Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488

Background: Most nursing home residents do not meet physical activity guidelines. Many interventions to promote physical activity and prevent falls in nursing home residents have low adherence rates, lack a theoretical foundation, or require much time from staff for preparation or delivery. Objective: This study aims to describe the rationale, development, and implementation approach of the BeSt Age app through a cluster randomized controlled trial. We also provide baseline characteristics of the study sample and discuss possible implications for further app developments. Methods: We iteratively developed a novel, tablet-based mobile app (BeSt Age) that enables nursing home staff to deliver individualized physical exercise training to residents with or without motor or cognitive impairments. The app was designed and developed based on an intervention-mapping approach. A needs assessment was performed, followed by defining objectives, theory-based methods, program development, implementation, and evaluation. We took several steps to ensure that the app was based on a sound theoretical background and considered limitations identified in prior research. For implementation and evaluation purposes, we conducted a study among 229 older adults from 19 nursing homes (171 females, 58 males; mean age 85, SD 7 years). Results will be used to examine the effectiveness of the app with regard to different outcomes. Primary outcomes among participating nursing home residents are quality of life, fall risk evaluated through 2 performance-oriented balance tests, and fall incidence. Secondary outcomes include motor performance, cognition, activities of daily living, physical activity behavior, and fall efficacy. In this paper, we examined differences between intervention group (IG) and control group (CG) participants at baseline using the chi-square test, the Mann-Whitney U test, or the t test. Results: The IG (n=137 from 11 nursing homes) received a 12-week intervention with the BeSt Age app in small, homogenous groups of 5‐7 nursing home residents, with 2 exercise sessions per week, each lasting 25‐30 minutes. The CG (n=92 from 8 nursing homes) received usual care. At baseline, the IG had a statistically significantly larger number of females, participants had a higher BMI, and more participants rated attending physical activity programs as important. There were no further statistically significant differences between the groups. Results with regard to the effectiveness of the BeSt Age app are expected to be published in spring 2026. Conclusions: If proven effective, the BeSt Age app may be a viable solution for physical activity promotion and fall prevention among older adults residing in nursing homes, thereby contributing to maintaining quality of life and overall well-being in this vulnerable population. The app can support nursing home staff in delivering exercise training to residents with minimal additional workload and without requiring specific resources.

Zusammenfassung: Hintergrund: Die Bedeutung der Digitalisierung im Gesundheitswesen wächst seit Jahren. Diese Studie untersucht das Ausmaß der Nutzung und Implementierung digitaler Lösungen im Bereich der Bewegungsförderung im Setting Pflege sowie die Technikaffinität und die Bereitschaft des Pflegepersonals zur Nutzung digitaler Lösungen. Ein weiterer Fokus liegt auf den Nutzungsbedingungen, die digitale Konzepte erfüllen sollten, sowie möglichen Risiken die bei der Nutzung derselbigen auftreten können. Methodik: Es wurde ein Onlinefragebogen mit quantitativen und qualitativen Fragestellungen zur Nutzungsbereitschaft und Voraussetzungen für digitale Lösungen entwickelt, unter Einbezug von zwei Fragebögen zur Technikaffinität (ATI und TA-EG). Die Pflegeeinrichtungen wurden deutschlandweit rekrutiert. Die Daten wurden qualitativ mit MAXQDA und quantitativ mit SPSS Version 27 analysiert. Ergebnisse: 200 Personen aus 15 Bundesländern nahmen an der Befragung teil. Eine flächendeckende Ausstattung mit digitalen Geräten und WLAN ist in Pflegeeinrichtungen noch nicht gegeben. Es zeigten sich signifikante Unterschiede in der Technikaffinität bezogen auf das Alter (t (198) = 3,705; p = 0,000), das Geschlecht (t (196) = -2,952; p = 0,004) und die berufliche Funktion (ATI: t (198) = 2,286; p = 0,023; TA-EG: t (198) = 2,126, p = 0,035). 47 % der Teilnehmenden haben keine Erfahrung mit digitalen Lösungen im Bereich Bewegungsförderung und Sturzprävention. Als Risiken wurden Stürze, falsche Übungsausführungen und Verringerung der sozialen Kontakte identifiziert. 65,4 % (n = 53) der Einrichtungsleitungen, und 54,6 % (n = 65) der Angestellten sind bereit eine digitale Lösung zu nutzen. Die Erwartungen beinhalteten eine gute Wirksamkeit, Individualisierungsmöglichkeiten, einfache Handhabung, sowie eine gute Alltagsintegration. Schlussfolgerung: Bei der Implementierung digitaler Lösungen muss die strukturelle, bislang wenig digitalisierte Situation von Pflegeeinrichtungen berücksichtigt werden. Die Ergebnisse zur Technikaffinität lassen darauf schließen, dass eine Bereitschaft zur Nutzung an sich vorhanden ist. Mögliche Risiken und bisherige Erfahrungen, sowie Erwartungen an digitale Lösungen müssen in die Entwicklung derselbigen einfließen, um eine langfristige Nutzung zu ermöglichen.

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluated the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Primary outcomes were fall incidence and fall risk (Berg Balance Scale [BBS], Timed Up and Go [TUG]); fear of falling was secondary. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1,190.81) = 8.25, p = .005), while changes in TUG performance, fear of falling, and fall incidence were nonsignificant. The intervention improved balance, a key component of fall risk, but did not reduce fall frequency within the study period. These findings demonstrate the feasibility and short-term functional benefits of a staff-mediated mHealth approach to fall prevention in NH residents.

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluates the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. Primary outcomes were fall incidence and fall risk (assessed using Berg Balance Scale [BBS] and Timed Up and Go [TUG]); fear of falling was a secondary outcome. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1, 190.81) = 8.25, p = 0.005, d = 0.22), while group × time changes in TUG performance, fear of falling, and fall incidence were nonsignificant. These findings demonstrate the feasibility of a staff-mediated mHealth approach to fall prevention in NH residents, showing significant improvements in BBS scores as one functional indicator of fall risk, while TUG, fall incidence and fear of falling showed no change.