Title: The Oxford CLEAR Pathway
Funder: Economic and Social Research Council

Abstract: We intend to use communication platforms to reach out to older adults who may also be disabled, living with learning difficulties or mental health issues and long-term single or multiple health conditions. We will engage and motivate isolated individuals and ageing groups in hospital wards, private and community care homes, leading them through a physical activity pathway suitable for all abilities, whether bedbound, bedside or chair-based. The specialised and evidenced 30 second exercise programmes can be delivered via apps. The 10 minute sessions can be 'live-stream' sessions using a platform such as YouTube, and presented via a large-screen TV or personal device enabling everyone to work in a group, no matter where they are. For this project, the community-setting demonstration / test screens will be supplied free of charge by our project partner Bell-Integration. People 'self-isolating' 'shielding' or unable to join the community exercise sessions will also be able to join from home using their own smartphone, pad, laptop or PC. The physical activity sessions will be 30 second exercise infusions performed regularly during the day, supplemented by twice weekly clinically-developed and proven 10 minute exercise routines. Originally designed for people with heart failure and renal patients undergoing haemodialysis, the chair-based programme was recognised by the NHS, the National Institute of Health Research and Oxford University Hospitals to be appropriate for older people with mobility problems or long-term health issues. The sessions will be a progressive experience, suitable from the very frail to the healthy agile, enabling them to move through stages to participate in sessions appropriate to their health status and physical capacity. We can also adapt the sessions for specific groups, e.g. wheelchair users, sufferers from neurological disorders like Parkinson's, Multiple Sclerosis or cardio-vascular and metabolic disease. This will serve to engage, retain and motivate everyone. The community-need is supported / recognised by, among others, the MS Society, Parkinson's UK, Age-UK. Since 2008, we have built up wealth of experience working both on a one-to-one basis and with these groups, and we are currently piloting a 'live' on-line programme. We will supplement the 'remote-live' sessions with the production of videos (virtual instruction), for personal use or in a community setting as per the 'remote-live' classes. We have already developed videos for 3 of the four exercise stages. Over the course of the next six months, we will create the additional content required for the delivery of exercise classes to bed-ridden elderly, select the audio/visual delivery platform, integrate the chair-based exercise programmes in the platform, test the system in five community-settings, and evaluate the system ready for wider roll-out, and extension in scope and reach. The key tasks are: i) Develop the suite of 'Live' classes (a 'progressive' offering) and finish recording the supplementary videos. ii) the technology platform to deliver the 'Live' classes will be selected and set-up by the CLEAR Trust and Video2web. This will be via webinar, Zoom, or an appropriate live-stream platform such as YouTube. iii) Five community groups will be recruited to trial the system. The CLEAR Trust have an extensive network of contacts to support this process. Bell-Integration will supply 60inch TV screens (free of charge); these will be delivered, along with any supplementary materials needed to run the 'live' sessions. v) Protocols will be finalised for session delivery by the CLEAR Trust; The community group sessions will be run by the CLEAR Trust. vii) Plans will be completed for local / regional roll-out, and extension in scope (settings) and reach (national and international), by the CLEAR Trust, in collaboration with our technology partners.

Lay abstract: For older adults, exercise improves fitness and health, maximises participation, increases functional independence and enhances quality of life. Higher fitness-levels are linked to lower levels of emotional distress and depression, improved mobility, functionality and independence encouraging a higher level of behavioural activation and social inclusion Adherence and compliance with recommended exercise guidelines remains poor amongst ageing adults who frequently avoid participation for fear of falling, exacerbating symptoms or provoking pain or fatigue. The shortage of appropriately qualified trainers means some institutionalised elderly are sedentary for over 12 hours a day, their only energy expenditure being when getting in and out of bed. We have created a series of bed and chair-based programs for older adults, some of whom may be resistant to exercise, providing a graduated course of physical activity suitable for everyone, from the very frail to the healthy agile. We will engage older adults who may be isolated, bedbound, frail, have multiple health conditions, physical disabilities, learning difficulties or mental health issues, and lead them through specialised bed and chair-based exercises given remotely, linked by a live-stream platform such as Webinar or Zoom, presented on large-screen TV, through their own smartphone, tablet or laptop enabling everyone to work in a group. The sessions will be supplemented by videos and an App. During the next 12 months we will complete the filming, select the live-stream platform and test the system in community settings with the aim of producing a solution ready to roll out to the Care Home sector.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE