Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises

Lisa McGarrigle, Elisabeth Boulton, Chris Todd, Lisa McGarrigle, Elisabeth Boulton, Chris Todd

Abstract

Background: Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people.

Methods: We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality.

Results: We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review.

Conclusions: Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.

Keywords: Apps; Balance; Behaviour change techniques; COVID-19; Exercise; Falls prevention; Strength; Websites.

Conflict of interest statement

Prof Todd declares that he is PI for the UK arm of the Standing Taller implementation evaluation funded by the Australian National Health and Medical Research Council, was the PI for the EC funded Prevention of Falls Network for Dissemination (ProFouND), which developed and maintained the www.profound.eu.com website. Prof Todd and Elisabeth Boulton were CIs on the EC funded PreventIT project that created the eLiFE app. The Keep On Keep Up app is being developed by researchers at the University of Manchester along with Reason Digital. None of the authors have any financial stake in any of the apps or websites reviewed. Lisa McGarrigle declares no conflict of interest.

Figures

Fig. 1
Fig. 1
App search flow chart
Fig. 2
Fig. 2
Website search flow chart
Fig. 3
Fig. 3
Frequency of BCTs by category across apps and websites. The figure illustrates the types of BCTs most frequently applied across apps and websites, based on categories provided in the 93-item BCT Taxonomy

References

    1. World Health Organization . Falls: key facts. 2018.
    1. Frieson CW, Tan MP, Ory MG, Smith ML. Editorial: evidence-based practices to reduce falls and fall-related injuries among older adults. Front Public Health. 2018;6:222. doi: 10.3389/fpubh.2018.00222.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146. 10.1002/14651858.CD007146.pub3.
    1. Kinney JM. Nutritional frailty, sarcopenia and falls in the elderly. Curr Opin Clin Nutr Metab Care. 2004;7:15. doi: 10.1097/00075197-200401000-00004.
    1. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019. 10.1002/14651858.CD012424.pub2.
    1. Department of Health and Social Care . UK chief medical officers’ physical activity guideline. 2019.
    1. Office for National Statistics . Health survey for England 2016. London: Office for National Statistics; 2017.
    1. Muellmann S, Forberger S, Mollers T, Broring E, Zeeb H, Pischke CR. Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review. Prev Med. 2018;108:93–110. doi: 10.1016/j.ypmed.2017.12.026.
    1. Yerrakalva D, Yerrakalva D, Hajna S, Griffin S. Effects of mobile health app interventions on sedentary time, physical activity, and fitness in older adults: systematic review and meta-analysis. J Med Internet Res. 2019;21. 10.2196/14343.
    1. Sato K, Kuroki K, Saiki S, Nagatomi R. Improving walking, muscle strength, and balance in the elderly with an Exergame using Kinect: a randomized controlled trial. Games Health J. 2015;4:161–167. doi: 10.1089/g4h.2014.0057.
    1. Stanmore EK, Mavroeidi A, de Jong LD, Skelton DA, Sutton CJ, Benedetto V, et al. The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC Med. 2019;17:49. doi: 10.1186/s12916-019-1278-9.
    1. Lamb SE, Becker C, Gillespie LD, Smith JL, Finnegan S, Potter R, et al. Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions. Trials. 2011;12:125. doi: 10.1186/1745-6215-12-125.
    1. Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise-based falls prevention programme. Age Ageing. 2001;30:77–83. doi: 10.1093/ageing/30.1.77.
    1. Featherstone RM, Dryden DM, Foisy M, Guise J-M, Mitchell MD, Paynter RA, et al. Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews. Syst Rev. 2015;4:50. doi: 10.1186/s13643-015-0040-4.
    1. Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Syst Rev. 2012;1:10. doi: 10.1186/2046-4053-1-10.
    1. Eysenbach G, Köhler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ. 2002;324:573–577. doi: 10.1136/bmj.324.7337.573.
    1. Spink A, Jansen BJ, Wolfram D, Saracevic T. From e-sex to e-commerce: web search changes. Computer. 2002;35:107–109. doi: 10.1109/2.989940.
    1. Whitehead SH, Nyman SR, Broaders F, Skelton DA, Todd CJ. The quality of English-language websites offering falls-prevention advice to older members of the public and their families. Health Informatics J. 2012;18:50–65. doi: 10.1177/1460458211432588.
    1. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT) Age Ageing. 2005;34:636–639. doi: 10.1093/ageing/afi174.
    1. Campbell AJ, Robertson MC. Otago exercise programme to prevent falls in older adults. Wellington: ACC Thinksafe; 2003. p. 3.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med Publ Soc Behav Med. 2013;46:81–95. doi: 10.1007/s12160-013-9486-6.
    1. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR MHealth UHealth. 2015;3:e27. doi: 10.2196/mhealth.3422.
    1. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343. 10.1136/bmj.d5928.
    1. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355. 10.1136/bmj.i4919.
    1. Health on the Net Foundation . HON Code of Conduct (HONCode) for medical and health websites. 2019.
    1. Hayes AF, Krippendorff K. Answering the call for a standard reliability measure for coding data. Commun Methods Meas. 2007;1:77–89. doi: 10.1080/19312450709336664.
    1. De Swert K. Calculating inter-coder reliability in media content analysis using Krippendorff’s Alpha. The Netherlands: University of Amsterdam; 2012.
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350. 10.1136/bmj.h1258.
    1. van Het Reve E, Silveira P, Daniel F, Casati F, de Bruin ED. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial. J Med Internet Res. 2014;16:e159. doi: 10.2196/jmir.3055.
    1. Delbaere K, Valenzuela T, Woodbury A, Davies T, Yeong J, Steffens D, et al. Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the standing tall randomised controlled trial. BMJ Open. 2015;5. 10.1136/bmjopen-2015-009173.
    1. Taraldsen K, Mikolaizak AS, Maier AB, Boulton E, Aminian K, van Ancum J, et al. Protocol for the PreventIT feasibility randomised controlled trial of a lifestyle-integrated exercise intervention in young older adults. BMJ Open. 2019;9:e023526. doi: 10.1136/bmjopen-2018-023526.
    1. Taraldsen K, Mikolaizak AS, Maier AB, Mellone S, Boulton E, Aminian K, et al. Digital technology to deliver a lifestyle-integrated exercise intervention in young seniors – the PreventIT feasibility randomised controlled trial. Front Digit Health. 2020;2. 10.3389/fdgth.2020.00010.
    1. Sherrington C, Tiedemann A, Fairhall N, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. New South Wales Public Health Bull. 2011;22:78–83. doi: 10.1071/NB10056.
    1. NIHR Policy Research Unit Older People and Frailty . Delivery of strength and balance exercises for falls prevention amongst older people using digital technologies to replace face-to-face contact during Covid-19 home isolation and physical distancing: briefing paper. 2020.
    1. Public Health England . Advancing our health: prevention in the 2020s. London: Public Health England; 2019.
    1. Matthews K, Nazroo J, Marshall A. Digital inclusion in later life: cohort changes in internet use over a ten-year period in England. Ageing Soc. 2019;39:1914–1932. doi: 10.1017/S0144686X18000326.
    1. Franco MR, Tong A, Howard K, Sherrington C, Ferreira PH, Pinto RZ, et al. Older people’s perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature. Br J Sports Med. 2015;49:1268–1276. doi: 10.1136/bjsports-2014-094015.
    1. Michie S, West R, Sheals K, Godinho CA. Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used. Transl Behav Med. 2018;8:212–224. doi: 10.1093/tbm/ibx019.
    1. Brusse C, Gardner K, McAullay D, Dowden M. Social media and mobile apps for health promotion in Australian indigenous populations: scoping review. J Med Internet Res. 2014;16:e280. doi: 10.2196/jmir.3614.

Source: PubMed

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