JMIR Publications

ABSTRACT

Background:

"Keep On Keep Up" (KOKU) is a tablet-based digital program based on the well validated Otago and FAME exercise programmes, for older adults to decrease the risk of falling.

Objective:

This sub-study involved a process evaluation in order to analyse usage patterns of the KOKU digital program, specifically training frequency, volume, and intensity among older adults over a three-month self-managed training period. Pre-post changes in physical capacity and real-world walking were examined.

Methods:

This study is a nested cohort study of the three-armed randomized controlled SMART-AGE trial conducted in Germany. Participants aged ≥ 67 years with basic digital literacy were included. KOKU provided guided but unsupervised progressive strength and balance training for three months. Data on training adherence, engagement, and progression were collected. Instrumented assessments included the Timed Up and Go Test (iTUG), the 30-Second Chair Rise Test (iCRT), and real-world walking monitoring using wearable sensors.

Results:

A total of 113 participants (57% female, mean age 74.02 ± 5.36 years) were included in the analysis. During the three months period, participants used KOKU for 24 ± 15 days, i.e. two to three times per week. Over the whole study period, no falls or other adverse events were reported due to KOKU usage. The number of exercises performed per participant ranged from 2 to 213, with a median value of 70. The iTUG results revealed a prolonged total duration (p = 0.009, d=0.26). In the iCRT, improvements were observed in the number of completed repetitions (p = 0.044, d = 0.21) and frequency of repetitions (p = 0.034, d = 0.23). This was mainly due to a reduction in inactive time (p < 0.001, Cohen’s d = -0.60). Real-world walking parameters remained unchanged, except a slower walking speed during walking bouts of >30s (p < 0.001, d = 0.49). All changes did not meet the criteria for minimally important differences.

Conclusions:

KOKU is a novel digital intervention for older adults, promoting balance and strength exercises. Physical capacity improvements were small. However, the use of instrumented assessments provided further insights into participants’ capacity and mobility that would not have been identifiable with conventional assessments. Future improvements to the program should focus on incorporating more challenging exercises for individuals with more different levels of physical capacity. Clinical Trial: German Clinical Trials Register ID: DRKS00034316