Personalized Exercise Programs Based upon Remote Assessment of Motor Fitness: A Pilot Study among Healthy People Aged 65 Years and Older.

BACKGROUND: The World Health Organization has recently updated exercise guidelines for people aged >65 years, emphasizing the inclusion of multiple fitness components. However, without adequate recognition of individual differences, these guidelines may be applied using an approach that "one-size-fits-all." Within the shifting paradigm toward an increasingly personalized approach to medicine and health, it is apparent that fitness components display a significant age-related increase in variability. Therefore, it is both logical and necessary to perform an accurate individualized assessment of multiple fitness components prior to optimal prescription for a personalized exercise program. OBJECTIVE: The aim of the study was to test the feasibility and effectiveness of a novel tool able to remotely assess balance, flexibility, and strength using smartphone sensors (accelerometer/gyroscope), and subsequently deliver personalized exercise programs via the smartphone. METHODS: We enrolled 52 healthy volunteers (34 females) aged 65+ years, with normal cognition and low fall risk. Baseline data from remote smartphone fitness assessment were analyzed to generate 42 fitness digital markers (DMs), used to guide personalized exercise programs (×5/week for 6 weeks) delivered via smartphone. Programs included graded exercises for upper/lower body, flexibility, strength, and balance (dynamic, static, and vestibular). Participants were retested after 6 weeks. RESULTS: Average age was 74.7 ± 6.4 years; adherence was 3.6 ± 1.7 exercise sessions/week. Significant improvement for pre-/posttesting was observed for 10/12 DMs of strength/flexibility for upper/lower body (sit-to-stand repetitions/duration; arm-lift duration; torso rotation; and arm extension/flexion). Balance improved significantly for 6/10 measures of tandem stance, with consistent (nonsignificant) trends observed across 20 balance DMs of tandem walk and 1 leg stance. Balance tended to improve among the 37 participants exercising ≥3/week. DISCUSSION: These preliminary results provide a proof of concept, with high adherence and improved fitness confirming the benefits of remote fitness assessment for guiding home personalized exercise programs among healthy adults aged >65 years. Further examination of the application within a randomized control study is necessary, comparing the personalized exercise program to general guidelines among healthy older adults, as well as specific populations, such as those with frailty, deconditioning, cognitive, or functional impairment. The study tool offers the opportunity to collect big data, including additional variables, with subsequent utilization of artificial intelligence to optimize the personalized exercise program.

Personalized multicomponent exercise programs using smartphone technology among older people: protocol for a randomized controlled trial.

BACKGROUND: Optimal application of the recently updated World Health Organization (WHO) guidelines for exercise in advanced age necessitates an accurate adjustment for the age-related increasing variability in biological age and fitness levels, alongside detailed recommendations across a range of motor fitness components, including balance, strength, and flexibility. We previously developed and validated a novel tool, designed to both remotely assess these fitness components, and subsequently deliver a personalized exercise program via smartphone. We describe the design of a prospective randomized control trial, comparing the effectiveness of the remotely delivered personalized multicomponent exercise program to either WHO exercise guidelines or no intervention. METHODS: Participants (n = 300) are community dwelling, healthy, functionally independent, cognitively intact volunteers aged ≥65 at low risk for serious fall injuries, assigned using permuted block randomization (age/gender) to intervention, active-control, or control group. The intervention is an 8-week program including individually tailored exercises for upper/lower body, flexibility, strength, and balance (dynamic, static, vestibular); active-controls receive exercising counselling according to WHO guidelines; controls receive no guidance. Primary outcome is participant fitness level, operationalized as 42 digital markers generated from 10 motor fitness measures (balance, strength, flexibility); measured at baseline, mid-trial (4-weeks), trial-end (8-weeks), and follow-up (12-weeks). Target sample size is 300 participants to provide 99% power for moderate and high effect sizes (Cohen's f = 0.25, 0.40 respectively). DISCUSSION: The study will help understand the value of individualized motor fitness assessment used to generate personalized multicomponent exercise programs, delivered remotely among older adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04181983.

Aerobic fitness and multidomain cognitive function in advanced age.

BACKGROUND: Studies generally describe the relationship between physical fitness and cognitive function by measuring only one or two specific cognitive tasks. In addition, in spite of the significant increase in life expectancy, the age of participants in these studies does not extend beyond a mean age of 70 years. This study was thus designed to examine the relationship between physical fitness and function in multiple cognitive domains in subjects older than those previously reported. METHODS: Thirty-eight individuals, aged 65.3 to 85.3 years, performed a graded, progressive, maximal exercise test. Based on a median score of peak VO2, participants were divided into low-fitness and moderately-fit groups. Cognitive function was assessed by means of a computerized neuropsychological battery. RESULTS: The moderately-fit group achieved significantly better scores on the global cognitive score (U = 97, p = 0.04), and a significant correlation was found between peak VO2 and attention, executive function, and global cognitive score (rs = .37, .39, .38 respectively). The trend for superior cognitive scores in the moderate-fitness compared to the low-fitness groups was unequivocal, both in terms of accuracy and reaction time. CONCLUSION: Maintenance of higher levels of cardiovascular fitness may help protect against cognitive deterioration, even at an advanced age. An adequately powered randomized controlled trial should be performed to further evaluate this hypothesis.

Fitness's moderation of the facilitative effect of acute exercise on cognitive flexibility in older women.

A recent study indicated that acute aerobic exercise improves cognitive flexibility in adults. The current study assessed age, habitual physical activity, and physical fitness as moderators of this improvement and examined whether the gains still exist an hour after the exercise session. The alternative-uses test, assessing cognitive flexibility, was administered individually to 20 older (age 63.67 +/- 3.55 yr) and 19 young (age 23.9 +/- 1.22) women before, immediately after, and an hour after a single moderate aerobic-exercise session. Results indicated significant improvement in cognitive flexibility in the older group immediately after the exercise but a decrease at the 1-hr follow-up. Further analysis indicated that physical fitness accounted for this improvement (R = -.622, p < .01). No such differences were observed in the young group. Further studies are needed to examine the duration of this effect, as well as the role of physical fitness as a moderator of it.

Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home.

PURPOSE: To demonstrate the feasibility of an innovative program of physical activity using a standing-support device targeted towards adult residents of a nursing home who are unable to transfer or stand independently. METHOD: Intervention study. PARTICIPANTS: Thirteen residents, age 82 +/- 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently. INTERVENTION: Eight-week observational period followed by 12-week physical activity performed while standing in a Standing-Support Device. MEASUREMENTS: Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure. RESULTS: Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker. CONCLUSION: A pilot program of physical activity using a Standing-Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.