Valenzuela Trinidad, Okubo Yoshiro, Woodbury Ashley, Lord Stephen R, Delbaere Kim
Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.
Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
J Geriatr Phys Ther. 2018 Jan/Mar;41(1):49-61. doi: 10.1519/JPT.0000000000000095.
Exercise participation and adherence in older people is often low. The integration of technology-based exercise programs may have a positive effect on adherence as they can overcome perceived barriers to exercise. Previous systematic reviews have shown preliminary evidence that technology-based exercise programs can improve physical functioning. However, there is currently no in-depth description and discussion of the potential this technology offers to improve exercise adherence in older people. This review examines the literature regarding older adults' acceptability and adherence to technology-based exercise interventions.
A comprehensive systematic database search for randomized controlled trials, clinical controlled trials, and parallel group trials was performed, including MEDLINE, PsycINFO, EMBASE, CINAHL, EMB Reviews, and Cochrane Library, completed in May 2015. Trials reporting adherence to technology-based exercise programs aimed at improving physical function were included. Adherence was defined as the percentage of exercise sessions attended out of the total number of sessions prescribed.
Twenty-two studies were included. The mean cohort age range was 67 to 86 years. Studies were conducted in research facilities, aged care facilities, and people's homes. Ten studies compared outcomes between technology-based and traditional exercise programs. Adherence to both types of interventions was high (median 91.25% and 83.58%, respectively). Adherence was higher for technology-based interventions than traditional interventions independent of study site, level of supervision, and delivery mode. The majority of the studies used commercially available gaming technologies, and both types of exercise interventions were mostly supervised. A lack of detailed reporting of adherence and the pilot nature of most studies did not allow computation of a comprehensive adherence rate.
This systematic review provides evidence that technology offers a well-accepted method to provide older adults with engaging exercise opportunities, and adherence rates remain high in both supervised and unsupervised settings at least throughout the first 12 weeks of intervention. The higher adherence rates to technology-based interventions can be largely explained by the high reported levels of enjoyment when using these programs. However, the small sample sizes, short follow-up periods, inclusion of mostly healthy older people, and problems related to the methods used to report exercise adherence limit the generalizability of our findings.
This systematic review indicates that technology-based exercise interventions have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people. More research is required to investigate the feasibility, acceptability, and effectiveness of technology-based exercise programs undertaken by older people at home over extended trial periods.
老年人参与锻炼及坚持锻炼的情况通常较差。基于技术的锻炼项目整合可能会对锻炼坚持性产生积极影响，因为它们能够克服人们感知到的锻炼障碍。以往的系统评价已显示初步证据表明，基于技术的锻炼项目可改善身体机能。然而，目前对于该技术在提高老年人锻炼坚持性方面的潜力，尚无深入的描述与讨论。本综述考察了关于老年人对基于技术的锻炼干预措施的接受度及坚持性的文献。
于2015年5月完成了全面的系统数据库检索，以查找随机对照试验、临床对照试验及平行组试验，包括MEDLINE、PsycINFO、EMBASE、CINAHL、EMB综述及Cochrane图书馆。纳入了报告针对改善身体机能的基于技术的锻炼项目坚持性的试验。坚持性定义为实际参加的锻炼课程数占规定课程总数的百分比。
纳入了22项研究。队列的平均年龄范围为67至86岁。研究在研究机构、老年护理机构及人们家中开展。10项研究比较了基于技术的锻炼项目与传统锻炼项目的结果。两种干预措施的坚持性均较高（中位数分别为91.25%和83.58%）。无论研究地点、监督水平及实施方式如何，基于技术的干预措施的坚持性均高于传统干预措施。大多数研究使用了商用游戏技术，两种锻炼干预措施大多有监督。由于缺乏对坚持性的详细报告以及大多数研究的试点性质，无法计算综合坚持率。
本系统评价提供了证据表明，技术提供了一种广受接受的方法，可为老年人提供有吸引力的锻炼机会，并且至少在干预的前12周内，在有监督和无监督的环境中坚持率均保持较高。基于技术的干预措施较高的坚持率在很大程度上可归因于使用这些项目时所报告的较高愉悦程度。然而，样本量小、随访期短、纳入的大多为健康老年人以及与锻炼坚持性报告方法相关的问题，限制了我们研究结果的可推广性。
本系统评价表明，基于技术的锻炼干预措施具有良好的坚持性，可能为促进老年人身体活动及预防跌倒提供一种可持续的手段。需要开展更多研究，以调查老年人在家中进行的基于技术的锻炼项目在延长试验期内的可行性、可接受性及有效性。
