Abstract
BackgroundWhile physical exercise is known to help prevent falls in the elderly, bad weather and long distance between the home and place of exercise represent substantial deterrents for the elderly to join or continue attending exercise programs outside their residence. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit.ObjectiveWe aimed to develop an elderly-friendly telepresence exercise platform and to evaluate the effects of a 12-week telepresence exercise program on fall-related risk factors in community-dwelling elderly women with a high risk of falling.MethodsIn total, 34 women aged 68-91 years with Fall Risk Assessment scores >14 and no medical contraindication to physical training-based therapy were recruited in person from a senior citizen center. The telepresence exercise platform included a 15-inch tablet computer, custom-made peer-to-peer video conferencing server system, and broadband Internet connectivity. The Web-based program included supervised resistance exercises performed using elastic resistance bands and balance exercise for 20-40 minutes a day, three times a week, for 12 weeks. During the telepresence exercise session, each participant in the intervention group was supervised remotely by a specialized instructor who provided feedback in real time. The women in the control group maintained their lifestyle without any intervention. Fall-related physical factors (body composition and physical function parameters) and psychological factors (Korean Falls Efficacy Scale score, Fear of Falling Questionnaire score) before and after the 12-week interventional period were examined in person by an exercise specialist blinded to the group allocation scheme.ResultsOf the 30 women enrolled, 23 completed the study. Compared to women in the control group (n=13), those in the intervention group (n=10) showed significant improvements on the scores for the chair stand test (95% confidence interval -10.45 to -5.94, P<.001), Berg Balance Scale (95% confidence interval -2.31 to -0.28, P=.02), and Fear of Falling Questionnaire (95% confidence interval 0.69-3.5, P=.01).ConclusionsThe telepresence exercise program had positive effects on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Elderly-friendly telepresence technology for home-based exercises can serve as an effective intervention to improve fall-related physical and psychological factors.Trial RegistrationClinical Research Information Service KCT0002710; https://cris.nih.go.kr/cris/en/search/ search_result_st01.jsp?seq=11246 (Archived by WebCite at http://www.webcitation.org/6zdSUEsmb)
Highlights
Falls represent a serious threat to quality of life in the elderly [1]
We developed the telepresence exercise platform including an operation server system and a website mainly based on Web Real-Time Communication (WebRTC), which is an open-source technology that works with various operating systems and Web browsers
We evaluated body composition in terms of body weight, percentage fat, upper and lower limb muscle mass, and appendicular lean soft tissue (ALST), measured using a dual-energy X-ray absorptiometry device (Lunar Prodigy Advance; GE Healthcare)
Summary
Falls represent a serious threat to quality of life in the elderly [1]. It has been reported that the yearly incidence of falls among the elderly population aged over 65 years is 30-50% globally [2]. Physical exercise has been shown to be very effective in lowering the risk and incidence rate of falls [5]. Resistance exercises are known to be effective at increasing muscle mass, strength, and balance in the elderly [6] and are highly indicated to prevent falls in this population. Balance exercises, such as stepping over a slipper before bending down to pick it up, tandem walking, and side-stepping while holding on to the back of the chair have been shown to be effective in decreasing the risk of subsequent falls [7]. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit
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