open source resource for the community, providing a basis for further study of the relationship between standardized physical performance assessment and real-world behavior and independence. %M 31774406 %R 10.2196/15191 %U http://mhealth.jmir.org/2019/11/e15191/ %U https://doi.org/10.2196/15191 %U http://www.ncbi.nlm.nih.gov/pubmed/31774406 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13757 %T Associations Between Heart Rate Variability Measured With a Wrist-Worn Sensor and Older Adults’ Physical Function: Observational Study %A Graham,Sarah Anne %A Jeste,Dilip V %A Lee,Ellen E %A Wu,Tsung-Chin %A Tu,Xin %A Kim,Ho-Cheol %A Depp,Colin A %+ Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive, #0664, La Jolla, CA, 92093-0664, United States, 1 858 534 5433, sagraham@ucsd.edu %K wearable technology %K aging %K electrocardiogram %K geriatric assessment %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart rate variability (HRV), or variation in beat-to-beat intervals of the heart, is a quantitative measure of autonomic regulation of the cardiovascular system. Low HRV derived from electrocardiogram (ECG) recordings is reported to be related to physical frailty in older adults. Recent advances in wearable technology offer opportunities to more easily integrate monitoring of HRV into regular clinical geriatric health assessments. However, signals obtained from ECG versus wearable photoplethysmography (PPG) devices are different, and a critical first step preceding their widespread use is to determine whether HRV metrics derived from PPG devices also relate to older adults’ physical function. Objective: This study aimed to investigate associations between HRV measured with a wrist-worn PPG device, the Empatica E4 sensor, and validated clinical measures of both objective and self-reported physical function in a cohort of older adults living independently within a continuing care senior housing community. Our primary hypothesis was that lower HRV would be associated with lower physical function. In addition, we expected that HRV would explain a significant proportion of variance in measures of physical health status. Methods: We evaluated 77 participants from an ongoing study of older adults aged between 65 and 95 years. The assessments encompassed a thorough examination of domains typically included in a geriatric health evaluation. We collected HRV data with the Empatica E4 device and examined bivariate correlations between HRV quantified with the triangular index (HRV TI) and 3 widely used and validated measures of physical functioning—the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), and Medical Outcomes Study Short Form 36 (SF-36) physical composite scores. We further investigated the additional predictive power of HRV TI on physical health status, as characterized by SF-36 physical composite scores and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) scores, using generalized estimating equation regression analyses with backward elimination. Results: We observed significant associations of HRV TI with SPPB (n=52; Spearman ρ=0.41; P=.003), TUG (n=51; ρ=−0.40; P=.004), SF-36 physical composite scores (n=49; ρ=0.37; P=.009), and CIRS-G scores (n=52, ρ=−0.43; P=.001). In addition, the HRV TI explained a significant proportion of variance in SF-36 physical composite scores (R2=0.28 vs 0.11 without HRV) and CIRS-G scores (R2=0.33 vs 0.17 without HRV). Conclusions: The HRV TI measured with a relatively novel wrist-worn PPG device was related to both objective (SPPB and TUG) and self-reported (SF-36 physical composite) measures of physical function. In addition, the HRV TI explained additional variance in self-reported physical function and cumulative illness severity beyond traditionally measured aspects of physical health. Future steps include longitudinal tracking of changes in both HRV and physical function, which will add important insights regarding the predictive value of HRV as a biomarker of physical health in older adults. %M 31647469 %R 10.2196/13757 %U http://mhealth.jmir.org/2019/10/e13757/ %U https://doi.org/10.2196/13757 %U http://www.ncbi.nlm.nih.gov/pubmed/31647469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e11759 %T Tailoring Persuasive Electronic Health Strategies for Older Adults on the Basis of Personal Motivation: Web-Based Survey Study %A van Velsen,Lex %A Broekhuis,Marijke %A Jansen-Kosterink,Stephanie %A op den Akker,Harm %+ eHealth Group, Roessingh Research and Development, PO Box 310, Enschede, 7500 AH, Netherlands, 31 0880875754, l.vanvelsen@rrd.nl %K persuasive communication %K health communication %K software design %D 2019 %7 06.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Persuasive design, in which the aim is to change attitudes and behaviors by means of technology, is an important aspect of electronic health (eHealth) design. However, selecting the right persuasive feature for an individual is a delicate task and is likely to depend on individual characteristics. Personalization of the persuasive strategy in an eHealth intervention therefore seems to be a promising approach. Objective: This study aimed to develop a method that allows us to model motivation in older adults with respect to leading a healthy life and a strategy for personalizing the persuasive strategy of an eHealth intervention, based on this user model. Methods: We deployed a Web-based survey among older adults (aged >60 years) in the Netherlands. In the first part, we administered an adapted version of the revised Sports Motivation Scale (SMS-II) as input for the user models. Then, we provided each participant with a selection of 5 randomly chosen mock-ups (out of a total of 11), each depicting a different persuasive strategy. After showing each strategy, we asked participants how much they appreciated it. The survey was concluded by addressing demographics. Results: A total of 212 older adults completed the Web-based survey, with a mean age of 68.35 years (SD 5.27 years). Of 212 adults, 45.3% were males (96/212) and 54.7% were female (116/212). Factor analysis did not allow us to replicate the 5-factor structure for motivation, as targeted by the SMS-II. Instead, a 3-factor structure emerged with a total explained variance of 62.79%. These 3 factors are intrinsic motivation, acting to derive satisfaction from the behavior itself (5 items; Cronbach alpha=.90); external regulation, acting because of externally controlled rewards or punishments (4 items; Cronbach alpha=.83); and a-motivation, a situation where there is a lack of intention to act (2 items; r=0.50; P<.001). Persuasive strategies were appreciated differently, depending on the type of personal motivation. In some cases, demographics played a role. Conclusions: The personal type of motivation of older adults (intrinsic, externally regulated, and/or a-motivation), combined with their educational level or living situation, affects an individual’s like or dislike for a persuasive eHealth feature. We provide a practical approach for profiling older adults as well as an overview of which persuasive features should or should not be provided to each profile. Future research should take into account the coexistence of multiple types of motivation within an individual and the presence of a-motivation. %M 31493323 %R 10.2196/11759 %U https://www.jmir.org/2019/9/e11759 %U https://doi.org/10.2196/11759 %U http://www.ncbi.nlm.nih.gov/pubmed/31493323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13416 %T A Web-Based and Print-Delivered Computer-Tailored Physical Activity Intervention for Older Adults: Pretest-Posttest Intervention Study Comparing Delivery Mode Preference and Attrition %A Boekhout,Janet Maria %A Peels,Denise Astrid %A Berendsen,Brenda Angela Juliette %A Bolman,Catherine %A Lechner,Lilian %+ Department of Psychology and Educational Science, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6401 DL, Netherlands, 31 455762448, janet.boekhout@ou.nl %K older adults %K physical activity %K Web-based intervention %K print-delivered intervention %K attrition %D 2019 %7 28.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions can play an important role in promoting physical activity (PA) behavior among older adults. Although the effectiveness of these interventions is promising, they are often characterized by low reach and high attrition, which considerably hampers their potential impact on public health. Objective: The aim of this study was to identify the participant characteristics associated with the preference for a Web-based or a printed delivery mode and to determine whether an association exists between delivery modes or participant characteristics and attrition in an intervention. This knowledge may enhance implementation, sustainability of participation, and effectiveness of future interventions for older adults. Methods: A real-life pretest-posttest intervention study was performed (N=409) among community-living single adults who were older than 65 years, with physical impairments caused by chronic diseases. Measurements were taken at baseline and 3 months after the start of the intervention. Hierarchical logistic regression was used to assess demographic and behavioral characteristics (age, gender, body mass index, educational attainment, degree of loneliness, and PA level), as well as psychosocial characteristics (social support for PA, modeling, self-efficacy, attitude, and intention) related to delivery mode preference at baseline and attrition after 3 months. Results: The printed delivery mode achieved higher participation (58.9%, 241/409) than the Web-based delivery mode (41.1%, 168/409). Participation in the Web-based delivery mode was associated with younger age (B=–0.10; SE 0.02; Exp (B)=0.91; P<.001) and higher levels of social support for PA (B=0.38; SE 0.14; Exp (B)=1.46; P=.01); attrition was associated with participation in the Web-based delivery mode (B=1.28; SE 0.28; Exp (B)=3.58; P<.001) and low educational attainment (B=–0.53; SE 0.28; Exp (B)=0.59; P=.049). Conclusions: A total of 41% of the participants chose the Web-based delivery mode, thus demonstrating a potential interest of single older adults with physical impairments in Web-based delivered interventions. However, attrition was demonstrated to be higher in the Web-based delivery mode, and lower educational attainment was found to be a predictor for attrition. Characteristics predicting a preference for the printed delivery mode included being older and receiving less social support. Although Web-based delivery modes are generally less expensive and easier to distribute, it may be advisable to offer a printed delivery mode alongside a Web-based delivery mode to prevent exclusion of a large part of the target population. Trial Registration: Netherlands Trial Register NTR2297; https://www.trialregister.nl/trial/2173 International Registered Report Identifier (IRRID): RR2-DOI: 10.2196/resprot.8093 %M 31464186 %R 10.2196/13416 %U http://www.jmir.org/2019/8/e13416/ %U https://doi.org/10.2196/13416 %U http://www.ncbi.nlm.nih.gov/pubmed/31464186 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e12496 %T Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis %A Lewis,Zakkoyya H %A Swartz,Maria C %A Martinez,Eloisa %A Lyons,Elizabeth J %+ Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, United States, 1 713 745 3763, mchang1@mdanderson.org %K social support %K aged %K middle aged %K physical activity %K technology %K fitness tracker %D 2019 %7 23.08.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is critical for maintaining independence and delaying mobility disability in aging adults. However, 27 to 44% of older adults in the United States are meeting the recommended PA level. Activity trackers are proving to be a promising tool to promote PA adherence through activity tracking and enhanced social interaction features. Although social support has been known to be an influential behavior change technique to promote PA, how middle-aged and older adults use the social interaction feature of mobile apps to provide virtual support to promote PA engagement remains mostly underexplored. Objective: This study aimed to describe the social support patterns of middle-aged and older adults using a mobile app as part of a behavioral PA intervention. Methods: Data from 35 participants (mean age 61.66 [SD 6] years) in a 12-week, home-based activity intervention were used for this secondary mixed method analysis. Participants were provided with a Jawbone Up24 activity monitor and an Apple iPad Mini installed with the UP app to facilitate self-monitoring and social interaction. All participants were given an anonymous account and encouraged to interact with other participants using the app. Social support features included comments and likes. Thematic coding was used to identify the type of social support provided within the UP app and characterize the levels of engagement from users. Participants were categorized as superusers or contributors, and passive participants were categorized as lurkers based on the literature. Results: Over the 12-week intervention, participants provided a total of 3153 likes and 1759 comments. Most participants (n=25) were contributors, with 4 categorized as superusers and 6 categorized as lurkers. Comments were coded as emotional support, informational support, instrumental support, self-talk, and other, with emotional support being the most prevalent type. Conclusions: Our cohort of middle-aged and older adults was willing to use the social network feature in an activity app to communicate with anonymous peers. Most of our participants were contributors. In addition, the social support provided through the activity app followed social support constructs. In sum, PA apps are a promising tool for delivering virtual social support to enhance PA engagement and have the potential to make a widespread impact on PA promotion. Trial Registration: ClinicalTrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 %M 31518281 %R 10.2196/12496 %U http://aging.jmir.org/2019/2/e12496/ %U https://doi.org/10.2196/12496 %U http://www.ncbi.nlm.nih.gov/pubmed/31518281 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e13962 %T Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study %A Santos,Luciano Henrique De Oliveira %A Okamoto,Kazuya %A Funghetto,Silvana Schwerz %A Cavalli,Adriana Schüler %A Hiragi,Shusuke %A Yamamoto,Goshiro %A Sugiyama,Osamu %A Castanho,Carla Denise %A Aoyama,Tomoki %A Kuroda,Tomohiro %+ Graduate School of Informatics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Dept of Medical Informatics, Kyoto University Hospital, Kyoto, 606-8507, Japan, 81 75 366 7701, lhsantos@kuhp.kyoto-u.ac.jp %K aged %K physical activity %K pervasive games %K social interaction %D 2019 %7 22.07.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior. Objective: The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity. Methods: Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and −106.1 (SE 979.9)/−2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: η2=.19, P=.01; proportional change: η2=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not. Conclusions: Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy) %M 31333202 %R 10.2196/13962 %U http://games.jmir.org/2019/3/e13962/ %U https://doi.org/10.2196/13962 %U http://www.ncbi.nlm.nih.gov/pubmed/31333202 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14090 %T A Combination of Indoor Localization and Wearable Sensor–Based Physical Activity Recognition to Assess Older Patients Undergoing Subacute Rehabilitation: Baseline Study Results %A Ramezani,Ramin %A Zhang,Wenhao %A Xie,Zhuoer %A Shen,John %A Elashoff,David %A Roberts,Pamela %A Stanton,Annette %A Eslami,Michelle %A Wenger,Neil %A Sarrafzadeh,Majid %A Naeim,Arash %+ Center for Smart Health, University of California, Los Angeles, , Los Angeles, CA,, United States, 1 4242997051, raminr@ucla.edu %K rehabilitation %K frailty %K remote sensing technology %K wearable electronic devices %K fitness trackers %K monitoring ambulatory %K smartwatches %K bluetooth low energy beacons %D 2019 %7 10.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care, in recent years, has made great leaps in integrating wireless technology into traditional models of care. The availability of ubiquitous devices such as wearable sensors has enabled researchers to collect voluminous datasets and harness them in a wide range of health care topics. One of the goals of using on-body wearable sensors has been to study and analyze human activity and functional patterns, thereby predicting harmful outcomes such as falls. It can also be used to track precise individual movements to form personalized behavioral patterns, to standardize the concept of frailty, well-being/independence, etc. Most wearable devices such as activity trackers and smartwatches are equipped with low-cost embedded sensors that can provide users with health statistics. In addition to wearable devices, Bluetooth low-energy sensors known as BLE beacons have gained traction among researchers in ambient intelligence domain. The low cost and durability of newer versions have made BLE beacons feasible gadgets to yield indoor localization data, an adjunct feature in human activity recognition. In the studies by Moatamed et al and the patent application by Ramezani et al, we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extracting indoor localization using BLE beacons, in concert. Objective: The study aimed to examine the ability of combination of physical activity and indoor location features, extracted at baseline, on a cohort of 154 rehabilitation-dwelling patients to discriminate between subacute care patients who are re-admitted to the hospital versus the patients who are able to stay in a community setting. Methods: We analyzed physical activity sensor features to assess activity time and intensity. We also analyzed activities with regard to indoor localization. Chi-square and Kruskal-Wallis tests were used to compare demographic variables and sensor feature variables in outcome groups. Random forests were used to build predictive models based on the most significant features. Results: Standing time percentage (P<.001, d=1.51), laying down time percentage (P<.001, d=1.35), resident room energy intensity (P<.001, d=1.25), resident bed energy intensity (P<.001, d=1.23), and energy percentage of active state (P=.001, d=1.24) are the 5 most statistically significant features in distinguishing outcome groups at baseline. The energy intensity of the resident room (P<.001, d=1.25) was achieved by capturing indoor localization information. Random forests revealed that the energy intensity of the resident room, as a standalone attribute, is the most sensitive parameter in the identification of outcome groups (area under the curve=0.84). Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features at baseline, a subset of which can better distinguish between at-risk patients that can gain independence versus the patients that are rehospitalized. %M 31293244 %R 10.2196/14090 %U http://mhealth.jmir.org/2019/7/e14090/ %U https://doi.org/10.2196/14090 %U http://www.ncbi.nlm.nih.gov/pubmed/31293244 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13965 %T A Mobility-Focused Knowledge Translation Randomized Controlled Trial to Improve Physical Activity: Process Evaluation of the Move4Age Study %A Neil-Sztramko,Sarah E %A Smith-Turchyn,Jenna %A Richardson,Julie %A Dobbins,Maureen %+ School of Nursing, McMaster University, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P0A1, Canada, 1 9055259140 ext 20459, neilszts@mcmaster.ca %K process evaluation %K physical activity %K health information %K mobility %K older adults %K knowledge translation %D 2019 %7 20.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Maintaining physical activity and physical function is important for healthy aging. We recently completed a randomized controlled trial of a targeted knowledge translation (KT) intervention delivered through the McMaster Optimal Aging Portal with the goal to increase physical activity and physical mobility in middle-aged and older adults, with results reported elsewhere. Objective: The purpose of this process evaluation study is to explore which KT strategies were used by both intervention and control group participants, as well as the intervention groups’ engagement, satisfaction, and perceived usefulness of the targeted KT intervention. Methods: Data on engagement with the intervention materials were gathered quantitatively through Google Analytics and Hootsuite throughout the intervention. Qualitative data were collected through a combination of open-ended surveys and qualitative interviews with a subset of participants at the end of the study to further understand engagement, satisfaction, and usefulness of the KT strategies. Results: Throughout the intervention period, engagement with content delivered through weekly emails was highest, and participants rated email content most favorably in both surveys and interviews. Participants were generally satisfied with the intervention, noting the ease of participating and the distillation of information in an easy-to-access format being beneficial features. Participants who did not find the intervention useful were those with already high levels of baseline physical activity or physical function and those who were looking for more specific or individualized content. Conclusions: This process evaluation provides insight into our randomized controlled trial findings and provides information that can be used to improve future online KT interventions. Trial Registration: ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/nct02947230 (Archived by WebCite at http://www.webcitation.org/78t4tR8tM) %M 31223121 %R 10.2196/13965 %U http://www.jmir.org/2019/6/e13965/ %U https://doi.org/10.2196/13965 %U http://www.ncbi.nlm.nih.gov/pubmed/31223121 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13084 %T Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort %A Tedesco,Salvatore %A Sica,Marco %A Ancillao,Andrea %A Timmons,Suzanne %A Barton,John %A O'Flynn,Brendan %+ Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland, 353 212346286, salvatore.tedesco@tyndall.ie %K aging %K fitness trackers %K wristbands %K older adults %K wearable activity trackers %K Fitbit %K Garmin %K energy expenditure %K physical activity %K sleep %D 2019 %7 19.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods: Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results: For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes. %M 31219048 %R 10.2196/13084 %U https://mhealth.jmir.org/2019/6/e13084/ %U https://doi.org/10.2196/13084 %U http://www.ncbi.nlm.nih.gov/pubmed/31219048 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e9832 %T The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change %A Kononova,Anastasia %A Li,Lin %A Kamp,Kendra %A Bowen,Marie %A Rikard,RV %A Cotten,Shelia %A Peng,Wei %+ Department of Advertising and Public Relations, Michigan State University, Room 319, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5174325129, kononova@msu.edu %K aging %K wearable electronic devices %K biobehavioral sciences %K transtheoretical model of behavior change %K exercise %K physical activity %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse. Objective: The aim of this study was to investigate older adults’ perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage. Methods: Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type). Results: The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior. Conclusions: The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology’s limitations and gaining awareness of one’s physical activity without changing the physical activity level itself. %M 30950807 %R 10.2196/mhealth.9832 %U https://mhealth.jmir.org/2019/4/e9832/ %U https://doi.org/10.2196/mhealth.9832 %U http://www.ncbi.nlm.nih.gov/pubmed/30950807 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12303 %T Relevance of Activity Tracking With Mobile Devices in the Relationship Between Physical Activity Levels and Satisfaction With Physical Fitness in Older Adults: Representative Survey %A Schlomann,Anna %A Seifert,Alexander %A Rietz,Christian %+ Department of Special Education and Rehabilitation Science, University of Cologne, Herbert-Lewin-Straße 2, Cologne, 50931, Germany, 49 221470 ext 3343, anna.schlomann@uni-koeln.de %K physical fitness %K wearable electronic devices %K smartphone %K mobile phone %K aged %K satisfaction %K fitness trackers %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity has been shown to positively affect many aspects of life, and the positive relationship between physical activity levels and health is well established. Recently, research on the interrelationship between physical activity levels and subjective experiences has gained attention. However, the underlying mechanisms that link physical activity levels with subjective experiences of physical fitness have not been sufficiently explained. Objective: This study aimed to explore the role of physical activity tracking (PAT) in the relationship between physical activity levels and satisfaction with physical fitness in older adults. It is hypothesized that higher levels of physical activity are associated with a higher satisfaction with physical fitness in older adults and that this positive association is stronger for older people who use mobile devices for PAT. Methods: As part of this study, 1013 participants aged 50 years or older and living in Switzerland were interviewed via computer-assisted telephone interviews. Bivariate and multivariate analyses were applied. The interaction effects between physical activity levels and PAT were evaluated using multiple linear regression analysis. Results: Descriptive analyses showed that 719 participants used at least 1 mobile device and that 136 out of 719 mobile device users (18.9%) used mobile devices for PAT. In the multivariate regression analysis, frequent physical activity was found to have a positive effect on satisfaction with physical fitness (beta=.24, P<.001). A significant interaction effect between physical activity levels and PAT (beta=.30, P=.03) provides some first evidence that the positive effects of physical activity on satisfaction with physical fitness can be enhanced by PAT. Conclusions: The results indicate the potential of PAT to enhance the physical fitness of older adults. However, the results also raise new issues in this context. Recommendations for further research and practice include the acquisition of longitudinal data, a more detailed observation of durations of use, and the development of devices for PAT considering health psychology and gerontology theories. %M 31518263 %R 10.2196/12303 %U http://aging.jmir.org/2019/1/e12303/ %U https://doi.org/10.2196/12303 %U http://www.ncbi.nlm.nih.gov/pubmed/31518263 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11598 %T Supporting Older Adults in Exercising With a Tablet: A Usability Study %A Mehra,Sumit %A Visser,Bart %A Cila,Nazli %A van den Helder,Jantine %A Engelbert,Raoul HH %A Weijs,Peter JM %A Kröse,Ben JA %+ CREATE-IT Applied Research Centre, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091GM, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K mobile phone %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. %M 30707106 %R 10.2196/11598 %U http://humanfactors.jmir.org/2019/1/e11598/ %U https://doi.org/10.2196/11598 %U http://www.ncbi.nlm.nih.gov/pubmed/30707106 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12199 %T Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study %A Katzman,Wendy B %A Gladin,Amy %A Lane,Nancy E %A Wong,Shirley %A Liu,Felix %A Jin,Chengshi %A Fukuoka,Yoshimi %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, United States, 1 415 514 6776, wendy.katzman@ucsf.edu %K acceptability %K exercise %K feasibility %K hyperkyphosis %K kyphosis %K posture %K spine %K technology-based %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods: In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results: A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training. %M 31363712 %R 10.2196/12199 %U http://aging.jmir.org/2019/1/e12199/ %U https://doi.org/10.2196/12199 %U http://www.ncbi.nlm.nih.gov/pubmed/31363712 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11955 %T When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults %A VanRavenstein,Kathy %A Davis,Boyd H %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, United States, 1 8437923054, vanraven@musc.edu %K older adults %K low income %K physical activity %K aging in place %K social isolation %K qualitative research %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: A telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity. Objective: The goal of this project was to increase older adults’ daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation. Methods: The Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis. Results: Twenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns. Conclusions: A telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place. %M 31518250 %R 10.2196/11955 %U http://aging.jmir.org/2018/2/e11955/ %U https://doi.org/10.2196/11955 %U http://www.ncbi.nlm.nih.gov/pubmed/31518250 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12363 %T Influence of Anthropometrics on Step-Rate Thresholds for Moderate and Vigorous Physical Activity in Older Adults: Scientific Modeling Study %A O'Brien,Myles William %A Kivell,Matthew Jordan %A Wojcik,William Robert %A D'Entremont,Ghislain Richard %A Kimmerly,Derek Stephen %A Fowles,Jonathon Richard %+ Centre of Lifestyle Studies, School of Kinesiology, Acadia University, 550 Main Street, Wolfville, NS,, Canada, 1 902 585 1560, jonathon.fowles@acadiau.ca %K aging %K walking %K public health %K cadence %K physical activity intensity %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Adults and older adults are recommended to engage in 150 minutes of moderate (MPA) to vigorous (VPA) aerobic physical activity (MVPA) per week, with the heuristic message of 3000 steps in 30 minutes (100 steps per minute [spm]). However, this message is based on adult populations, with a paucity of research on step-rate thresholds that correspond to absolute MVPA (moderate=3 metabolic equivalents [METs], vigorous=6 METs) and relative MVPA (moderate=40% estimated METmax, vigorous=60% estimated METmax) in older persons, who have lower stride lengths and a lower exercise capacity. Also, there is a need to consider the influence of anthropometric differences when quantifying the relationship between step rate and intensity-related physical activity. Objective: This study assessed absolute and relative MVPA step-rate thresholds and anthropometric factors (ie, height, leg length, and body mass index [BMI]) in older adults. Methods: Nineteen older adults (7 females; age 69 years, SD 2, BMI 26 kg/m2, SD 4) completed a staged treadmill walking protocol: six minutes at 2.4, 3.2, 4.0, 5.6, and 6.4 km/h. Steps were manually counted and volume rate of oxygen consumed (VO2) was measured via indirect calorimetry. Aerobic fitness was estimated via the submaximal single-stage treadmill protocol. Results: When BMI was considered, mixed effects modeling revealed absolute and relative MPA step-rate thresholds of 108 spm and 117 spm, respectively. Absolute and relative VPA corresponded to step rates of 135 spm and 132 spm, respectively. Neither height nor leg length improved the ability of the model to predict stepping cadence from METs. Conclusions: In general, older adults need to walk faster than 100 spm (ie, approximately 110 spm) to reach MPA and in excess of approximately 130 spm to achieve VPA, depending on BMI status. Health care professionals and researchers should adjust cadence-based recommendations for differences in BMI in their older patients and consider using relative intensity to most appropriately tailor their physical activity recommendations. %M 31518246 %R 10.2196/12363 %U http://aging.jmir.org/2018/2/e12363/ %U https://doi.org/10.2196/12363 %U http://www.ncbi.nlm.nih.gov/pubmed/31518246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10486 %T The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis %A Li,Jinhui %A Erdt,Mojisola %A Chen,Luxi %A Cao,Yuanyuan %A Lee,Shan-Qi %A Theng,Yin-Leng %+ Centre for Healthy and Sustainable Cities, Nanyang Technological University, 31 Nanyang Link, Singapore,, Singapore, 65 67915214, lijinhuihust@gmail.com %K active video games %K psychosocial well-being %K ageing %K literature review %K citation analysis %D 2018 %7 28.06.2018 %9 Review %J J Med Internet Res %G English %X Background: Recently, many studies have been conducted to investigate the effects of exergames on the social well-being of older adults. Objective: The aim of this paper is to synthesize existing studies and provide an overall picture on the social effects of exergames on older adults. Methods: A comprehensive literature search with inclusive criteria was conducted in major social science bibliographic databases. The characteristics of exergames, participants, methodology, as well as outcome measurements were extracted from the relevant studies included in the review. The bibliometric and altmetric outreach of the included studies were also investigated. Results: A total of 10 studies were included in the review, with 8 studies having used the Nintendo Wii platform. Most of the studies recruited healthy older adults from local communities or senior activity centers. Three groups of social-related outcomes have been identified, including emotion-related, behavior-related, and attitude-related outcomes. A metric analysis has shown that the emotion-related and behavior-related outcomes received high attention from both the academic community and social media platforms. Conclusions: Overall, the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others. The paper also provided implications for health care researchers and exergame designers. %M 29954727 %R 10.2196/10486 %U http://www.jmir.org/2018/6/e10486/ %U https://doi.org/10.2196/10486 %U http://www.ncbi.nlm.nih.gov/pubmed/29954727 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e117 %T Translating Behavior Change Principles Into a Blended Exercise Intervention for Older Adults: Design Study %A Mehra,Sumit %A Visser,Bart %A Dadema,Tessa %A van den Helder,Jantine %A Engelbert,Raoul HH %A Weijs,Peter JM %A Kröse,Ben JA %+ Digital Life - CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091 GM, Netherlands, 1 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K telemedicine %K remote consultation %K mobile devices %K tablet computers %K behavior control %K health behavior %K treatment adherence and compliance %D 2018 %7 02.05.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Physical activity can prevent or delay age-related impairments and prolong the ability of older adults to live independently. Community-based programs typically offer classes where older adults can exercise only once a week under the guidance of an instructor. The health benefits of such programs vary. Exercise frequency and the duration of the program play a key role in realizing effectiveness. An auxiliary home-based exercise program can provide older adults the opportunity to exercise more regularly over a prolonged period of time in the convenience of their own homes. Furthermore, mobile electronic devices can be used to motivate and remotely guide older adults to exercise in a safe manner. Such a blended intervention, where technology is combined with personal guidance, needs to incorporate behavior change principles to ensure effectiveness. Objective: The aim of this study was to identify theory-based components of a blended intervention that supports older adults to exercise at home. Methods: The Medical Research Council framework was used to develop the blended intervention. Insights from focus group, expert panels, and literature were combined into leading design considerations. Results: A client-server system had been developed that combined a tablet app with a database in the cloud and a Web-based dashboard that can be used by a personal coach to remotely monitor and guide older adults. The app contains several components that facilitate behavior change—an interactive module for goal setting, the ability to draw up a personal training schedule from a library containing over 50 exercise videos, progress monitoring, and possibilities to receive remote feedback and guidance of a personal coach. Conclusions: An evidence-based blended intervention was designed to promote physical activity among older adults. The underlying design choices were underpinned by behavior change techniques that are rooted in self-regulation. Key components of the tablet-supported intervention were a tailored program that accommodates individual needs, demonstrations of functional exercises, monitoring, and remote feedback. The blended approach combines the convenience of a home-based exercise program for older adults with the strengths of mobile health and personal guidance. %M 29720358 %R 10.2196/resprot.9244 %U http://www.researchprotocols.org/2018/5/e117/ %U https://doi.org/10.2196/resprot.9244 %U http://www.ncbi.nlm.nih.gov/pubmed/29720358 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e71 %T Therapist-Assisted Progressive Resistance Training, Protein Supplements, and Testosterone Injections in Frail Older Men with Testosterone Deficiency: Protocol for a Randomized Placebo-Controlled Trial %A Rasmussen,Rune %A Midttun,Mette %A Kolenda,Tine %A Ragle,Anne-Mette %A Sørensen,Thea Winther %A Vinther,Anders %A Zerahn,Bo %A Pedersen,Maria %A Overgaard,Karsten %+ Department of Neurology, University Hospital of Copenhagen, Herlev Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark, 45 28757500, rsr@sund.ku.dk %K accidental falls %K aged %K exercise %K testosterone %K therapeutics %K men %D 2018 %7 02.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Fall accidents are a major cause of mortality among the elderly and the leading cause of traumatic brain injury. After a fall, many elderly people never completely recover and need help in coping with everyday life. Due to the increasing older population in the world, injuries, disabilities, and deaths caused by falls are a growing worldwide problem. Muscle weakness leads to greatly increased risk of falling, decreased quality of life, and decline in functional capacity. Muscle mass and muscle power decrease about 40% from age 20 to 80 years, and the level of testosterone decreases with age and leads to impaired muscle mass. In addition, 20% of men older than 60 years—and 50% older than 80 years—have low levels of testosterone. Treatments after a fall are significant financial burdens on health and social care, and it is important to find treatments that can enhance function in the elderly people. Objective: The purpose of this study is to investigate whether testosterone and progressive resistance training alone or combined can improve muscle strength and reduce the risk of falls in older men. Additionally, we will examine whether such treatments can improve quality of life, functional capacity, including sexual function, and counteract depression. Methods: This is a randomized placebo-controlled, double-blind trial in which frail older men with testosterone deficiency are treated with testosterone supplemental therapy and therapist-assisted progressive resistance training for 20 weeks, with the possibility to continue treatment for 1 year. Four study arms of 48 participants each are provided based on factorial assignment to testosterone supplemental therapy and progressive resistance training. The 4 groups are as follows: controls given placebo injections without physical exercise for 20 weeks, testosterone-alone group given testosterone injections without physical exercise for 20 weeks, training-alone group given placebo injections for 20 weeks combined with 16 weeks of progressive strength training, and combination group given testosterone injections for 20 weeks combined with 16 weeks of progressive strength training. Performance in the 30-second chair stand test to measure improvement of general strength, balance, and power in lower extremities is the primary endpoint. Secondary endpoints comprising tests of cognition, muscle strength, and quality of life are applied before and after the training. Results: Funding was provided in October 2016. Results are expected to be available in 2020. Sample size was calculated to 152 participants divided into 4 equal-sized groups. Due to age, difficulty in transport, and the time-consuming intervention, up to 25% dropouts are expected; thus, we aim to include at least 192 participants. Conclusions: This investigation will evaluate the efficacy of testosterone supplemental therapy alone or combined with progressive resistance training. Additionally, improvements in quality of life and cognition are explored. Trial Registration: Clinicaltrials.gov NCT02873559; https://clinicaltrials.gov/ct2/show/NCT02873559 (Archived by WebCite at http://www.webcitation.org/6x0BhU2p3) %M 29500160 %R 10.2196/resprot.8854 %U https://www.researchprotocols.org/2018/3/e71/ %U https://doi.org/10.2196/resprot.8854 %U http://www.ncbi.nlm.nih.gov/pubmed/29500160 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e40 %T Feasibility of Virtual Tablet-Based Group Exercise Among Older Adults in Siberia: Findings From Two Pilot Trials %A Nikitina,Svetlana %A Didino,Daniele %A Baez,Marcos %A Casati,Fabio %+ Department of Information Engineering and Computer Science, University of Trento, Via Sommarive, 9 - Povo, Trento, 38123, Italy, 39 0461 28 5299, svetlana.nikitina@unitn.it %K physical fitness %K exercise training %K tablet computers %K elderly %K social support %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity has a positive effect on physical health, well-being, and life satisfaction of older adults. However, engaging in regular physical activity can be challenging for the elderly population because of reduced mobility, low motivation, or lack of the proper infrastructures in their communities. Objective: The objective of this paper was to study the feasibility of home-based online group training—under different group cohesion settings—and its effects on adherence and well-being among Russian older adults. We focused particularly on the technology usability and usage and on the adherence to the training (in light of premeasures of social support, enjoyment of physical activity, and leg muscle strength). As a secondary objective, we also explored the effects of the technology-supported intervention on subjective well-being and loneliness. Methods: Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period from 2015 to 2016 in Tomsk, Russian Federation. A total of 44 older adults (59-83 years) participated in the two pilots and followed a strength and balance training program (Otago) for 8 weeks with the help of a tablet-based virtual gym app. Participants in each pilot were assigned to an interaction condition, representing the online group exercising, and an individual condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialize and train together. Results: Both interaction and individual groups reported a high usability of the technology. Trainees showed a high level of technology acceptance and, particularly, a high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Private texting (short service message [SMS]) was used more than public texting, and the strong cohesion condition resulted in more messages per user. Joint participations to training sessions (copresence) were higher for the social group with higher cohesion. The overall adherence to the training was 74% (SD 27%). Higher levels of social support at baseline were associated with higher adherence in the low cohesion condition (F1,18=5.23, P=.03), whereas in the high cohesion, such association was not found. Overall improvement in the satisfaction with life score was observed between pre and post measures (F1,31=5.85, P=.02), but no decrease in loneliness. Conclusions: Online group exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed. %M 29487045 %R 10.2196/mhealth.7531 %U http://mhealth.jmir.org/2018/2/e40/ %U https://doi.org/10.2196/mhealth.7531 %U http://www.ncbi.nlm.nih.gov/pubmed/29487045 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e23 %T Reducing Sedentary Time for Obese Older Adults: Protocol for a Randomized Controlled Trial %A Rosenberg,Dori E %A Lee,Amy K %A Anderson,Melissa %A Renz,Anne %A Matson,Theresa E %A Kerr,Jacqueline %A Arterburn,David %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2532, rosenberg.d@ghc.org %K Sedentary lifestyle %K exercise %K aging %K chronic conditions %K medical informatics %D 2018 %7 12.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults have high rates of obesity and are prone to chronic health conditions. These conditions are in part due to high rates of sedentary time (ST). As such, reducing ST could be an innovative strategy for improving health outcomes among obese older adults. To test this theory, we developed a novel, technology-enhanced intervention to reduce sitting time (I-STAND) and pilot tested it to assess the feasibility, acceptability, and preliminary effects of the intervention on ST and biometric outcomes. Objective: The current paper aims to describe the rationale, design, and methods of the I-STAND sitting reduction pilot trial. Methods: Older adults with obesity (n=60) were recruited from a large health care system and randomized to receive I-STAND or a healthy living intervention. I-STAND combined personal coaching with a technology-enhanced intervention (Jawbone UP band) to cue breaks from sitting. Participants completed self-report and biometric assessments at baseline and 3 months. Additional qualitative results were collected from a subset of I-STAND participants (n=22) to further inform the feasibility and acceptability of the interventions. The primary outcome was total hours of daily sitting time measured by the activPAL device. Secondary outcomes included sit-to-stand transitions, bouts of sitting longer than 30 minutes, physical function, blood pressure, fasting glucose, cholesterol, and depressive symptoms. Results: Study enrollment has ended and data processing is underway. Conclusions: Data from randomized trials on sitting reduction are needed to inform novel approaches to health promotion among older adults with obesity. Our trial will help fill this gap. The methods used in our study can guide future research on using technology-based devices to assess or prompt sedentary behavior reduction, or those interested in behavioral interventions targeting obese older adults with novel approaches Trial Registration: ClinicalTrials.gov: NCT02692560; https://clinicaltrials.gov/ct2/show/NCT02692560 (Archived by WebCite at http://www.webcitation.org/6wppLTWAl) %M 29434012 %R 10.2196/resprot.8883 %U http://www.researchprotocols.org/2018/2/e23/ %U https://doi.org/10.2196/resprot.8883 %U http://www.ncbi.nlm.nih.gov/pubmed/29434012 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e34 %T Activity Monitors as Support for Older Persons’ Physical Activity in Daily Life: Qualitative Study of the Users’ Experiences %A Ehn,Maria %A Eriksson,Lennie Carlén %A Åkerberg,Nina %A Johansson,Ann-Christin %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, S-721 23, Sweden, 46 21 107093 ext 107093, maria.ehn@mdh.se %K exercise %K behavior %K aged %K seniors %K mobile applications %K fitness trackers %D 2018 %7 01.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems. Objective: The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective? Methods: This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis. Results: The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days. Conclusions: Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA. %M 29391342 %R 10.2196/mhealth.8345 %U http://mhealth.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/mhealth.8345 %U http://www.ncbi.nlm.nih.gov/pubmed/29391342 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e173 %T User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study %A Puri,Arjun %A Kim,Ben %A Nguyen,Olivier %A Stolee,Paul %A Tung,James %A Lee,Joon %+ Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Lyle Hallman North, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 5198884567 ext 31567, joon.lee@uwaterloo.ca %K health %K mHealth %K fitness trackers %K older adults %D 2017 %7 15.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective: The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results: Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions: Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults. %M 29141837 %R 10.2196/mhealth.8211 %U http://mhealth.jmir.org/2017/11/e173/ %U https://doi.org/10.2196/mhealth.8211 %U http://www.ncbi.nlm.nih.gov/pubmed/29141837 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e104 %T Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting %A Rye Hanton,Cassia %A Kwon,Yong-Jun %A Aung,Thawda %A Whittington,Jackie %A High,Robin R %A Goulding,Evan H %A Schenk,A Katrin %A Bonasera,Stephen J %+ Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE, 68198-6155, United States, 1 402 559 8409, sbonasera@unmc.edu %K mobile phone %K functional status %K mobility %K gait speed %K mobility measures %K LLFDI %K SAFFE %K PROMIS short %K PROMIS Global %K step count %K behavioral classification %K frailty phenotype %K normal aging %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory. Objective: The objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs. Methods: A total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment. Results: We identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH. Conclusions: Continuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain. %M 28974482 %R 10.2196/mhealth.5090 %U http://mhealth.jmir.org/2017/10/e104/ %U https://doi.org/10.2196/mhealth.5090 %U http://www.ncbi.nlm.nih.gov/pubmed/28974482 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e39 %T Experiences of Older Adults With Mobile Phone Text Messaging as Reminders of Home Exercises After Specialized Manual Therapy for Recurrent Low Back Pain: A Qualitative Study %A Lilje,Stina Charlotta %A Olander,Ewy %A Berglund,Johan %A Skillgate,Eva %A Anderberg,Peter %+ Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-171 77, Sweden, 46 708233332, titti.lilje@gmail.com %K text messages %K older adults %K recurrent low back pain %K manual therapy %D 2017 %7 30.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Clinical experience of manual therapy for musculoskeletal pain is that patients often suffer from recurrent pain and disorders, but that they do not continue to perform their physical home exercises when they are free from symptoms. The chance of positive long-term effects of manual therapy would probably increase if patients were reminded that they are to continue to perform their exercises. Mobile phone text messaging (short messaging service, SMS) is increasingly used as an innovative intervention to remind patient to exercise. However, there are only a few studies on such interventions in the field of low back pain (LBP). Qualitative studies of patients’ experiences of receiving text messages as reminders of home exercises after manual treatment for recurrent LBP have to the best of our knowledge never been published. Objectives: The aim of this study was to explore older persons’ common experiences of receiving reminders of home exercises through mobile phone text messaging after specialized manual therapy for recurrent LBP. Methods: A total of 7 men and 8 women (67-86 years), who had sought specialized manual therapy (Naprapathic manual therapy) for recurrent LBP were included in the study. Individual one-way text messages as reminders of home exercises (to be performed on a daily basis) were sent to each patient every third day for 3 weeks, then once a week for another 2 weeks. Semistructured interviews with 2 broad, open-ended questions were held and data were analyzed with systematic text condensation, based on Giorgi’s principles of psychological phenomenological analysis. Results: The participants appreciated the messages, which were perceived as timely and usable, and also stimulated memorizing. The messages made the participants reflect on the aim of the exercise, value of being reminded, and on their improvement in pain. During the interviews, the participants created their own routines for continued adherence to the exercises. Conclusions: It seems plausible that mobile phone text messaging may serve as a useful tool for patient empowerment with regard to recurrent LBP in older persons. Further studies are needed to explore whether future compliance with the exercises will be as large if the participants are not being interviewed. %M 28360026 %R 10.2196/mhealth.7184 %U http://mhealth.jmir.org/2017/3/e39/ %U https://doi.org/10.2196/mhealth.7184 %U http://www.ncbi.nlm.nih.gov/pubmed/28360026 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e28 %T Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial %A Lyons,Elizabeth J %A Swartz,Maria C %A Lewis,Zakkoyya H %A Martinez,Eloisa %A Jennings,Kristofer %+ Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 4097722575, ellyons@utmb.edu %K physical activity %K technology %K mobile health %K health behavior %K self-control %D 2017 %7 06.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As adults age, their physical activity decreases and sedentary behavior increases, leading to increased risk of negative health outcomes. Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques. However, little is known about the feasibility and acceptability of non-Fitbit wearables (Fitbit, Inc, San Francisco, California) combined with telephone counseling among adults aged more than 55 years. Objective: The purpose of our study was to determine the feasibility, acceptability, and effect on physical activity of an intervention combining a wearable physical activity monitor, tablet device, and telephone counseling among adults aged 55-79 years. Methods: Adults (N=40, aged 55-79 years, body mass index=25-35, <60 min of activity per week) were randomized to receive a 12-week intervention or to a wait list control. Intervention participants received a Jawbone Up24 monitor, a tablet with the Jawbone Up app installed, and brief weekly telephone counseling. Participants set daily and weekly step goals and used the monitor’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone. Feasibility was measured using observation and study records, and acceptability was measured by self-report using validated items. Physical activity and sedentary time were measured using ActivPAL monitors following standard protocols. Body composition was measured using dual-energy x-ray absorptiometry scans, and fitness was measured using a 6-min walk test. Results: Participants were 61.48 years old (SD 5.60), 85% (34/40) female, 65% (26/40) white. Average activity monitor wear time was 81.85 (SD 3.73) of 90 days. Of the 20 Up24 monitors, 5 were reported broken and 1 lost. No related adverse events were reported. Acceptability items were rated at least 4 on a scale of 1-5. Effect sizes for most outcomes were small, including stepping time per day (d=0.35), steps per day (d=0.26), sitting time per day (d=0.21), body fat (d=0.17), and weight (d=0.33). Conclusions: The intervention was feasible and acceptable in this population. Effect sizes were similar to the sizes found using other wearable electronic activity monitors, indicating that when combined with telephone counseling, wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior. Trial registration: Clinicaltrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 (Archived by WebCite at http://www.webcitation.org/6odlIolqy) %M 28264796 %R 10.2196/mhealth.6967 %U http://mhealth.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mhealth.6967 %U http://www.ncbi.nlm.nih.gov/pubmed/28264796 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e35 %T Older Adults’ Experiences Using a Commercially Available Monitor to Self-Track Their Physical Activity %A McMahon,Siobhan K %A Lewis,Beth %A Oakes,Michael %A Guan,Weihua %A Wyman,Jean F %A Rothman,Alexander J %+ University of Minnesota, School of Nursing, 308 Harvard Street SE, Minneapolis, MN, 55455, United States, 1 2182903422, skmcmaho@umn.edu %K Aged %K Mobile Health %K Self-Appraisal %K Physical Activity %K Motivation %K Monitoring %K Ambulatory %K Wearables %D 2016 %7 13.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Physical activity contributes to older adults’ autonomy, mobility, and quality of life as they age, yet fewer than 1 in 5 engage in activities as recommended. Many older adults track their exercise using pencil and paper, or their memory. Commercially available physical activity monitors (PAM) have the potential to facilitate these tracking practices and, in turn, physical activity. An assessment of older adults’ long-term experiences with PAM is needed to understand this potential. Objective: To assess short and long-term experiences of adults >70 years old using a PAM (Fitbit One) in terms of acceptance, ease-of-use, and usefulness: domains in the technology acceptance model. Methods: This prospective study included 95 community-dwelling older adults, all of whom received a PAM as part of randomized controlled trial piloting a fall-reducing physical activity promotion intervention. Ten-item surveys were administered 10 weeks and 8 months after the study started. Survey ratings are described and analyzed over time, and compared by sex, education, and age. Results: Participants were mostly women (71/95, 75%), 70 to 96 years old, and had some college education (68/95, 72%). Most participants (86/95, 91%) agreed or strongly agreed that the PAM was easy to use, useful, and acceptable both 10 weeks and 8 months after enrolling in the study. Ratings dropped between these time points in all survey domains: ease-of-use (median difference 0.66 points, P=.001); usefulness (median difference 0.16 points, P=.193); and acceptance (median difference 0.17 points, P=.032). Differences in ratings by sex or educational attainment were not statistically significant at either time point. Most participants 80+ years of age (28/37, 76%) agreed or strongly agreed with survey items at long-term follow-up, however their ratings were significantly lower than participants in younger age groups at both time points. Conclusions: Study results indicate it is feasible for older adults (70-90+ years of age) to use PAMs when self-tracking their physical activity, and provide a basis for developing recommendations to integrate PAMs into promotional efforts. Trial Registration: Clinicaltrials.gov NCT02433249; https://clinicaltrials.gov/ct2/show/NCT02433249 (Archived by WebCite at http://www.webcitation.org/6gED6eh0I) %M 27076486 %R 10.2196/mhealth.5120 %U http://mhealth.jmir.org/2016/2/e35/ %U https://doi.org/10.2196/mhealth.5120 %U http://www.ncbi.nlm.nih.gov/pubmed/27076486