We investigated the preliminary effectiveness and feasibility of an online exercise program for community-dwelling older adults. The program did not affect participants’ habitual PA levels but reduced depression, improved life-space mobility, and had excellent adherence and acceptability.
Habitual PA did not change pre- to post-intervention or at the 2-month follow-up for the ACTIVE group. Daily steps and daily active energy expenditure may not have changed due to the decreased level of PA in older adults during the quarantine period of COVID-19, which was in place while the study was implemented (43). However, participants perceived improved function (e.g., walking, strength, gardening), chronic disease management (e.g., reduced blood pressure, vertigo), and improved energy and overall health. Participants stated they “felt better” and “had more energy”.
The between-group changes in the GDS-SF showed the preliminary mental health benefits of the program. Participants in the ACTIVE group had reduced feelings of depression compared to the CON group post-intervention, which were maintained at follow-up. Pre-intervention, 58% of our participants scored below five on the GDS-SF, suggesting no depression. Strong evidence suggests the benefits of aerobic and resistance exercise on mental health, particularly depression (16). Evidence also suggests the benefits of exercise in improving anxiety and loneliness (19, 44); however, there were no between-group differences in these outcomes. Most participants scored below five on the GAI-SF at pre-intervention, indicating the absence of clinically significant anxiety, which may have resulted in a floor effect. Similarly, most participants scored low on the R-UCLA loneliness scale pre-intervention. Interestingly, participants qualitatively described the importance of social connectivity and their desire to connect with other participants in the group. For example, two participants desired continued connection with the group following the end of the program (i.e., exchanging email or phone numbers). In contrast, a few participants preferred to refrain from engaging in socialization, as they did not view this as an important aspect of exercise and felt their social needs were already met.
Our results from a life space perspective are consistent with pre-post exercise intervention (stretching, muscle strength, balance, and walking) for older women (45), in which these authors reported improved life-space mobility scores post-intervention. Our data showed that the intervention improved life-space mobility in the ACTIVE group. The online exercise program may have emboldened participants to navigate spaces outside their homes, neighbourhoods, or towns. Higher scores on life-space mobility are associated with higher quality of life, improved social participation, reduced cognitive impairment, improved physical health, and decreased nutritional risk (46, 47). However, participants' SCREENII scores were categorized as high nutrition risk. This score is associated with poor health outcomes for older adults (e.g., increased risk of hospitalization and mortality) (48). Future research should focus on multi-component interventions.
Our program was feasible, with 97% of classes attended and 98% of participants were either satisfied or very satisfied with each class. Online exercise programs are novel and emerging modalities for engaging community-dwelling older adults in exercise. There is evidence from different patient populations using online exercise to improve important outcomes, including falls, balance, and health conditions. However, many programs focus on exergaming (49) or virtual gyms (50) and do not include live, real-time instructors to support individualized adaptations. Participants described enjoying the social connectivity associated with synchronous/live delivery. This modality is acceptable to those seeking PA or exercise alone rather than seeking social connection. Overall, the live instructors, the routine of the group-based online program, and accountability facilitated engagement and high satisfaction, resulting in high program adherence. Online exercise programs are viable service-delivery options, particularly when in-person programming is unavailable due to physical distance, space limitations, and/or public health measures encouraging reduced mobility to slow viral spread. Future work should focus on synchronous online resources to engage older adults in exercise programs.
The qualitative interviews highlighted participants' desire to grow old gracefully and prevent disability. Some participants described the fear of disability from aging as a motivator to exercise. Others described their desire to continue to play with grandchildren, maintain their activities of daily living, and become healthier as motivators. These findings are consistent with previous studies investigating older adults’ influences, motivations, and barriers to PA engagement (51, 52).
There are several limitations with our study; however, primarily we acknowledge the small sample size. The study was a pilot and, therefore, underpowered to determine if there was an interaction for our primary outcome. However, we noted that participants reported perceived health benefits and improved physical function post-intervention. Another limitation of the study includes a lack of blinding for our assessors and participants to group allocation. Our study only included English-speaking individuals with internet access at home with a tablet, computer, or phone. Future studies should attempt to include marginalized populations to improve generalizability with different language options, including subtitles.