Strengthening Program Research Articles

The Psychological and Physical Benefits of the Supervised Individual Exercise Program During Radiotherapy in Breast Cancer Patients: A Randomized Prospective Study

Treatment side effects lead to a negative impact on quality of life in breast cancer survivors. Exercise is reported to improve the physical and psychological status of these patients. The aim of the study is to investigate the effect of exercise during radiotherapy on physical and psychological status in breast cancer patients. A randomized prospective study was set in an outpatient rehabilitation clinic. Histologically proven stage I-III breast cancer patients referred for adjuvant radiotherapy were randomly assigned to a supervised aerobic and strengthening exercise program (10 patients) or usual medical care without exercise training (10 patients). The primary outcome parameters were Rosenberg Self Esteem Scale (RSES), Short Form-36 (SF_36) Quality of life, Coping Orientation to Problems Experienced (COPE) Inventory, Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI). End points were assessed 1 week prior to and 1 week following 6 weeks exercise training. In the repeated measures analysis, BAI and FSS scores decreased, while general health (GH) and energy/fatigue (E) subscores of SF-36 increased in the exercise group (p=0.045, Cohen d=0.757 for BAI, p=0.02, Cohen d=0.863, p=0.010, Cohen d=1.02 for GH, p=0.032, Cohen d=0.801 for E). In addition, the use of problem-based coping score decreased in the control group (p=0.049, Cohen d=0.641). No significant differences were found between two groups in scores for BDI and RSES (p>0.05). In conclusion, supervised combined exercise training during adjuvant radiotherapy improved anxiety, fatigue, energy, and general health perceptions and also prevented decrease in using effective coping strategies.

STRATEGI PENGUATAN LITERASI BERBAHASA ARAB BAGI SANTRI MILENIAL

Arabic literacy is a necessity that needs to be nurtured from an early age for students, especially among students. As millennials, the better literacy skills they have, the better their academic achievement will be so that they are more ready to answer the challenges of the times. This paper tries to dissect the various strategies that can be done to strengthen Arabic literacy for millennial students who are members of the MTSN 1 Kota Bima Boarding School Program. Through descriptive qualitative research with the case study method, it can be seen that the literacy strengthening program is carried out through habituation, development, and learning activities by combining the intracurricular curriculum and the non-curricular supplement curriculum. Arabic literacy can go hand in hand, reinforce each other with Al-Qur'an literacy and can be developed through digital literacy skills. The obstacle that is still being faced is the perception of the guardians of the students and the learning motivation of the students.

The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review.

Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions. The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice. A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist. From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance. Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.

Poster 178: Blood Flow Restriction Therapy Before and After Arthroscopic Rotator Cuff Repair

Objectives:To evaluate the effect of blood flow restriction (BFR) therapy conducted before and after rotator cuff repair (RCR) on rotator cuff strength and patient reported outcomes.Methods:A total of 30 patients (22 male, 8 female; age 58.2 ± 9.0 years) presenting for surgical treatment of a rotator cuff tear were randomized into two groups, BFR (N=15) and Control (N=15). Rotator cuff strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force. Strength measurements included supraspinatus, infraspinatus and subscapularis testing in multiple positions. Prior to surgery, patients completed a rotator cuff strengthening program, with and without the use of BFR. All patients underwent arthroscopic RCR and a standardized period of post-operative immobilization. Following surgery, patients underwent physical therapy utilizing standard post-RCR therapy protocols, with exercises performed with and without the use of BFR in each respective group. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal arm, under the direction of a physical therapist. Patient Reported Outcome Measurement System Upper Extremity (PROMIS-UE), American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion were collected on the day of surgery as well as 2 weeks, 6 weeks and 3 months after surgery. Rotator cuff strength measurements were completed the day of surgery and repeated three months following RCR.Results:No significant differences were noted between the BFR and control groups in peak rotator cuff muscle force generation, time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-UE scores (30.3 ± 4.7 versus 26.3 ± 6.3, p=0.03, Figure 1) and active range of motion in abduction (82.4º ± 24.7 versus 65.1º ± 18.8, p=0.03) compared to the control group. These differences were not apparent at 3 month follow up.Conclusions:Blood flow restriction therapy following RCR results in improved patient reported outcomes scores and range of motion at six week follow up. At three months post-surgery, there was no noted improvement in rotator cuff strength when utilizing BFR compared to standard physical therapy.

Psikoedukasi Prophetic Parenting pada Orangtua Siswa TK ABA Nganggring Turi Sleman Yogyakarta

This prophetic parenting psychoeducation is one of a series of large programs in the form of strengthening psychospiritual and economic resilience for parents of ABA Nganggring Kindergarten students, Turi District, Sleman Regency, Special Region of Yogyakarta. The program aims to increase understanding and awareness of the importance of implementing prophetic parenting. The empowerment method chosen was psychoeducation with the target parents of students, which was carried out for three meetings, starting from the assessment, core program, and follow-up plans. The program participants were 30 parents/guardians of ABA Nganggring Kindergarten students. The result of implementing the program is that they have an adequate understanding of prophetic parenting for program participants. Through prophetic parenting psychoeducation, parents' awareness about the importance of applying prophetic parenting to children at home began to grow and support groups were formed to solve parenting problems in daily life. It is recommended that this psychological strengthening program be followed by a continuous care assistance program for the support groups that have been formed.

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families: the Strong Families Trial

BackgroundObesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years.MethodsEight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention.DiscussionThis study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status.Trial RegistrationThis study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019.

Combined Use of Transcutaneous Electrical Nerve Stimulation and Short Foot Exercise Improves Navicular Height, Muscle Size, Function Mobility, and Risk of Falls in Healthy Older Adults.

Electrical stimulation is an established method that is used to improve muscle strength. The present study compared changes in the navicular drop test (NDT), muscle size, the five times sit to stand (5TSTS) test, the timed up and go (TUG) test, and the risk of falls in response to transcutaneous electrical nerve stimulation (TENS) plus short foot exercise (SFE) and SFE alone in 68 healthy elderly participants aged 65–75 years. Participants were randomly assigned to two groups: TENS plus SFE and SFE alone (with sham TENS). Measurements of NDT, muscle size, 5TSTS, TUG, and risk of falls were made before and after 4 weeks of training. The NDT was significantly improved by a median of 0.31 mm in the TENS plus SFE group and 0.64 mm in the SFE alone group (p < 0.001). Similarly, there was a significant improvement in Falls Efficacy Scale International (FES-I), 5TSTS, and TUG for both groups (p < 0.001). The abductor hallucis muscle size increased by 0.23 cm2 in the TENS plus SFE group and 0.26 cm2 in the SFE alone group (p < 0.001). There were no significant differences between the two groups for any variables (p > 0.05) except TUG, which showed a greater improvement in the TENS plus SFE group (p = 0.008). Our findings demonstrated that TENS plus SFE and SFE alone improved intrinsic foot muscle size. However, TENS plus SFE tended to improve NDT more than SFE alone, particularly in cases of severe muscle weakness. Thus, the combined use of TENS plus SFE could be recommended for muscle strengthening and balance programs for fall prevention in older adults.

The Role of the Teacher in the Character Education Strengthening Program for Grade V Elementary School Students

Education is a process of educating and requires students to achieve certain goals in the form of positive changes from within students. The desired change is part of a process towards maturity that occurs continuously in students' lives. This research is motivated by the low character of the younger generation, especially at the elementary school level. Therefore, the government implements a character education strengthening program at every level of education. This study analyzes the teacher's role in implementing character education strengthening programs for fifth-grade elementary school students. This research is research with a qualitative approach. Data were collected using interview and observation methods. The results show that many character education strengthening programs have been implemented in elementary schools and are following the five character values ​​of students, one of which is religious values ​​by getting used to praying before the start of learning. One of the teacher's roles in strengthening character education programs is to develop learning implementation plans and carry out learning and assessments that integrate the main values ​​of strengthening character education.

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

BackgroundCausal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome.MethodsSixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome.ResultsThe results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability.ConclusionScapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up.

Faktor Pendukung dan Penghambat Pelaksanaan Program Penguatan Pendidikan Karakter Religius Terhadap Siswa

This study aims to determine the supporting and inhibiting factors for the implementation of a strengthening program of religious character education for students in SMP Negeri 13 Padang which is accredited A in the city of Padang, West Sumatra. The research uses qualitative methods through a case study approach. Research data sources are taken from fourteen informants consisting of school principals, Islamic Religious Education teachers, and students of class IX.8 Research data were taken through in-depth interviews with all informants. The results showed that the implementation of the program for strengthening the religious character education of students at SMP Negeri 13 Padang had four supporting factors including the existence of a student character strengthening book, the desire of students, supporting religious activities, and adequate facilities and infrastructure. While the five inhibiting factors include: environment, peers, and cellphones. self-awareness of students themselves and lack of teacher supervision.

Strengthening the Literature of Islamic Religious Education Teachers to Increase Pedagogic and Professional Competence at Teacher Working Group Islamic Religious Education Cianjur Regency

This study aims to determine the implementation of Islamic Religious Education Teacher literacy strengthening to improve pedagogic and professional competencies, analyze Islamic Religious Education Teacher literacy strengthening programs to improve pedagogic and professional competencies, analyze the increase in Islamic Religious Education Teacher pedagogic and professional competencies after strengthening Islamic Religious Education Teacher literacy, and find out the results of the Islamic Religious Education Teacher literacy strengthening program to improve pedagogical and professional competence. The research method used is an experiment with pre and post-matching control groups. The research subjects were 34 Islamic Religious Education Teacher Primary School at Teacher Working Group Islamic Religious Education Cianjur. Collecting data using tests, interviews, observations, and documentation. The data were analyzed with a quantitative approach. The results of the study are as follows. First, some Islamic Religious Education Teachers are still weak in understanding pedagogic and professional competencies. This condition is motivated by the low involvement of Islamic Religious Education teachers in the Continuing Professional Development (PKB) program. Second, the literacy program focuses on two things, namely literacy strengthening training, mentoring, and product documentation assessment. The training is carried out using a learning by doing approach. Strengthening literacy is guided by the team to produce products following the substance.

Analysis of the Quality of Public Services in a Cleanliness, Security and Health Strengthening Program in Jakarta Province

This study aimed to determine the quality of public services in the Cleanliness, Security, Order and Health Strengthening Program in the Kelapa Dua subdistrict, in Kebon Jeruk District, West Jakarta Administration City, DKI Jakarta Province. Qualitative research methods were used. The researcher collected the data through interviews, observations, and document review. This study examined five aspects of service quality: physical evidence (tangibles), reliability, responsiveness, assurance, and attention (empathy) for the three areas of strengthening: a) cleanliness, b) security, peace and order, and c) health. The results showed that the general hygiene conditions were quite good; security, peace, and order were good; and health was not good. The cleanliness aspect lacked physical evidence, specifically the lack of more sophisticated equipment for mud dredgers, productive waste management, and reliability aspects, especially in terms of the expertise of officers which still needed to be improved. The condition of security, peace and order needed improvement in terms of the physical evidence, such as sophisticated integrated communication tools, and the reliability of officers. Health conditions also lacked physical evidence, particularly health equipment, medicines, self-isolation facilities for those affected by infectious diseases such as Covid-19, and reliability, because of a lack of medical personnel.&#x0D; Keywords: quality of public services, strengthening of cleanliness, security, peace, order and health

Relationship of Extrinsic Risk Factors to Lower Extremity Injury in Collegiate Ballet Dancers.

Ballet dancers are thought to be at higher risk of lower extremity injury. This objective of this study was to describe the self-reported incidence, location, and factors associated with lower extremity injury in collegiate ballet dancers. Two hundred and forty-nine female ballet dancers responded to a questionnaire that addressed their injury event/location, dance behavior over the past 2 years, and overall dance history. Behaviors assessed included the following: types and number of shoes worn (pointé shoes/ballet slippers), wear time, training time (session frequency and duration), use of warm-up/cool-down, and use of a strengthening program and lower extremity accessory. Overall dance history included age of the onset of training, total years of experience, and number of dance styles. Backward multivariable logistic regression analysis was used to determine the extent to which variables measured were associated with injury. Ankle injury was the most prevalent injury. Years of wearing pointé shoes (adjusted odds ratio = 1.21, p = 0.01) and days/weeks in pointé shoes (adjusted odds ratio = 1.26, p = 0.04) were associated with an increased risk of injury; while additional strengthening (adjusted odds ratio = 0.39, p = 0.02) and use of lower extremity accessories during classes/rehearsals (adjusted odds ratio = 0.64, p = 0.01) were protective associations. These findings suggested that the use of pointé shoes, lower extremity accessories, and additional exercise should specifically be recorded during evaluation of injured ballet dancers; and must be considered potential factors to modify during rehabilitation.

Effectiveness of unreinforced masonry seismic retrofit programmes: review of policies in New Zealand and the United States

Implementing seismic risk mitigation programmes for earthquake-prone unreinforced masonry buildings (URM) is critical to ensure public safety and community resilience in regions of moderate and high seismicity. In New Zealand, it is a mandatory requirement to strengthen earthquake-prone buildings within a prescribed timeframe. However, the rate of compliance has been slow. Building owners delay or hesitate to undertake seismic strengthening, mainly due to uncertainties involved in cost (Egbelakin et al., 2014) [1]. While cost is the pivot of the owner's decision-making process, an effective design of government-led programmes is essential to engage the owners and increase the rate of compliance. This paper compared similar mandatory URM programmes in the United States and New Zealand to identify critical contributors to the success of each programme. In addition, this paper implements a regression analysis using actual remediation cost data gathered from a recent mandatory strengthening programme in New Zealand to identify significant cost factors in seismic strengthening. From the comparison, six key contributors to programme success were recognised, including 1) efficient and flexible financial options; 2) alternative retrofit design solutions; 3) fair penalties and enforcement tools; 4) a clearly laid out action plan and time limits for compliance; 5) dedicated local council staff and case managers; 6) consultation with building owners. The cost model suggested that building characteristics, location, and heritage status are significant in seismic strengthening costs. The findings contribute to the fine-tuning of future programme designs and the understanding of financial impediments building owners face in seismic strengthening. Significant cost factors identified in this study indicate where the allocation of government funding is required the most to maximise the incentivising of owners for early adoption of compliance measures.

The strategy of three education centers for strengthening character education in Indonesia in the era of Industrial Revolution 4.0

Education plays an important role in developing the character of a nation. Education is not only implemented in formal education institutions, but also in the family and amongst the community. This study aims to describe the three-center education strategy in Indonesia for strengthening character education in the era of industrial revolution 4.0, and to obtain an overview of the feasibility of infrastructure in schools that support the implementation of strengthening character education appropriately through this strategy. This research is a qualitative descriptive study conducted in three junior high schools (SMP) that were piloted for the strengthening of character education in Yogyakarta, Indonesia. The research subjects included the students, teachers, education personnel, parents of students, and community leaders. Data collection used interviews, observations, documentation, and a focus group discussion (FGD). Data analysis was performed with the interactive technique of the Miles and Huberman model. The results showed that the strengthening of character education in schools in the era of industrial revolution 4.0 is carried out well through the strategy of three education centers. Three state junior high schools in Bantul, Yogyakarta, namely SMPN 1 Bantul, SMPN 1 Sewon, and SMPN 1 Pandak, have implemented character strengthening for students using the strategy of three education centers appropriately. In general, the support for the facilities and infrastructure for the strengthening character education programs is sufficient, allowing the character education strengthening program to run well.

Mental Health, Quality of Life and Coping Strategies in Vulnerable Children During the COVID-19 Pandemic.

The coronavirus pandemic has led to a situation without precedent in modern history. The aim of this study is to analyse the consequences after one year of the pandemic on a group of children and adolescents assessed at the beginning of the pandemic in 2020 and to determine the most effective ways of psychologically coping with this pandemic. Two different, but equivalent, groups with a total of 604 (study I, 2020) and 743 (study II, 2021) children and adolescents in residential care, foster families, kinship families or family strengthening programs in Spain were evaluated using the SDQ (mental health measure), KIDSCREEN-10 index (quality of life measure) and Kidcope (coping behaviour measure). An independent sample t-test and a decision tree analysis were used. The mental health of children and adolescents decreased by 9.7%, and Self-Perceived quality of life did not change after one year of the COVID-19 pandemic. Nonactive coping strategies predicted worse mental health and worse quality of life. Problem solving served as a protective factor. One year after, the COVID-19 pandemic has an effect on the psychological wellbeing of children and adolescents, and the consequences can be reduced if proper coping strategies are used.

The implementation of a neck strengthening exercise program in elite rugby union: A team case study over one season

ObjectivesTo investigate the effect of a neck strengthening program on maximal isometric neck strength and incidence of head and neck injuries including concussion, and to evaluate the acceptability and feasibility of the program within one professional men's rugby union team over one season. DesignPre- and post-intervention study. MethodsA phased neck strengthening program was implemented in one rugby union team (n = 26 Forward Group; n = 13 Back Group) throughout the 2020 Super Rugby season, with maximal isometric neck strength measured at each training phase. Strength changes were analysed using one-way, repeated measures analysis of variance and paired samples t-test. Injury data from 2019 to 2020 were compared using incidence rate ratios (IRR). Player and staff surveys, reported as percentage of agreement, assessed program acceptability and feasibility. ResultsForward Group's neck flexors (p < 0.001), left-lateral flexors (p = 0.04) and flexor/extensor ratio (p < 0.001) and Back Group's neck flexors (p = 0.01) significantly improved across the season, with uncertain evidence to support the reduction of head and neck injuries (IRR:0.86 (0.23–2.56) and concussion (IRR:0.63 (0.06–3.34) between seasons. Survey responses revealed high percentages of agreement for the program's acceptability and feasibility. ConclusionsTargeted sport-specific neck exercises have the potential to increase the maximal isometric neck strength of professional rugby players and may assist in reducing head and neck injuries including concussion.

Livelihood Capitals, Income Inequality, and the Perception of Climate Change: A Case Study of Small-Scale Cattle Farmers in the Ecuadorian Andes

The Sustainable Development Goals (SDG) of 2015 identify poverty, growth, and inequality as three key areas of intervention towards the UN 2030 Agenda for human well-being and sustainability. Herein, the predominant objectives are: (a) To determine the poverty groups by quintiles through the cattle income in households of small milk producers; (b) To characterize rural livelihoods by using capital theory; and (c) To assess the perception of climate change (CC) and the willingness to accept adaptation as well as mitigation measures. The current study was performed in communities that are located in the Ecuadorian Andes, where some 178 surveys were conducted with indigenous Kichwa and mestizo heads of households. From the total net income determined, five groups were organized. The Lorenz curve was applied as a general indicator of the relative inequality, as well as the Gini coefficient (G). On the basis of the theory of capital, the human, social, natural, physical, and financial characteristics were determined, and seven variables were considered to evaluate the perception and willingness to accept mitigation and adaptation actions of the given quintiles. The result of the Gini coefficient was 0.52, which indicates that the poorest 20% of the population only receives 3.40% of the income, while the richest 20% of the quintile obtain about 54% of the total income. It is evident that most producers know little about CC, but that they are willing to receive strengthening programs. Therefore, it is essential to establish strategic guidelines from public policy in order to reduce inequality and to improve the social welfare of producers, with a transversal axis in the strengthening of the capacities on the impact, mitigation, and adaptation to CC, as well as the provision of several tools, such as access to climate information.

Male Caregivers and Engagement in a Family Strengthening Program for Child Disruptive Behavior Disorders.

Awareness and interest in involving male caregivers in child mental health treatment has grown, especially for youth with disruptive behavior disorders like oppositional defiant disorder (ODD). The purpose of this study was to examine the relationship between male caregiver involvement and treatment engagement for child ODD. Children (n=122) ages 7-11 and their caregivers participated in the 4 Rs 2 Ss Strengthening Families Program for child-onset ODD. Families were compared based on male caregiver presence. Families with a male caregiver were significantly more resourced with respect to income, educational status, and food security. Additionally, they were over three times less likely to drop out of the program than those without a male caregiver. The presence of a male caregiver was associated with increased resources and higher rates of engagement in services than single, female-headed families. Future research is needed to discern the underlying mechanisms of this association.

Barriers and enablers for older adults participating in a home-based pragmatic exercise program delivered and monitored by Amazon Alexa: a qualitative study

BackgroundThe remote delivery and monitoring of individually-tailored exercise programs using voice-controlled intelligent personal assistants (VIPAs) that support conversation-based interactions may be an acceptable alternative model of digital health delivery for older adults. The aim of this study was to evaluate the enablers and barriers for older adults participating in a home-based exercise program delivered and monitored by VIPAs.MethodThis qualitative study used videoconferencing to conduct semi-structured interviews following a 12-week, prospective single-arm pilot study in 15 adults aged 60 to 89 years living alone in the community. All participants were prescribed an individualized, brief (10 min, 2–4 times per day), home-based muscle strengthening and balance exercise program delivered and monitored using an Amazon Echo Show 5 device (Alexa). Qualitative interview data were analysed using inductive thematic analysis.ResultsAll 15 participants (aged 70.3 ± 4.3 years, mean ± SD) attended the semi-structured interview. Themes including enjoyability and ease of use, social engagement and motivation were enablers for participation in the exercise program. Errors in voice recognition, lack of feedback, and preference for other existing digital health modes of exercise delivery were barriers associated with the Alexa technology.ConclusionsThis qualitative study identified enablers and barriers associated with using an Alexa device to deliver and monitor an individualized, home-based exercise program in older adults living alone. Future interventions using VIPAs should focus on reducing technical errors, providing regular exercise feedback, and comparing participants’ experiences of exercise programs delivered by VIPAs to programs delivered via other digital health tools.