Effects of a Combined Exercise Program Using an iPad for Older Adults

 

The benefits of exercise have been documented in numerous studies, but in 2012 only 15% of older adults between 65–75 years and 8% of adults over 75 in the United States met the 2008 guidelines (at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity) for aerobic and strength training activities.¹ These guidelines recommend that aerobic activity should be performed in sessions lasting a minimum of 10 minutes, and should ideally be spread throughout the week. The 2008 guidelines also recommend adults perform muscle-strengthening activities that involve all major muscle groups on 2 or more days a week, because these activities provide additional health benefits.

It has been found that group-based exercise programs are beneficial in enhancing functional performance in older adults. However, group-based exercise programs can be expensive, hard to implement, and difficult to access for many older adults.² The challenge then is in finding cost-effective and easily accessible physical activity programs targeted for older adults that they can implement successfully.

  

Most of the outcomes measured were not significant when the experimental and control groups were compared in terms of group and time levels.³ However, statistical analysis showed that the intervention had significant effects on cognitive status. Specifically, there was not a significant change in the cognitive status of the experimental group, but the cognitive status of the control group significantly declined. From this result, the researchers inferred that intervention was necessary to maintain cognitive status, and that cognitive status will regress without the proper treatment.

 

 For older adults with cognitive impairment, a burden of care is often placed on another person for many activities of daily living, including delivering their loved one to regular fitness classes. Therefore, finding an exercise program that combines group and individual exercise may be more effective in improving adherence to exercise in older adults, especially if this program can be administered in the home. Thus, the researchers in this study wanted to examine the function, health status, and efficacy effects of a combined exercise program using an iPad among older women in Korea.

 Study participants, recruited from a senior center in a community of Seoul, Korea, were aged 65 years or older; able to communicate with an interviewer without difficulty; able to independently perform activities of daily living; and able to comprehend and follow instructions. Researchers contacted 22 older females for the experimental group, with 18 participating in the intervention. After completion of the intervention for the experimental group, an additional 15 older females were recruited for the control group (needed sample size of > 14 was determined by power analysis). There were 16 members in the intervention group who completed the posttest, and 10 in the control group who completed the posttest.

The researchers measured participation, cognitive and physical function, perceived health status, and efficacy outcomes. The Korean version of the Mini-Mental State Examination (K-MMSE) was used to evaluate the participants’ cognitive status. The Barthel Index was used to measure participants’ performance of activities of daily living. The Barthel Index has 11 measures and is scored from 0 to 100, with a higher score indicating a better functional state. Perceived health status was assessed by scoring answers to three questions (excellent =5 to poor=1): “How would you rate your health?”, “How is your health status compared to three years ago?”, and “How is your health status compared to other people your age?”. A higher score indicated a better perceived health status. The self-efficacy measure for exercise asks about participants’ confidence related to their ability to continue exercising when faced with barriers to exercising, with a higher score indicating a higher state of self-efficacy towards exercise. The outcomes expectations for exercise were measured with a 13-item inventory that identifies an individual’s belief that exercise will result in certain outcomes, with a higher score on this scale signifying higher expectations.

All intervention participants were provided with weekly group exercise classes lasting approximately 30 minutes and home-based exercise at least 3 times a week. The on-site classes the participants were provided with combined aerobic and resistance exercises that focused on enhancing muscle strength, flexibility, and balance. The home-based iPad exercise program consisted of a video clip of the exercise trainer from the group classes performing the same exercise movements from the group-based program. Participants were encouraged to exercise at home using the iPad at any time they desired, with an aim of at least three sessions weekly. Detailed explanations on how to use the iPad were given before the 8-week home based exercise program began. Also participants were given a booklet of instructions on the using the iPad and a phone number to contact with questions. All members of the control group continued to take part in their usual group based yoga program at the senior center that occurred one day per week.

The researchers identified that this pilot study had many limitations including a nonequivalent control group, pretest-posttest design was adopted instead of a randomized controlled design, participants were categorized into the control and experimental groups based on convenience, sample size was small (n=26). Also, the ability to generalize their findings is limited because their study targeted an older population within a single area. Finally, the control group participants failed to meet the expected sample size caused by a high attrition rate (33%) due to control participants moving and being absent from post-testing. The researchers concluded that a larger study using randomized design in number of community dwelling centers should be conducted in the future to test the validity of these results.

 

1. Centers for Disease Control and Prevention. Data for the selected characteristics of 2008 Physical Activity Guidelines for Americans: Centers for Disease Control and Prevention; 2012 http://www.cdc.gov/nchs/data/hus/2012/067.pdf. Accessed September 6, 2016.
2. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health 1999; 89(9):1322-7.
3. Lee J, Jung D, Byun J, Lee M. Effects of a Combined Exercise Program Using an iPad for Older Adults. Healthcare Informatics Research. 2016; 22(2):65-72. doi: 10.4258/hir.2016.22.2.65. Epub 2016 Apr 30.