Feasibility study of home telerehabilitation for physically inactive

The aim of this study was to develop a sy stem for and determine the feas ibility of monitoring home exercise for physically inact ive old er adul ts using a Heal th Bud dy (H B) text m essaging devi ce (R obert Bosch Healthcare; Palo Alto, California). Questions and messages related to exercise adher ence are displayed on the HB screen and participants choose a response by pressing the corresponding button on the device. Responses are transmitted t hrough a l andline co nnection and high-risk responses are h ighlighted by the system for fo llowup. We developed the questions and messages based on input from patient and clinician focus groups. We evaluated feasibility by admi nistering the in tervention to inpat ient an d ou tpatient adults aged 60 or older. We gave participants a choice of exercise m onitoring by HB ( n = 2 0) or t elephone ( n = 18). The results showed that home exercise monitoring by HB and telephone is safe, as evidenced by low adverse event rates. We saw a decline in exercis e adherence rates to both the H B and t elephone after 8 weeks, alt hough adherence was better for HB than telephone. Taken together, the results demonstrate the feasibility of using text m essaging to m onitor hom e exerci se adherence in physically inactive older adults. Clinical Trial Registration: ClinicalTrials.gov; Home Telerehabilitation for D econditioned Ol der Adul ts, N CT00386256; http://clinicaltrials.gov/ct2/show/NCT00386256. Key w ords: deconditioning, exercis e, exercise adherence, exercise mon itoring, Health Bud dy, old er adul ts, ph ysical activity, telephone, telerehabilitation, text messaging. INTRODUCTION The Healthy People 2010 guidelines recommend that all Americans engage in at least 30 minutes of moderateintensity activity 5 days per week or at leas t 20 minutes of vig orous-intensity exercise 3 da ys per w eek [1]. In 2001, approximately 34 p ercent of adults in th e general U.S. population achieved th is level of activity . Even fewer older adults met these gu idelines; amon g old er adults aged 65 to 74, only 16 percent met the guidelines for moderate-intensity exer cise an d 13 percen t met the guidelines for vigorous-inten sity e xercise [2]. Although U.S. veterans are more physically active than nonveterans across all age groups, many veterans also do not meet Federal recommendations for weekly moderate physical activity [3–4]. In an analysis of a national sample of veterans, Littman et al. found t hat 45.6 percent of veterans aged 50 to 59 and 40.7 percent of veterans 70 years met daily physical activity level r ecommendations [4]. Physical Abbreviations: HB = Health Buddy, TEM = transtelephonic exercise monitoring, VA = Department of Veterans Affairs. *Address all correspondence to Nancy D. Harada, PhD; VA Greater Los Angeles Healthcare System—ACOS/E ducation, 11301 Wilshire Blvd, Los Angeles, CA 90073; 310-2683632; fax: 310-268-4631. Email: [email protected] DOI:10.1682/JRRD.2009.09.0149