MoveSTroNg at Home: A feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail adults.

Background: The Coronavirus disease (COVID-19), caused by SARS-CoV-2 exacerbated the potential for physical inactivity1, nutritional risk2, and loneliness3 among older adults, especially in those with pre-existing health or mobility impairments. There is high quality evidence to suggest that functional training and balance exercises can prevent falls, improve functional capacity and increase levels of physical activity in vulnerable populations4,5. Now and in the future, we need alternate ways to promote safe movement and proper nutrition that does not require participants to leave their homes. \nObjectives: The primary aim was to assess the feasibility of an 8-week remotely delivered exercise and nutrition education program. The primary outcomes (and criteria for success) were recruitment (≥25 participants/12 weeks), retention (80% at follow-up), adherence (≥70% exercise & nutrition Q&A sessions). \nDesign: An 8-week feasibility study with 4-week follow-up (time series design). \nParticipants: Pre-frail and frail community-dwelling Ontario residents, ≥ 60 years of age, living with ≥1 diagnosed chronic condition; score of ≥1 on the FRAIL Scale. \nMethods: MoveStrong was delivered to participants in their homes, using mailed program instructions and private training sessions through Physitrack®. Online nutrition Q&As and group sessions were hosted over Microsoft Teams®. Telephone was used for participants without internet access. Recruitment was determined by the number of participants who started the intervention. Retention was determined by the number of participants who completed the follow-up assessment. Adherence was calculated from a total of 36 exercise sessions (three per week for 12 weeks) and three nutrition Q&A sessions throughout the intervention. Secondary outcomes including the Physical Activity Screen (PAS), Modified Exercise Self-Efficacy Scale (ESES), Center for Epidemiology Studies Depression Scale (CES-D), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), EuroQol 5 Dimensions 5 Levels (EQ5D5L), and Seniors in the Community Risk Evaluation for Eating and Nutrition (SCREEN©) were assessed by online questionnaire at program end and 4 weeks later to measure short-term sustainability. Physical function was assessed using adapted and self-administered versions of the SPPB 3-point balance test and 30s chair stand test. Adverse events and process outcomes were monitored and recorded throughout the study. Qualitative exit and follow-up interviews were used to capture participant experience, suggestions for future studies and identify facilitators of and barriers to sustainability. \nResults: We enrolled 30 participants in 12 weeks with an average age of 74 (SD 7.29); 22 (73%) were pre-frail, 8 (27%) were frail. 28 participants (93%) completed program and follow-up assessments. Adherence to exercise was 84%, while adherence to nutrition was 82%. \nExploratory analyses of secondary outcomes revealed significant improvements [program end, follow-up] in 30s chair stand test [3.5 (SD 6.1), 4.5 (SD 6.7)], physical activity [132 (SD 167), 82 (SD 150)], exercise self-efficacy [8.4 (SD 11.1), 9.7 (SD 12.1)], fatigue [0.70 (SD 1.17), 0.70 (SD 1.27)], health status [4.9 (SD 10.8), 9.1 (SD 11.9)], nutritional risk [10.0 (SD 5.4), 8.3 (SD 6.4) ], and dietary protein intake [12.9 (SD 18.4), 9.2 (SD 22.7)]. No statistically significant changes occurred for other outcomes. 6 non-serious adverse events, not attributable to intervention, occurred. Overall participants were satisfied with the program and reported physical and psychological benefits. Barriers to maintenance were mapped to the TDF domains of Environmental Context and Resources, and Social Influences (opportunity). \n \nConclusion: We determined that remotely delivered one-on-one functional strength and balance training, combined with nutrition education was feasible according to a priori criteria. A larger pragmatic trial is necessary to confirm our findings. \nRegistration: This trial was registered in ClinicalTrials.gov under identifier NCT04663685. \nFunding: This research was funded by the Network for Aging Research.

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