Synchronous Group-Based Tele-Exercise versus Community-Based Interventions: Effects on Physical Functioning and Adherence in Older Adults at Risk of Falls - A Randomized Controlled Trial
Authors: Chan Karly O. W. , Yuen Peter P. , Fong Ben Y.F. , Law Vincent T.S. , Ng Fowie S.F. , Lee Janet L.C. , Cheung I.S. , Ng Tommy K.C. , Fung Wilson C.P. 
Published: June 2024

Objective

This study aimed to assess the effectiveness of synchronous group-based tele-exercise (TE) in improving physical functioning and exercise adherence among older adults at risk of falls, comparing it to a community-based group (CB).

Methods

91 community-dwelling older adults at risk of falls were recruited from 10 community centres in Hong Kong. Participants were randomly assigned to either the TE or CB group based on their community centre. Both groups received modified Otago exercise training for three months, with the difference in the mode of delivery (tele-exercise at home or face-to-face at a community centre). The primary outcomes assessed Fall Efficacy Scale (FES-I), 6-meter walk test, Timed Up and Go test (TUG), Berg Balance Scale (BBS), Functional Reach Test (FRT), Appendicular Skeletal Muscle Mass Index (ASMI) and percentage of body fat. Secondary outcomes included exercise adherence, dropout rate, and Physical Activity Enjoyment Scale (PACES). The primary analysis was conducted using a modified intention-to-treat approach, utilizing all available data.

Results

Both groups showed significant improvements in FES-I, 6-meter walk test, TUG, and BBS over time (p<0.05). High adherence rates (TE: 85%; CB: 90%), low dropout rates (TE: 4.4%; CB: 0%), and high PACES scores (TE: 108.6±9.3; CB: 108.2±7.9) were observed in both groups. TE and CB were comparable in most outcomes at baseline and at three months (p>0.05). No serious adverse events were reported.

Conclusions

The findings revealed synchronous group-based tele-exercise training demonstrated comparable effectiveness to face-to-face community training in terms of physical functioning, adherence, and enjoyment.

Trial registration numberChiCTR2200063370

SUMMARY BOX

What is already known on this topic -

Community-based exercise programme has been proven effective in reducing the risk of falls and preventing fall-related injuries.

Tele-exercise presents a viable solution to address the challenges faced by community-dwelling older adults at risk of falls such as limited exercise space in the community and travel constraints.

Currently, there is a plethora of published studies on the effectiveness of tele-exercise. However, these studies are primarily small-scale, non-randomized, pilot feasibility studies, resulting in a generally low-to-moderate methodological quality of evidence.

What this study adds -

This is the first rigorously designed RCT with sufficient statistical power to investigate the effectiveness of the tele-exercise group compared with the community-based group.

Synchronous group-based tele-exercise training demonstrated comparable effectiveness to face-to-face community training in terms of physical functioning, adherence, and enjoyment.

Tele-exercise training proved to be safe, feasible and enjoyable for older adults at risk of falls, including those with diverse age ranges (65-91), educational backgrounds, and technological proficiency.

How this study might affect research, practice or policy -

Incorporating well-designed tele-exercise programmes with professional support and technical assistance is crucial to effectively engage older adults, promote their physical functions, improve exercise adherence and reduce the risk of falls.

These findings will inform future research on tele-exercise interventions, guide the implementation of tele-exercise programmes in practice, and influence policy decisions regarding the application of tele-exercise for older adults at risk of falls.