Objective: To determine which exercise adherence interventions are most effective for achieving ongoing exercise adherence in adults with chronic health conditions who had already completed a supervised short-term program. Method: Search of MEDLINE (Ovid Medline 1946 to April 8^th, 2016), EMBASE (1980 to April 8^th, 2016), CINAHL (1982-April 8^th 2016) and the Cochrane Central Register of Controlled Trials was conducted. The chronic health conditions search terms as per the Chronic Disease and Participation in Work AIHW Report, 2008. Included were randomised (or quasi-randomised) trials and observational studies evaluating interventions that aimed to improve exercise adherence in adults with chronic health conditions that had completed a supervised exercise program. Random-effects meta-analyses and random-effects logistic meta-regression were used to examine relationships between exercise adherence strategy and adherence. Results: Eleven studies were included with a total of 1231 participants with Chronic Obstructive Pulmonary Disease, Diabetes, Cardiovascular disease or Osteoarthritis. Methods used for maintaining adherence were categorized post hoc as: centre based programs; home exercise programs with telephone follow-up; home exercise programs with no follow-up; and weaning programs that transitioned patients to an independent, off-site exercise program. There was no difference in the proportion of participants who were fully adherent to an exercise program 12 months between the centre-based follow-up (pooled proportion fully adherent=0.34) and telephone follow-up (pooled proportion fully adherent=0.30, difference p-value=0.75). Conclusion: Interventions such as centre-based exercise programs or home exercise programs (with or without telephone follow-up) do not differentially impact exercise adherence for people who have completed a short-term supervised program.

Objectives To evaluate the feasibility of using voice-controlled intelligent personal assistants (VIPAs) to remotely deliver and monitor an individually-tailored, home-based exercise program to older adults living independently and alone. Design 12-week, prospective single-arm feasibility study. Setting Community residences. Participants 15 adults aged 60 to 89 years living alone. Intervention All participants were prescribed home-based muscle strengthening, weight-bearing impact and balance exercises, increasing from two to four 10-minute sessions per day over 12 weeks. Sessions were delivered using VIPAs (Amazon Alexa Echo Show 5; “Alexa”) and a novel software program (“Buddy Link”). The program was individualized by an exercise physiologist based on participant voice responses to Alexa questions. Measurements Study outcomes were feasibility (rate of retention, adherence, and adverse events), usability (System Usability Scale) and changes to quality of life (European Quality of Life Scale), and lower-extremity function (30 second sit-to-stand test). Results All 15 participants (mean age, 70.3 years) completed the study (retention 100%). Mean adherence to the exercise program was 115% (i.e., collectively all participants were prescribed 8640 exercises but completed 9944 exercises) with no adverse events reported to be related to the intervention and usability scored as above average (75/100). Other outcomes did not significantly change across the 12-week follow-up (all P>0.05). Conclusions In this feasibility study of community-dwelling older adults living alone, a home-based exercise program delivered and monitored remotely by an exercise physiologist using VIPAs was safe and feasible.

Objective: The purpose of this study was to investigate the association between ankle plantar flexor muscle (PF) strength and balance and walking speed in healthy adults. Methods: Four databases (Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, and SPORTDiscus) were searched from inception to December 2019. Studies with any design were included if the association between PF strength and balance and walking speed was investigated among healthy adults. Articles were screened for eligibility independently by 2 reviewers. Study characteristics and Pearson r values derived from the association between PF strength and balance and walking speed were extracted. Thirty-four studies were eligible. The main group of interest in the studies was older adults. Pearson r values were transformed to rz values using Fisher z-transformation. Meta-analysis of rz values was conducted and then back-transformed to r. Results: In older adults, PF maximal isometric strength had a positive weak association with static balance (r = 0.20; 95% CI = 0.08–0.32), a positive moderate association with dynamic reactive balance (r = 0.42; 95% CI = 0.32–0.57) and proactive balance (r = 0.55; 95% CI = 0.18–1.06), and a positive weak association with preferred walking speed (r = 0.29; 95% CI = 0.19–0.41) and maximum walking speed (r = 0.34; 95% CI = 0.06–0.63). In younger adults, there was a moderate association between early-phase PF rate of torque development and reactive balance (0.42 < r < 0.52). Conclusions: PF strength appears to be moderately associated with dynamic reactive and proactive balance and weakly associated with static balance and walking speed. This finding highlights the potential role of PF strength in dynamic reactive and proactive balance. Impact: This meta-analysis showed that ankle PF strength might be important for challenging dynamic balance tasks.

Summary: To determine relative lean mass and fat mass changes in adults with obesity following surgical weight loss interventions, a systematic review and meta‐analysis was conducted. The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, and Scopus were screened for eligible studies. Inclusion criteria included randomized controlled trials (RCTs) performed in populations with obesity (body mass index ≥30 kg/m²) aged over 18 years, who underwent any type of bariatric surgery and reported body composition measures via dual‐energy X‐ray absorptiometry or bio‐electrical impedance analysis. Authors conducted full text screening and determined that there were six RCTs eligible for inclusion, with data extracted at 12 months post‐surgery. Meta‐analysis revealed that, relative to gastric banding, Roux‐en‐Y gastric bypass (RYGB) led to greater total body mass loss (mean difference [MD]: −9.33 kg [95% CI: −12.10, −6.56]) and greater fat mass loss (MD: −8.86 kg [95% CI: −11.80, −5.93], but similar lean mass loss (MD: −0.55 kg [95% CI: −3.82, 2.71]. RYGB also led to similar changes in total body mass, fat mass, and lean mass compared with sleeve gastrectomy. RYGB results in greater 12‐month weight and fat loss, but similar changes in lean mass, compared with gastric banding. Further RCTs comparing body composition changes following different bariatric surgery procedures are required.

Background: The 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. Method: This 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. Results: All 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. Conclusions: This 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.

What is the effectiveness of gym-based exercise versus home-based exercise with telephone follow-up amongst adults with chronic conditions who have completed a short-term exercise program supervised by a health professional? A randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome assessment at baseline and 3, 6, 9 and 12 months. The participants were recruited following a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program for 12 months (gym group). The other group received a home-based exercise program for 12 months with telephone follow-up for the first 10 weeks (home group). Outcome measures included European Quality of Life Instrument (EQ-5D), the Friendship Scale, the Hospital and Anxiety and Depression Scale, Phone-FITT, 6-minute walk test, body mass index and 15-second sit-to-stand test. There was no significant difference between study groups in the primary outcome (EQ-5D visual analogue scale, 0 to 100) across the 12-month intervention period, with an estimate (adjusted regression coefficient) of the difference in effects of 0 (95% CI -5 to 4). The gym group demonstrated slightly fewer symptoms of depression over the 12-month period compared to the home group (mean difference 0.8 points on a 21-point scale, 95% CI 0.1 to 1.6). Similar long-term clinical outcomes and long-term exercise adherence are achieved with the two approaches examined in this study. Participation in gym-based group exercise may improve mental health outcomes slightly more, although the mechanisms for this are unclear because there was no change in the selected measure of social isolation or other measures of health and wellbeing. This finding may also be a Type 1 error. Further research to reproduce these results and that investigates the economic efficiency of these models of care is indicated. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2017) Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154-160].