JMIR Publications

ABSTRACT

Background:

Falls and fractures are the leading cause of unintentional injury among older adults, resulting in increased mortality and morbidity, and reduced physical function and quality of life. In-person exercise programs aimed at improving strength, balance, and postural control have demonstrated benefits in physical function and a reduction in fall risk among older adults. Technology-driven approaches can enhance the accessibility of fall prevention resources, making them more accessible. In particular, digitally delivered programs offer the opportunity to balance risks and benefits during times of social distancing, while promoting community engagement and potentially enhancing physical function.

Objective:

The overall aim of this review was to determine the reach, implementation, safety, and effectiveness of digitally delivered group exercise programs with a focus on improving physical function.

Methods:

Medline via PubMed, Cochrane Registry of Controlled Trials (CENTRAL), and EMBASE databases were searched for this review. The search was initially conducted in November 2022 and updated in July 2024. Randomized controlled trials, non-randomized trials, and single arm pilot studies at least six weeks in duration and reporting digitally delivered exercise for presumptively healthy older adults taught by a qualified instructor in real-time (not videotaped) were included. Interventions specifically for clinical subpopulations (i.e. cardiac rehabilitation, Parkinson’s, COPD, etc.) were excluded, although common diseases of older age (hypertension, diabetes, osteoporosis) were included. The review was preregistered via INPLASY (#3773)

Results:

4242 studies were screened by title and abstract, with 76 studies progressing to full-text screening. Of these, 23 (30%) met all inclusion criteria. Sixteen (70%) studies reported physical outcomes (i.e. balance, strength, function, etc.). Fourteen (88%) of these reported improvements following the intervention. Twenty (87%) reported one or more observations regarding safety and/or program usability. Most studies were conducted injury-free, or with no greater than minor injuries, and with high adherence to the exercise sessions and overall study compliance. Furthermore, most studies indicated a high level of acceptance of the digital delivery mechanism(s).

Conclusions:

Overall, these findings demonstrate partial effectiveness in improving physical function, high attendance, participant enjoyment, and safety of digitally delivered exercise programs for older adults taught in real-time. Clinical Trial: INPLASY (#3773)