Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Feasibilityofonlinetablet-basedgroup-exercisingamongolderadultsinSiberia:FindingsfromtwopilottrialsSvetlanaNikitina1,2,DanieleDidino2,3,MarcosBaez1,2,FabioCasati1,21UniversityofTrento,TheDepartmentofInformationEngineeringandComputerScience,Trento,Italy.2TomskPolytechnicUniversity,Tomsk,Russia3HumboldtUniversity,DepartmentofPsychology,Berlin,Germany.
AbstractBackground:Regularphysicalactivityhasapositiveeffectonphysicalhealth,well-beingandlifesatisfactionforolderadults.However,engaginginregularphysicalactivitycanbechallengingfortheelderlypopulationduetoreducedmobility,lowmotivationorlackoftheproperinfrastructuresintheircommunities.Objective:Thegoalofthispaperistostudythefeasibilityofhome-basedonlinegrouptraining-underdifferentgroupcohesionsettings-anditseffectsonadherenceandwell-beingamongRussianolderadults.Wefocusparticularlyonthetechnologyusabilityandusage,andontheadherencetothetraining(inlightofpre-measuresofsocialsupport,enjoymentofphysicalactivityandlegmusclestrength).Asasecondaryobjectivewealsoexploretheeffectsofthetechnology-supportedinterventiononsubjectivewell-beingandloneliness.Methods:Twopilottrialswerecarriedoutexploringtwodifferentgroupcohesionsettings(weakcohesionandstrongcohesion)intheperiod2015-2016,inTomsk,RussianFederation.Atotalof44olderadults(59-83yearsold)participatedinthetwopilots,andfollowedastrengthandbalancetrainingprogram(OTAGO)foreightweekswiththehelpofatablet-basedvirtualgymapplication.ParticipantsineachpilotwereassignedtoanInteractioncondition,representingtheonline-groupexercising,andanIndividualcondition,representingahome-basedindividualtraining.Bothconditionsfeaturedpersuasionstrategiesbutdifferedintheabilitytosocialiseandtraintogether.Results:BothInteractionandIndividualgroupreportedahighusabilityofthetechnology.Traineesshowedahighleveloftechnologyacceptanceand,particularly,ahighscoreinintentiontofutureuse(4.2-5.0ona5-pointLikertscale).Privatemessagingwasmoreusedthanpublicmessaging,andthestrongcohesionconditionresultedinmoremessagesperuser.Jointparticipationstotrainingsessions(co-presence)washigherfortheSocialgroupwithhighercohesion.Theoveralladherencetothetrainingwasof74%(SD=27%).Higherlevelsofsocialsupportatbaselinewereassociatedwithhigheradherenceinthelowcohesioncondition(F(1,18)=5.23,
p=.034),whereasinthehighcohesionsuchassociationwasnotfound.Overallimprovementinthesatisfactionwithlifescorewasobservedbetweenpreandpostmeasures(F(1,31)=5.85,p=.022),butnodecreaseinloneliness.Conclusions:Onlinegroup-exercisingwasprovenfeasibleamonghealthyindependentlylivingolderadultsinRussia.Thepilotssuggestthataphysicaltrainingperformedinavirtualenvironmentpositivelyaffectthelifesatisfactionofthetrainees,butitdoesnotprovidesupportforadecreaseinloneliness.Highcohesiongroupsarepreferableforgroup-exercising,especiallytomitigateeffectsoflowsocialsupportonadherence.Furtherresearchinmotivatinggroupinteractionsintrainingsettingsisneeded.Keywords:PhysicalFitness;ExerciseTraining;Userstudies;TabletComputers;Elderly;SocialSupport
Introduction
BackgroundRegularphysicalactivityisakeyfactortoasuccessfulageing,contributingtopositiveoutcomesinhealthandwell-beinginlaterlife[1]-[4].Itcanimprovephysicalfunction[4],slowtheprogressionofdegenerativediseases[3],reduceriskoffalls[1]butalsoimprovecognitiveperformance,moodandqualityoflifeofolderadults[2],[4].Aphysicallyinactivelifestyle,onthecontrary,canincreasetheriskofdevelopingchronicdiseases,oneoftheleadingcausesofdeathanddisabilityinolderadults[5],[6].Engaginginregularphysicalactivitycanbechallenging.Olderadultsmightsufferfromreducedmobility,lowself-efficacy,lacktheproperinfrastructuresintheircommunitiesorsimplyfinditdifficulttoleavehomeandparticipateinphysicalactivitiesonaregularbasis[7],[8].Fortheseandmanyotherreasons,physicalinactivityisstillprevalentinolderadults[9],leadingtotheundesiredeffectsonhealthandwell-being.Interventionprogramstopromotephysicalactivityhaveshowntobeeffectiveinincreasingandmaintainingphysicalactivity[10].Inparticular,group-basedinterventionshaveshownpromisingresultsinlong-termsettings,withhigheradherencecomparedtoindividualhome-basedinterventions.Studieshavealsoreportedapreferencebyolderadultsforgroupexercising[11],anddiscussedthepotentialofthesocialcontexttostimulatesocialinteractionsandincreasesocialwell-being[12].However,despitethebodyofliteratureonthetopic,littleattentionhasbeenpaidonpopulationslivingunderdifficultenvironmentalconditionsandundergoingcomplexsocialchanges,suchastheSiberiancommunity.Seasonalfluctuationhasbeenfoundtodeterminethelevelofphysicalandsocialactivitiesofolderadults
[13]leadingtolessopportunitiestogooutandinteract,especiallyinhighlatitudeswherewintercanresultinadeclineofphysicalfunctionsofolderadults,suchasaanklestrength[14].RecenthistoryhasalsoshapedthelivesofolderadultsinRussia.ThebreakupofSovietUnionintheearly90s,andthedifficultyearsthatfollowed,negativelyaffectedthesocialandeconomicwell-beingoftheRussianpopulation:Thelifeexpectancyofmenis14yearslowerthanintheEuropeanUnion[15],andlonelinesslevelsareamongthehighestinEurope[16].Thesocial,political,andeconomicaluncertaintyalsodeeplyaffectedqualityoflife,withadecreaseinlifesatisfactionandhappiness[17].Theaboveobservationspointtotheneedforsolutionsthatcanhelpolderadultslivingundertheaboveconditionstokeepphysicallyandsociallyactive.Technology-supportedinterventionshavebeenshowninthepasttobesuccessfulinthisgoal[18].
RelatedworkRecentresearchhasdemonstratedaneffectivenessoftechnology-supportedexerciseinterventionsforolderadultsintermsofphysicalfitness[18].However,althoughthereisanongoingdiscussiononwhethergroupexercisingorhome-basedindividualexercisingismoreeffectiveinincreasingadherenceofindividualstotrainingprograms(e.g.,[19],[20])anddespitecallsforanalysisfocusingonunderstandinggroup-basedexercisingintermsofcohesiveness(frequencyofcontactandgroupdynamics)[21],nointerventionhascomparedtheeffectivenessofindividualand(differenttypesof)groupsettingsinatechnology-supportedintervention.Researchhasalsoshownapreferencebyolderadultsingrouptraining[11],[12].However,implementinggroupexercisingcanbechallenging,especiallyinaheterogeneouselderlypopulation,withindividualdifferencesleadingtomotivationalissuesandproblemsintailoringthetraining[11].Fitnessapplicationsforhome-basedtraininghavebeenwidelyexploredintechnology-supportedinterventions(see[22]forareview),howeverwearenotawareofinterventionssupportingonlinegroup-exercisingforindividualsofdifferentlevelsoffitness.Consequently,thereisverylimitedresearchontheeffectsofleveloffitness,socialsupportandsubjectivewell-beinginonlinegroupsettings.Theexceptioncomesfromarecentstudyonaninternet-basedgrouptrainingintervention[23]relyingonageneral-purposeteleconferencesoftwaretodeliverrealtimeexercisestoolderadultsinruralareas.Althoughtargetinghomogeneousgroups,focusedonphysicalfitnessoutcomes,andlimitedtoasmallsampleof10olderadults,thestudyhighlightssomeinterestingchallengesindeployingthistypeoftechnology.Inourpreviousstudy[12],[24],wemadesomestepstotestthefeasibilityofatoolforonlinegroup-exercising,namelyGymcentral,thatallowsindividualofdifferentlevelsoffitnesstofollowexerciseswiththeremotecompanyofothers.We
conducteda8-weekpilotstudyexploringtheeffectsofonlinegroup-exercisetraininginTrento,Italy,with37adults65yearsoldandabove,whofollowedtheOtagoexerciseprogram[25]aimingatstrengthandbalanceimprovementinolderage.Thespecificfocusofthestudywasontechnologyacceptance,attitudeandpreferencetowardsgrouptraining,anditseffectsonphysicalandsocialwell-being;incomparisontoatraditionaltablet-basedindividualtrainingprogramimplementingnopersuasionstrategies.Still,despitethepriorworkandtheextensiveexistingliterature,openquestionsremain:i)Howdoestheonlinegroup-exercisingtranslatetootherculturalandenvironmentalsettings?ii)Howeffectiveisonlinetrainingwithgroupsofdifferentlevelsofcohesion?iii)Howdoesonlinegroup-exercisingcomparetoindividualtrainingfeaturingpersuasionstrategies?
ObjectivesThispaperreportsontwopilotstudiesofanonlineexerciseinterventionwitholderadultslivinginTomsk,SiberianFederalDistrict(Russia).Theaimoftheinterventionwastoenableolderadultsofdifferentlevelsoffitnesstofollowapersonalisedexerciseprogramfromhome,withthe(virtual)companyoftrainingcompanionsandunderthesupervisionofaremoteCoach.Thiswasdonewiththesupportofatabletapplicationofferinggroup-exercisinginavirtualgym,whileleveragingonthesocialcontextofthegroup-exercisingtoenablesocialinteractionsandfeedback.Themainobjectiveofthepilotwastostudythefeasibilityofonlinegroup-exercisingunderdifferentcohesionsettingsamongSiberianolderadults.Wefocusedonthetechnologyacceptance,ontheadherencetothetraining(especiallyinlightofpre-measuresofsocialsupport,aswellasontheenjoymentofphysicalactivityandlegmusclestrength).Asasecondaryobjectivewealsoexploredtheeffectsofthetechnology-supportedinterventiononsubjectivewell-beingandloneliness.
Methods
TrainingapplicationsThetechnologysupportwasprovidedbyGymcentral,atabletandwebapplicationthatallowstraineesofdifferentfunctionalabilitiestofollowonlinegroup-exercisesfromhome,underthesupervisionofaremotecoach[26].GymcentralservestheneedsoftraineesandcoachviatheTraineeandCoachapps(seeFigure1).
Figure1.FeaturesofthevirtualgymenvironmentofthetraineeapplicationThedesignoftheTraineeAppisbasedonavirtualgymenvironmentthatprovidesthefollowingmainfeatures:
● Tailoredtrainingprogram.Itdeliversvideoexercisesthataretailoredtotheabilitiesandprogressofindividualtrainees.TraineesmayreceiveexercisesofdifferentintensitylevelornotreceivesomeexercisesdependingontheirconditionandtheCoachassessment.
● Onlinegroup-exercising.Itallowstraineestoparticipateinonlinegroup-exercisesessionsinavirtualclassroom.TraineescanseethevideooftheCoachandalsothepresenceofothertraineesviaavatars.However,differencesinfunctionalabilitiesortheintensityleveloftheexercisesremainhidden.
● Persuasionstrategies.Itprovidesindividualpersuasionfeaturessuchaspositiveandnegativereinforcement,andself-monitoring(implementedusingagrowinggardenmetaphor);aswellassocialpersuasionfeatures,suchassociallearning,socialsupport,socialfacilitationandnormativeinfluence.
● Remotemonitoringandfeedback.Participationtotrainingsessionsandcompletenessofexercisesarerecordedbytheappandmadeavailabletothetrainingcoach.Thecoachcanactonthisdatatoprovidefeedback(usingthecommunicationfeatures)andincreaseortailortheintensityofthetrainingprogram.
● Communicationfeatures.Itenablestraineestosharepublicmessageswithalltheothertraineesinabulletinboardortoexchangeprivatemessageswithindividualtrainees(orthetrainingcoach)usinganinternalmessagingfeature.
ThemonitoringandfeedbackissupportedbytheCoachApp,acompanionwebapplicationforthetrainingexpert.DetailsaboutthefeaturesoftheGymcentralapplicationarediscussedindetailin[26],andtheunderlyingconceptualmodelin[27].
ResearchquestionsInthisworkwestudiedthefeasibilityandeffectivenessoftheonlinegroup-exerciseinterventionanditseffectsonthewell-beingofSiberianolderadultsbyaddressingthefollowingspecificresearchquestions:
• RQ1.Istheonlinegroup-exercisingtechnologyusableandacceptedbyolderadults?Weaimedatexploringtheperceptionofolderadultstowardsthetechnologybymeasuringtheusabilityandacceptance.Moreimportantly,wealsoexploredhowtheapplicationwasusedinpracticeandhowtheusagerelatestotheobservedeffectsoftheapplication.
• RQ2.Howonlinegroup-exercisingandbaselinemeasuresinfluencetheadherenceofolderadultstoatrainingprogram?Previousresearchsuggeststhatexercisinginagroupresultsinhigheradherenceandpreferencebyolderadults[7],[11].However,researchalsopointstomajorobstacleswhendeliveringgroup-exercisestoheterogeneouspopulations,whichcanmaketraininginthissettingdifficultandlessmotivating[11].Inthisstudyweexploredhowavirtualgroupenvironmentinfluencestheadherenceofolderadults,underdifferentmeasuresofknowndeterminantsofphysicalactivity.
• RQ3.Doesonlinegroup-exercisingaffectthewell-beingofolderadults?Weexploredtheeffectsofphysicaltrainingviaavirtualsocialenvironmentonthesubjectivewell-beingandsocialwell-beingofolderadults.Byaddressingthisquestion,weaimedatcontributingtotheexistingresearchontheassociationbetweenphysicaltrainingandwell-being[1]-[4].
StudydesignWeexploredtheabovequestionsintwopilotstudiesinTomsk,SiberianFederalDistrict(RussianFederation)thatadheredtothesameprotocolandconditions,exceptforthegroupcohesionsetting:
• Tomsk1.(Jul-Sept2015)Participantswithhighgroupcohesion,recruitedfromtwoorganisations,themajorityperformingsharedactivities(computercourses,hobbiesclasses).
• Tomsk2.(Apr-Jun2016)Participantswithlowgroupcohesion,recruitedfromvariousorganisations,withweak/notieswitheachother.
Asseenabove,weexploredtwogroupcohesionsettings:participantswithstronggroupcohesionandparticipantswithlowgroupcohesion.Thus,forthereasonsexplainedabove,candidateparticipantsfromTomsk1hadastrongercohesionthanTomsk2atrecruitmenttime,regardlessofthetreatmenttheyendedupreceiving.Wedidsotounderstandtheeffectofthepriorconnectednessamongparticipantsontheobservedoutcomes.Bothpilotstudieswerefollow-upstoapreviouspilotperformedinTrento,Italy,andsotheyfollowthesamestudydesign[12].AnoverviewofthestudyflowinCONSORT-compliantformatisshowninFigures2,3.
Figure2.StudyflowchartforTomsk1(July-Sept2015).
Figure3.StudyflowchartforTomsk2(Apr-June2016).Inbothstudiesdescribedhere,participantswereassignedtoanInteractiongroup(onlinegroup-exercisecondition)ortoaIndividualgroup(individualexercisecondition)usingarandomassignmentprocedure,withageandparticipants'frailtylevelasrandomassignmentvariables.InTomsk1,theprocesswasslightlydifferentastoensureahighlevelofcohesionafterrandomisation:pairsoffriends,identifiedduringtheinformativemeeting,weretreatedassingleelementsduringrandomisation.Inthismodifiedprocess,wefirstlyfollowedtherandomisationprocedureforparticipants"withoutfriends",assigningparticipantstoInteractionandIndividualtreatments,andthenrepeatingtheprocessforthefriendpairunits.Thus,friendswereassignedtothesametreatments,contributingtotheoverallgroupcohesioninTomsk1.Thetwostudiesandthetwotreatmentconditionsdefinedfoureffectivegroups(seeTable1).ParticipantsintheInteractiongroupshaveaccesstoonlinegroup-exercisingwithsocialinteractionandpersuasionfeatures,whereasintheIndividualgroups,participantshaveaccesstoindividualtrainingwithpersuasionfeaturesbutwithsocialinteractionslimitedtocontactswiththecoach.DetailsaboutthegroupcohesionandfeaturesavailabletoeachgroupcanbeseeninTable1.Table1.GroupcohesionandfeaturesoftheTraineeAppavailabletoeachstudygroup. Tomsk1 Tomsk2Groups Interaction Individual Interaction IndividualApplicationfeaturesTailoredexercisesprogram(OTAGO) x x x xTrainingwithothersintheclassroom x x Invitationtojoinatrainingsession x x
Self-monitoringprogress(gardenmetaphor)
x x x x
Positive/Negativereinforcement x x x xSharingoftrainingactivitytheinbulletin x x ContextualmessagesintheLockerroom x x Publicmessagesinthebulletinboard x x Privatemessageswithothertrainees x x PrivatemessageswiththeCoach x x x xGroupCohesionWeakgroupcohesion x xStronggroupcohesion x x Bothversionsoftheapplicationimplementedthesametrainingprogram,developedonthebasisoftheOTAGOExerciseProgram[25],whichincludesasetofmusclestrengtheningandbalance-retrainingexercises.Thetrainingprogramwasdesignedwithastandardsetofexercisestobeperformedineachtrainingsession,varyinginintensityeachweekaccordingtotheperformanceofthetrainees.Intheapplication,eachexercisehad10levelsofintensitybasedonthedurationandthenumberofrepetitions.Atthebeginningofthestudy,apersonaltrainer(whowasalsothecoachinthevirtualgym)performedaphysicalassessment,whichwasusedtosetthestartingintensityleveloftheprogram.ParticipantsreceivedaniPadAir®tablet(9.7-inch)pre-installedwiththeassignedversionoftheapplicationandinternetaccess,acasetosupporttheverticalpositioningofthetablet,anactivitymonitoringsensor(MisfitShine®),onepairofankleweights(0.5Kgeach),andthetelephonenumberofthesupportteam.Beforethestartofthetrainingprogram,participantsjoinedpre-testandtechnologytrainingmeetings:i)aninitialmeetingwheretheysignedtheinformedconsentandfilledoutenrollmentquestionnaires,ii)asessionwithamedicaldoctortoevaluateeligibility,iii)atechnologytrainingsessionintheuseoftabletsandtheassignedversionoftheapplication,andiv)asessionforthephysicalassessmentwiththecoachandpre-testmeasures.Thetechnologytrainingfollowedaworkshopformat,andwasdoneinsmallgroupsof10participantseach.ParticipantsassignedtoIndividualandInteractionconditionsattendedworkshopsseparatelyastheywereprovidedwithdifferentversionsoftheapplication.Inthe8weeksofthetraining,participantsperformedthehome-basedtrainingactivitywiththemonitoringofthecoachandofthesupportstaff.Thetrainingscheduleoffered3exercisesessionsperweek,andparticipantswererequiredtoperformatleast2exercisesessionseveryweek.Thedurationofthetrainingsessionrangedfrom30to40minutesdependingontheintensitylevel.Participantswerefreetojointhetrainingsessionsatanytime.Post-testmeasurestookplaceontheweekafterthetraining.TheCoachguidingtheparticipantsduringthetrainingwasapracticingdoctorwithaprimarycaredoctordegree,andhadover10yearsofexperienceingymnastics,
rehabilitationexercisesandyogaforolderadults.BeforethebeginningofexperimenttheCoachwasacquaintedwiththeOtagotrainingprogramandGymcentralapplicationsettings.Duringthetrainingperiod,theCoachhadthetaskofprogressingtheintensityoftheexerciseprogramandprovidingfeedback.Attheendofeveryweek,theCoachcouldmaintainorincreasetheintensitylevelofeachtraineeaccordingtotheattendanceandcompletenessofthetrainingsessionsintheweek.TheCoachwasalsoinstructedtocontacttraineesatleastonceaweektoprovidefeedbackandtorespondtoanyquestionfromthetrainees.TheCoachwasnotawareofthedifferencebetweentheInteractionandIndividualgroups,andbothreceivedthesameamountoftechnicalsupport.Thepre-testmeasuresincludedtheGroningenFrailtyIndicator(GFI)[28],theRapidAssessmentofPhysicalActivityQuestionnaire(RAPA)[29],demographicinformation,questionnairesconcerningpsychologicalandsocialwell-being.Thepost-testmeasuresincludedtheSystemUsabilityScale(SUS)[30],asetofquestionsontheacceptanceoftheapplication,theSatisfactionwithLifeScale(SWLS)[31],[32]theMOSSocialSupportscale(MOS)[33],[34],andthe3-itemR-UCLALonelinessScale[35],[36].Theparticipantsfilledinallthequestionnairesbythemselvesinpencil-and-paperformat.ThestudyprotocolreceivedethicalapprovalfromtheCREATE-NETEthicsCommitteeonICTResearchInvolvingHumanBeings(ApplicationN.2014-001)inTrento,Italy.Thestudiesreportedinthispaper-asfollow-upstoourpreviousstudy-complywiththisprotocol,withtheinformedconsentandinformationalmaterialstranslatedintotheRussianlanguage.
ParticipantsWeconsideredeligibleforthestudy:participantsaged59yearsoldorolder,independent-living,self-sufficientandwithanon-frail,transitionallyfrailoramildfrailtylevel.Thesecriteriaweremeasuredbyself-reports.Allparticipantshadtopassadoctorassessmenttoascertaintheabsenceofconditionsthatwouldpreventthemfromperforminglightphysicalexercises.Participantswearingpacemakerswereconsiderednoteligible,sincethestudyrequiredtheuseofanactivitysensor(Misfitshinemonitor).ThespecificsofbaselinemeasuresforeachstudysitearedescribedintheTable2.Table2.Baselinemeasuresforeachstudysite.Features Site Individual Interaction PaPreallocationtestAge,M(SD) Tomsk1 65.0(6.1) 68.2(7.8) .71
Tomsk2 68.8(7.2) 67.6(6.2) .48
Females,% Tomsk1 100% 90% Tomsk2 100% 100%
GFIb,M(SD) Tomsk1 4.2(2.04) 4.5(2.42) .99
Tomsk2 3.6(2.54) 3.56(2.5) .91RAPAc,M(SD) Tomsk1 5.78(1.79) 5.9(1.73) .72
Tomsk2 5.15(2.41) 5.13(1.96) .84Postallocationtests-Self-reportedPACESd,enjoyment Tomsk1 50.0(3.5) 50.0(4.8) .99
Tomsk2 49.9(5.4) 47.8(4.2) .49R-UCLAe,loneliness Tomsk1 4.2(1.6) 5.4(1.4) .18
Tomsk2 4.3(1.1) 4.0(1.2) .35MOSf,socialsupport Tomsk1 4.0(1.5) 5.1(1.6) .99
Tomsk2 4.3(1.1) 4.0(1.2) .55SWLSg,well-being Tomsk1 4.0(1.5) 5.4(1.4) .52
Tomsk2 4.3(1.1) 4.1(1.2) .35Postallocationtests-PhysicalassessmentLegmusclestrength,M(SD) Tomsk1 13.6(2.2) 12.9(1.4) .49
Tomsk2 16.5(3.8) 16.5(3.0) .96aDifferencescomputedusingindependentsamplest-testforageandlegmusclestrength;alltheothervariableswereanalyzedwithMann-Whitneytests.bGFI-GroningenFrailtyIndicatorcRAPA-RapidAssessmentofPhysicalActivityQuestionnairedPACES-PhysicalActivityEnjoymentscaleeR-UCLA-LonelinessScalefMOSSocialSupportscalegSWLS-SatisfactionwithLifeScaleParticipantsinbothstudieswerecontactedthroughretirementorganizationsinTomsk,Russia.Inthefirststudy,Tomsk1,participantsweremainlyinvitedthroughorganizationofferingcomputerlearningclassesandhobbiesactivitiesforseniors.IntheTomsk2studytherecruitmentwascarriedoutthroughthreeorganizationsorganizingsocialactivitiesandevents.Weconductedpresentationsexplainingtheprojectandtheirexpectedinvolvement,andhandedoutprintedbulletins.Olderadultsinterestedinparticipatingprovidedtheirphonenumbers,andwerelateroncontactedbytheprojectcoordinator.DetailsabouttheretirementorganisationsandthenumberofcandidatesreachedcanbeseeninTable3.Table3.Seniorcitizenorganisationscontactedandcandidatesreachedineachstudy.RetirementOrganisation
Study Sizeofgroupsreached
Tomskunionofretirees
Tomsk1 Largeorganisationprovidingcoursestoaround600retireesperyear.Fouractivecoursesatthetime(~20memberseach)werecontacted,reachingaround80olderadultsintotal.
VeteranscouncilofTPU
Tomsk1 Smallorganisationofaround80retirees.Theinvitationwasextendedtoallmembers.
VeteransCouncilof Tomsk2 Smallorganisationofaround80retirees.Theinvitation
TomskScientificCenter wasextendedtoallmembers.
Tomskregionveteranscouncil
Tomsk2 Smallorganisationofaround100retirees.Theinvitationwasextendedtoallmembers.
Veteranscounciloftpu Tomsk2 Smallorganisationofaround80retirees.Theinvitationwasextendedtoallmembers.
IntheTomsk1study20participantswerefoundeligibleforthestudy(meanageindividualgroup:65,s.d.=6.1;interactiongroup:68.2,s.d.=7.8;19femalesand1male).IntheTomsk2study40participantswereacceptedaccordingtheinclusioncriteria(meanageindividualgroup:68.9,s.d.=7.2;interactiongroup:67.6,s.d.=6.2;all40female).Thedifferenceinthenumberofmaleandfemaleparticipantsisduetothedemographicsofthestudylocationandtheavailabilityofmalecandidatesattheretirementorganisations.InSiberia,lifespangapbetweenmalesandfemalesisoneofthebiggestintheworld:lifeexpectancyatbirthformenis64.7years,whereasforwomenitis76.3years[46].Thesedemographicsposeddifficultiesinrecruitingmaleparticipantsfromtheretirementorganizations.ThestudyflowforTomsk1andTomsk2isdepictedinFigures2,3.Aftertherecruitment,participantsinbothstudiessignedtheinformedconsentbeforeparticipatingintheexperiment.IntheTomsk1study,outof20participants,5withdrewbeforethestartofthestudyforhealthproblemsorpersonalreasons,thereforedataof15participantswasincludedintheanalysis.IntheTomsk2study,outof40participants,2withdrewbeforethebeginningofthetrainingduetotravelplans.Duringthetrainingprogram4participantsintheindividualgroupand5participantsintheinteractiongroupdroppedoutbecauseofhealthissues,travelsorreportedlackoftimeforparticipation.Thus,inTomsk2study,atotalof29participantswereincludedintheanalysis(individual:16,interaction:13).Therewerenostatisticaldifferencesbetweenindividualandinteractiongroupsintermofinitialmeasures(Table2).Thesebaselinecomparisonshavebeenperformedonparticipantsthatfinishedthetrainingprogram.
Outcomemeasures
AcceptanceandUsabilityWefocusontheusability,acceptanceofthetechnologyandpreferencetotraintogether:
● Usability.TheusabilityoftheapplicationwasevaluatedbymeansoftheSystemUsabilityScale[30].Thisscaleincludes10itemsratedona5-pointLikertscale(from1="completelydisagree"to5="completelyagree").TheSUSscorerangefrom0(lowusability)to100(highusability).However,inapretestofthescale,olderadultsfounddifficulttounderstandtwoitems(``Ifoundthevariousfunctionsinthissystemwerewellintegrated"and``I
thoughttherewastoomuchinconsistencyinthissystem").Therefore,wedecidedtoexcludethesetwoitemsinthequestionnaireweadministeredtoourparticipants.ThismeanthattheSUSscoreinourstudyrangedfrom0to80.
● Acceptance.Acceptancewasmeasuredwithasetofquestionsdesignedtoevaluatepositive("Ienjoyusingtheapp")ornegativefeelings("Theappmakesmenervous")associatedwiththeuseoftheapplications,theresponsetothecommunicationfeature("Itiseasytocommunicatewithotherpeoplewiththeapp"),theintentiontouseit("Iwouldliketousetheappinthefuture"),andtheperceivedeaseofuse("Itiseasytousethevirtualgymtoperformexercises").Thesequestionswereratedona5-pointLikertscale(from1="completelydisagree"to5="completelyagree").Thequestionnairewasdevelopedbyourteamonthebasisofpreviousliterature[49].Eachquestionhasbeenseparatelyanalysed.
● Co-presence.Participantshadthechoicetotrainatanytime,buttheycouldalsocoordinatetotrainatthesametimeviamessagingorusingtheinviteusertojoinfeature.Tocapturethepreferenceofusersforgrouptraining,weloggedtheattendancetothetrainingsessionstocomputeforeachuserwhetherheorshetrainedalone(individualattendance)ortogetherwithanothertrainee(jointattendance).Wethendefineco-presenceofagroupastheratioofjointattendanceswithrespecttothetotalnumberofattendances.
AdherencetothetrainingMeasuredwith:
● Persistence.Persistencewascomputedconsideringtheratiobetweenthenumberofattendancestoexercisesessionsbyaparticipantandthenumberoftheexercisesessionsplannedintheprogram.Participationwasmeasuredbyloggingtheattendancetothescheduledtrainingsessionsinthevirtualclassroom.Forpersistence,arateequalto100%wasconsideredasparticipationinall3sessionsperweek,forall8weeksoftraining.Participantswerenotawareofhowthepersistencewasscoredbutcouldmonitortheindividualprogressinthegarden(self-monitoringfeature).
Subjectivewell-being,socialsupport,andlonelinessInordertomeasureiftherewasanimprovementinthewell-beingoutcomesasaresultoftraining(secondaryoutcomes),wereliedthefollowinginstruments:
● SatisfactionwithLifeScale(SWLS)[31]:5questionsratedona7-pointLikertscale(from1"Stronglydisagree"to7"Stronglyagree").TheSWLSwastranslatedandadaptedtoRussianlanguagebyTuckeretal[32].Thetotalscorerangesfrom5to35,withhigherscoresindicatinghigherlevelsoflifesatisfaction.
● Loneliness.Tomeasureloneliness,weusedashorterversionoftheR-UCLALonelinessScale[35]developedbyHughesetal.[36].Thescaleusedincludes3itemsscoredona5-pointLikertscale,withthetotalscorerangingfrom3to15,andhigherscoresindicatinghigherlevelsofloneliness.
DeterminantsofphysicalactivityIntheanalysesexplainedinthefollowingsections,weusethefollowingdeterminantsofphysicalactivityascovariates:● PhysicalActivityEnjoymentScale.(PACES)[37].Thisscaleincludes16
itemsscoredona5-pointLikertscale(from1="disagreealot"to5="agreealot").ThePACEStotalscorerangesfrom16to80(maximumenjoyment).
● MOSSocialSupport.[33],[34]:8questionsscoredona5-pointLikertscale(from1"Noneofthetime"to5"Allofthetime").Thisscalewastranslatedbyusaccordingtotheinternationalguidelines[38].Itaimsatmeasuringthesocialsupportprovidedbyothers.Thetotalscorerangesfrom1to8,withhigherscoresindicatinghigherlevelsofsocialsupport.
● Legmusclestrength:Measuredwiththe30secondChairStandtest[39].Thepurposeofthistestistoevaluatelegstrengthandendurance.Fromseatedposition,theparticipantrisestoafullstandingpositionandthensitsbackdownagainfor30seconds.Theoutcomemeasureisthenumberoftimestheparticipantcomestoafullstandingpositionin30seconds.
StatisticalAnalysisWeanalyzedthedifferencebetweentheinteractionandtheindividualgroupsintermofSUSscorewithtwoMann-Whitneytests,whereasforthedifferenceinthepercentageofco-presenceweuset-tests.Weanalyzedadherence(measuredasrateofpersistence)tothetrainingprogramwithananalysisofcovariance(ANCOVA)withgroup(Interactionvs.Individual)andstudy(Tomsk1vs.Tomsk2)asbetween-subjectfactors,andlegmusclestrength,socialsupport(MOSscore),andenjoymentofphysicalactivity(PACESscore)ascovariates.Forwell-beingmeasuresweselectedtheSWLSscoreandR-UCLALonelinessScalescoreasdependentvariablestobeusedintwoseparaterepeated-measuresanalysisofvariance(ANOVA).WeusedthesameindependentvariablesinbothANOVAs:time(pre-testvs.post-test)aswithin-subjectfactor,andgroup(Interactionvs.Individual)andstudy(Tomsk1vs.Tomsk2)asbetween-subjectfactors.ThestatisticalanalyseswereperformedusingtheopensourcestatisticalsoftwareR[40],usingtheggplot2packagetocreateplots[41].
Results
PerceptionandadoptionofthetechnologyAstartingpointtounderstandthefeasibilityofthetechnologyforourtargetpopulationwastoaddress(Q1),andinvestigatetheperceivedusability,acceptanceandusageoftheonlinegroup-exercisingtechnology.
UsabilityNineparticipantsdidnotanswertosomeofthequestionsoftheSUSandthushavebeenexcludedbytheanalysisonthisaccount.Onaverage,theSUSscore(ona80pointsscalesinceweexcluded2questions)wasverysimilarbetweentheInteractiongroup(mean=63;SD=9;N=19;range=48-80)andtheIndividualgroup(mean=66;SD=14;N=15;range=40-80).Fromamoredetailedperspective,aMann-WhitneytestshowedthatneitherintheTomsk1study(W=11,p>p=.99)norintheTomsk2study(W=89.5,p=.32)theSUSscoresweredifferentbetweenthetwogroups(Individualvs.Interaction),despitethehighercomplexityoftheapplicationassignedtotheinteractiongroups.
AcceptanceTable3reportstheresultsforthequestionsconcerningacceptance.ConsistentlywiththeSUSscore,traineesshowedahighlevelofacceptanceoftheapplication.Infact,asthetableshows,traineesreportedhighlevelsofenjoyment(A1)andlowlevelsofnervousness(A2)inusingtheapplication.Trainingwiththeapplicationwasperceivedasveryeasytodo(A4)aswellascommunicating(A3)butwithalowerscoreby1point.Traineesalsoreportedwithahighscoretheirintentiontousetheapplicationinthefuture.Table3.Mean(SD)ofthetechnologyacceptanceresponsesforeachgroupandstudy(range:1to5)Features Tomsk1 Tomsk2 Interaction Individual Interaction IndividualA1(feeljoy) 3.9(1.4) 3.9(1.6) 2.8(1.9) 3.3(1.9)A2(feelnervous) 2.3(1.2) 1.2(0.4) 1.4(0.8) 1.1(0.3)
A3(easysocial) 4.4(0.9) 3.0(2.3) 3.1(1.7) 4.1(1.5)A4(easytrain) 4.9(0.4) 4.6(1.1) 4.7(0.5) 5.0(0)A5(futureuse) 4.9(0.4) 4.2(1.8) 4.6(0.7) 5.0(0)
CharacterizationofappusageInordertocharacterisetheusageofthevariousfeaturesoftheapp,weanalysedtheapplicationlogstoderivehowparticipantsspenttheirtimeintheapp.Overall,themeantimespentin-appwashigherinTomsk1(16hrs)comparedtoTomsk2(9hrs),thedifferencebeingmarkedbyahighertimespentbytheInteractiongroupinthefirststudy(seeFigure4A).
Figure4.Applicationusagebygroupandstudy.A)Totaltime(inminutes)spentbyuserintheapplicationduringtheexperimentB)UsageoftheapplicationfeaturesintheInteractiongroup,andC)UsageoftheapplicationfeaturesintheIndividualgroup,%fromtotaltimespentintheapplication.Notsurprisingly,mostofthetimewasspenttrainingintheclassroom,asthedurationofexercisesessionrangedfrom20-40minsdependingontheintensitylevel.Lookingatthetimespentintheclassroomrelativetothetimespentin-appbyeachparticipant,wecanseethatparticipantsoftheIndividualgroupinbothstudiesspentnearlythesamepercentageoftheirtime(Tomsk1=95.3%,Tomsk2=95.6%)intheclassroom.ParticipantsintheInteractiongroupsspentalittlelessontheclassroom-especiallyinTomsk2(Tomsk1=92.5%,Tomsk2=81.4%).TheloweruseintheInteractionappisduetothepresenceofextrafeatures,andinthecaseofTomsk2,duetothelowertimespenttraining.Analysingtheusageoftheotherfeaturesweobservethatparticipantsspentasignificantpercentageoftheirtimemessaging,particularlythoseintheIndividualgroups(seeFigure4C).WecanderivethattheIndividualgroupnotonlyusedthetrainingfeaturebutalsothemessagingtooltointeractwiththeCoachandtochecktheirprogress.ThebulletinboardandthelockerroomwerenotavailablefortheIndividualgroup.TheInteractiongroupalsousedthesocialfeatures(seeFigure4B).ThemessagingfeaturewasusedtosendprivatemessagestootherparticipantsandtheCoach,especiallyinTomsk1.Thebulletinboardwasalsoused,althoughvisitsweremorerelatedtoalurkingbehaviorratherthanactualcontributions.Weattributethistoautomaticsharingoftheparticipant’sperformance(asa3-starratingbasedoncompleteness)onthebulletinboard(sociallearningpersuasionstrategy[12]).TheLockerroomcomprisesalsoanimportantpercentagebutitismostlyduetothefactthatitprecededtheclassroominthenavigation.Noimportantinteractionsorinvitationtothejointheclassroomwereregisteredfromthisvirtualspace.
OnlineinteractionsParticipantsintheInteractiongrouphadthepossibilityofexchangingpublicandprivatemessages,eitherwiththeCoachorothertrainees,whileintheIndividualgrouptheinteractionswerelimitedtoprivatemessageswiththeCoach.Table4
summarizestheexchangesamongparticipantsofbothgroupsinthetwopilotstudies.Table4.Mean(SD)messagesexchangedamongallusers(includingtheCoach)andonlytrainees. Tomsk1 Tomsk2 Interaction Individual Interaction IndividualPrivatemessagessent Allusers 8.4(6) 8.1(7) 4.3(6) 5.7(4) Only
trainees4.4(3) N/A 0.4(1) N/A
Privatemessagesreceived
Allusers 13.5(2) 13.1(7) 11.1(3) 10.9(1)
Onlytrainees
4.3(2) N/A 0.5(1) N/A
Publicmessagesposted
Trainees 0.6(1) N/A 0.5(1) N/AParticipantsinthesocialconditionmadesignificantlymoreuseofprivatemessagescomparedtopublicmessages.ThiswasthecaseevenforparticipantsinTomsk1(stronggroupcohesion),with4.4privatemessagescomparedtoonly0.6publicmessagesperuser.Notsurprisingly,participantsofTomsk1interactedsignificantlymoreamongthemselves(4.4messagesperuser,comparedtoonly0.4inTomsk2).ItisalsonoteworthytheasymmetrybetweensentandreceivedmessageswhenincludingmessagesbytheCoach.ThisisduetothescheduledmessagesbytheCoach,whoreachedparticipantsonaweeklybasisbutwasnotalwaysreciprocated,aswellastotheinteractionbehavioroftheCoach,i.e.,sendingmorethanonemessagesperinteraction.
Co-presenceinthetrainingParticipantsintheInteractiongroupwereabletoseeeachother,traintogetherandcoordinatetheirparticipations.ParticipantsintheIndividualgroupwerenot.Thus,co-presenceintheIndividualgroupisonlyanindicationofmeetingsbychance,andusedforcomparisons.Theco-presencebystudyandgroupisshowninFigure5.
Figure5.Co-presencebystudyandgroup.Theco-presenceintheTomsk1studywasonaveragesignificantlyhigherintheInteractiongroup:36.25%(SD=17.25%)incomparisonwith10.71%(SD=4.15%)fortheIndividualgroup.At-testshowedasignificantdifferencebetweentheinteractionandindividualgroups(t(7.9)=-4.05,p-value=.004)infavorofthegrouptrainingcondition.IntheTomsk2study,theco-presencewasof16.38%(SD=11.44%)inaverageintheInteractiongroupand19.4%(SD=11.13%)intheIndividual.At-testshowednosignificantdifferencebetweengroups(t(25.22)=0.7,p-value=.49).
ProgramadherenceTheoverallpersistenceratewasof74%(SD=27%)whenconsideringthenumberofsessionsavailableinthe8weeksoftraining.Breakingdownthisnumberbygrouptreatmentweobserveapersistencerateof75%(SD=28%)fortheIndividualgroupsand74%(SD=26%)fortheInteractiongroups,whiletheresultbystudyshowsapersistencerateof82%(SD=24%)forTomsk1and70%(SD=28%)forTomsk2.InthestudyTomsk1thepersistenceratewas77%(SD=25)fortheIndividualgroupand87%(SD=23)fortheInteractiongroup;inTomsk2itwas74%(SD=30)fortheIndividualgroupand65%(SD=25)fortheInteractiongroup.AnanalysisofcovariancewasperformedtocomparethepersistenceofparticipantsofIndividualandInteractiongroupsinthetwostudieswhilecontrollingfortheinitialbaselinemeasuresoflegmusclestrength,socialsupport,andPACES.Theresultsshowneitherasignificantmaineffectforgroup(F(1,18)<1,p=.74)orforstudy(F(1,18)=1.46,p=.24),norinteractionbetweenstudyandgroup(F(1,18)=1.15,p=.3).Consideringthebaselinemeasurestheresultsshowasignificantinteractionbetweenstudyandtheinitialsocialsupportscore(F(1,18)=5.23,p=.034).AsobservedinFigure6A,inTomsk2participantswithhighersocialsupportlevelshowedhigheradherencetothetraining,whereasinTomsk1theadherenceisnotsignificantlyassociatedwithbytheinitialsocialsupportscore.
Nosignificanteffectswerefoundfortheinitialscoresoflegmusclestrength.
Figure6.Interactionplotsforpersistenceandbaselinemeasures.A)Interactionbetweenstudyandinitiallevelofsocialsupport(MOSscorehasbeengroupedinthreeequallydistributedintervals:Low,Medium,andHigh),B)InteractionbetweengroupandinitialPACESscoreinTomsk1.C)InteractionbetweengroupandinitialPACESscoreinTomsk2.TheinteractionbetweenPACESscoreandgroupwasalsosignificant(F(1,18)=6.001,p=.025).AsshowninFigure6inTomsk2participantswithhigherenjoymentofphysicalactivityhadahigheradherencelevel(Figure6B),whereasinTomsk1enjoymentofphysicalactivityhadanegativeeffectontheInteractiongroup(Figure6C).
Well-beingoutcomesEightparticipantsdidnotanswertooneormorequestionsoftheSWLSandthushavebeenexcludedbythisanalysis.Onthesubsetofparticipantswithoutmissinganswers,SWLSscorewasanalysedwitharepeatedmeasureAnovawithtime(pre-testvs.post-test)aswithin-subjectfactor,andgroup(Individualvs.Interaction)andstudy(Tomsk1vs.Tomsk2)asbetween-subjectfactors.Onlythemaineffectoftimewassignificant(F(1,31)=5.85,p=.022).Participantsreportedhighsatisfactioninthepost-testquestionnaire(mean=23.8,SD=6.2)comparedtothepre-testmeasures(mean=21.34,SD=5.8).ThesameanalysiswasperformedonR-UCLALonelinessScale.Eightparticipantswereexcludedfromtheanalysisduetomissingvaluesinthepre-testorpost-testquestionnaires.Onlythemaineffectofstudyshowedatendencytowardsignificance(F(1,31)=3.55,p=.069).ParticipantsreportedalowerleveloflonelinessintheTomsk1study(mean=4.77,SD=1.7)comparedtotheTomsk2study(mean=4,SD=1).
Discussion
Mainfindings
Onlinegroup-exercisingtoolratedashighlyusable(RQ1)Participants’ratingontheusabilityoftheapplicationshowsthatthegroupexerciseapp(assignedtotheInteractiongroup)hasahighusability,andthattheaddedcomplexityinrelationtothemoretraditionalhome-basedversion(assignedtotheIndividualgroup)didnotsignificantlyaffectitsusability.Whenaskedindetail,participantsreportedthetrainingfeatureasveryusable,whilethemessagingasusablebutwithalowerscore(1pointlower),possiblyduetothetyping.Theintentiontousetheappinthefuturewasalsoveryhigh,whichalongwiththeanalysisoftheactualusage,pointstothefeasibilityofusingtheonlinegroup-exercisingtoolfortraininginasocialcontext.TheseresultsareinlinewithaprevioususabilitystudyandusagebehaviouranalysisdoneontheGymcentraltool[26].
Privatemessagesaspreferredinteractionchannelamongtrainees,eveninthestrongcohesiongroup(RQ1)AsinourpreviousstudyanalysingonlineinteractionsinatrainingcontextamongItalianolderadults[26],weexpectedtoobserveahigherusageofpublicmessagesforcommunicationamongtrainees.Surprisinglyhowever,participantsexchangedmoreprivatemessagesamongthemselvesthanpublicones,eveninthestrongcohesiongroup.Thehighcohesionsettingonlyaccountedformoreexchangesperuser,notforgroup-levelinteractions.Thisresultsuggestsdifferentattitudestowardsgroupinteractionspossiblyduetoculturaldifferences.Infact,theusagelogssuggestmainlyalurkingbehavior,possiblyduetotheautomaticsharingoftheparticipant’sperformance-asociallearningfeature.Thus,furtherstudiesarerequiredinordertodesignbetteronlineinteractiontoolsthatwouldmotivategroupbuildingintheculturalcontextofreference.
Co-presencehigherinthestrongcohesiongroup(RQ1)Theresultsofco-presenceshowusthatparticipantsfromtheInteractiongroupinTomsk1(strongcohesiongroup)participatedofsignificantlymoretrainingsessionswiththecompanyofothers,comparedtothemeetingsbychanceintheIndividualgroup.Wehaveseenthesameeffectinourpreviousstudy[12]featuringahigh-cohesiongroupofItalianolderadults.ThiseffectwasnotobservedinTomsk2(lowcohesiongroup),suggestingthattrainingtogetherisnotnecessarilyapreferenceingroupswithlowcohesion,andthusthecohesionlevelmightaffectthewillingnesstotraintogether.
Online-groupexercisingdidnotresultinhigheradherencewhencomparedtoindividualtrainingwithpersuasionfeatures(RQ2)Wehaveobservedahigheradherenceforthegroupswithhigh-cohesion,andinparticular,underthegroup-exercisingtreatment(Interaction:87%,SD=23;Individual:77%,SD=25).However,theanalysisofcovarianceshowedneithera
significantmaineffectforgrouporforstudy,norinteractionbetweenstudyandgroup.Thissuggeststhattheaddedgroup-exercisingfeaturedidnotaccountforasignificantdifferenceinpersistenceratecomparedtotheindividualtrainingwithpersuasionfeatures(Interaction:65%,SD=25;Individual:74%,SD=30).InourpreviousstudywithItalianolderadults[12],weobservedahigheradherencetotheonlinegroup-exercisingcomparedtoindividualtraining(withnopersuasionstrategies).Here,wedidnotobservethesameeffectwhencomparingonlinegroup-exercisingtoindividualtraining(withpersuasionstrategies).Weattributethiseffectto:i)Persuasionfeaturesintheindividualtrainingconditionthatraisedtheadherenceby10%comparedtoourpreviousstudy[12].Thisincreasemadethedifferenceinfavorofthegroup-exercisingconditionnon-significant.ii)WeakercohesionamongparticipantsinTomsk2,whichmighthavereducedtheeffectofnormativeinfluenceandpeersupport,resultingina20%dropinadherencecomparedtoTomsk1andourpreviousstudy[12].Theseresultscontributetotheongoingdiscussiononthedifferencesbetweenindividualandgrouptraining(see[21]forthemostrecentmeta-analysisonthetopic).First,itaddstotheevidencethatgroup-exercisinginlowcohesiongroupsresultsinanadherencecomparabletothatofindividualtrainingwithcontact(withacoach),extendingtheevidencetoonlinesettings.Second,itpartiallysupportstheevidencethatgroup-exercisinginhighcohesiongroupsresultsinhigheradherencethanindividualtrainingwithcontact.Onthispoint,wehaveseenevidenceonlywhencomparinggroup-exercisingtoindividualtrainingwithnopersuasionstrategies,whichisindeedclosertotheindividualconditionexploredin[21].Thepossibilityofincorporatingpersuasionstrategiesinonlinesettingaddsanewdimensionthatrequiresfurtherinvestigation.
Socialsupportcanpredictadherencetoatrainingprogramwhensocialconnectionsareweakorabsent(RQ2)Inanalysingtheeffectsofsocialsupportonadherence,wehaveseenasignificantinteractionbetweenstudyandtheinitialsocialsupportscoreatbaseline.InTomsk2participantswithhighersocialsupportlevelshowedhigheradherencetothetraining.Thissuggeststhathigherlevelsofsocialsupportisassociatedwithhigherlevelsofadherencewhentheconnectionamongparticipantsisweak(Tomsk2).Thisobservationisinlineswiththeliteraturehighlightingthesocialsupportstructureasanimportantdeterminantofadherence[7],[8].Interestingly,Tomsk1didnotshowasignificantassociationbetweeninitialsocialsupportandadherence.Thissuggeststhatlowlevelsofexternalsocialsupport(asmeasuredatbaseline)canalsobecompensatedwiththesocialdynamicsofanonlinegroupwithstrongcohesion(Tomsk1).
Enjoymentofphysicalactivitywithcontradictingeffectsonadherenceforgroupswithweakandstrongcohesion(RQ2)Enjoymentofphysicalactivityisdescribedasdeterminantofphysicalactivity[7],[8]andisassociatedwithpositiveattitudestowardexercise,intrinsicmotivation,
andconsequentlylong-lastingadherencetophysicalactivity[42],[43].Wehaveseenhoweversomeconflictingeffectsofthisvariable-asmeasuredwiththePACESscale-ontheadherenceofthegroupswithweakandstrongcohesion:allgroupsshowedhigheradherenceforhigherPACESscore,exceptfortheInteractiongroupwithlowcohesionthatshowedtheoppositeeffect.Thisnegativeeffectonadherenceinthelattergroupcameasasurprise,anditrequiresfurtherstudytoinvestigateitsroots,andwhetheritisduetonegativesocialdynamicsinlowcohesionsettings.
Initialleveloffitnesswithnonsignificanteffectonadherenceofonlinegroup-exercisingandindividualtrainingwithpersuasionstrategies(RQ2)Implementinggroupexercisingcanbechallenging,especiallyinheterogeneouspopulations.Individualdifferencesamongolderadultscanleadtomotivationalissuesandproblemsintailoringthetraining[11].Inaddition,perceivedbarrierssuchaslackofskills,pain,fearofinjuriesandfallscanalsoconstituteobstaclestothemotivationofolderadultstoexercise.InourpreviousstudywithItalianolderadults[26]weobservedthattheinitialleveloffitnesscouldpredicttheadherenceofolderadultstoanindividualtraining(withoutpersuasionstrategies).Itwasalsoobservedthattheonlinegroup-exercisingtool-thesameusedinthepilotsreportedinthispaper-waseffectiveinmitigatingthateffect.Inlineswiththispriorstudy,theresultsfromourtwopilotsshowedthattheinitialleveloffitnessdidnothaveasignificanteffectonadherenceoftheInteractiongroup,butneitherontheadherenceoftheIndividualgroup.OnepotentialexplanationisthepresenceofindividualpersuasionstrategiesintheversionoftheappusedbyIndividualgroup,whichmighthaveleveledtheeffect.Thissuggeststhatmorestudiesareneededinordertobetterunderstandtherootsoftheobservedeffectsoftheinitialleveloffitness,aswellastheeffectsofindividualandsocialpersuasioninmitigatingthem.
Seasonalfluctuationsanditsinfluenceonavailabilityofcandidateparticipants(RQ2)Seasonalfluctuationhasbeenfoundtodeterminethelevelofphysicalandsocialactivitiesofolderadults[13]especiallyinhighlatitudeswherewintercanresultinadeclineofphysicalfunctionsofolderadults[14].InSiberia,thesefluctuationsgreatlyinfluencetheactivitiesofthedailylivingandtheopportunitiestoengageinactivitiesingeneral.Althoughourstudiesweresetinspringandsummerperiods,wedidexperimenttheeffectsoftheseasonalfluctuationbutatrecruitment,andforquitetheoppositereasons.June-Septemberisgardeningseasonandindependentlivingolderadultsusuallyengageinthisactivity,spendingmostoftheperiodintheirsummerhouses(Dacha).Thisinfluencedtheavailabilityofparticipantsinourstudyasitcreatedobstaclesforsomecandidatesthatshowedinitialinterestinparticipating(e.g.,findingtimetotrainandworriesofbringingtabletswiththemoutdoorsortotheDacha).Afterthisexperience,thesecondstudywasmovedtoearlierspringmonths(April-June)toincreasethepoolofpotentialcandidates.However,wedidnotseea
significantdifferenceintheprogramadherencethatcouldbeexplainedbythesetwodifferentseasons.Furtherstudiesareneeded,especiallytounderstandtheeffectsoftheextremewinterseason.
Increaseinlifesatisfactionasresultofthetraining,regardlessoftheversionoftheapplication(RQ3)Recenthistory,alongwithcurrentsocial,political,andeconomicalfactorshaveimpactednegativelyinlifesatisfactionandhappinessofolderadultsintheRussianFederation[17].Thus,devisingandstudyingsolutionsaimingincreasingthehappinessandwell-beingofolderadultsinthisregionisofparamountimportance.Ininvestigatingtheimpactofphysicaltraining,wehaveseenanoverallimprovementinthesatisfactionwithlifescoreforallparticipants,regardlessoftheversionofthetoolused.ThisisconsistentwithourpreviousstudywithItalianolderadults[26]whereweobservedanimprovementinthesubjectivewell-beingoftheparticipantsregardlessofbeingpartoftheindividualorgroupcondition.Furthermore,theseresultsareinlinewithpreviousliteratureonthebenefitsofphysicalactivityonthequalityoflifeofolderadults[44],[45],andcontributewithadditionalevidenceinfavoroftechnology-supportedinterventionsandtheirbenefitforolderadultsintheSiberianregion.
Nosignificantdecreaseinloneliness,despitesocialfeatures(RQ3)Participantsdidnotobserveanydecreaseinthelonelinessscoreasaresultofthetraining,noteventhoseintheonline-groupexercisecondition.Thisiscontrarytoourexpectations,giventhesocialcontextprovidedbythegroup-exercisingandthesocialinteractionfeatures.InTrento,Italy[26]wedidobserveasignificantdecreaseinthelonelinessscore,butcomparedtocurrentstudy,theusageofsocialinteractiontoolsandadherencetothetrainingwasmuchhigher.Thisdifferenceintheusageofsocialinteractionfeatures,possiblyduetoculturaldifferencesasreportedearlier,couldhavelimitedtheeffectivenessofthemedium.
Limitations
GenderimbalanceThelifespangapbetweenmalesandfemalesintheSiberianregionisoneofthebiggestintheworld:lifeexpectancyatbirthformenis64.7years,whereasforwomenitis76.3years[46].Thesedemographicslimittheavailabilityofmalecandidatesintheseniorcitizenorganisations,andthereforeourabilitytorecruitmoremaleparticipants.However,previousstudiessuggestthatmaleandfemaleparticipantsmayhavethesamereactionstosportactivitiesdespitedifferencesinmotivestoparticipation[47,48].Still,furtherstudiesareneededtoseeiftheseobservationscanbetranslatedtotheinterventiondescribedinthispaper.
GroupsizedifferenceTheamountofparticipantsintheTomsk2studywastwicebiggerthaninthefirstTomsk1study,40and20partcipantsrespectively.
Thedifferenceinthegroupsizebetweenthetwostudiesisduetoi)thecomplexityofthestudydesignandii)thedifficultyinfindingparticipantsofolderagewillingtoparticipate,giventhespecificsocialcharacteristicsoftheregion(olderadultslivinginSiberiaarenotusedtoparticipateinstudies).Therefore,wewereabletoinvolveonly20participantsforthestudyTomsk1.Thefollowingyear,aswebuiltbettercontactswithvariousretirementorganisations,andlocalorganisationsbecamemorefamiliarwiththeproject,wewereabletoinvolve40peopleinthestudy(Tomsk2).
NoquantitativemeasuresofgroupcohesionGroupcohesionwasdefinedasapropertyofthepoolofcandidates:participantsacquaintedwitheachotherandengaginginjointactivities.Thispropertywasmaintainedduringrandomisationbyensuringthatpairsoffriendswouldendupinthesamegroups.Whilebeingasoliddefinition,thefactthatcohesionwasnotqualitativelymeasuredshouldbenotedasalimitation.
ScalesvalidationinRussianlanguageThereisalackoftranslationsofinternationalstandardizedmeasureinRussia.Therefore,excepttheSatisfactionwithLifeScale(whichhasalreadybeenvalidateinRussianlanguage),notranslationwasavailableforthemeasuresusedinthestudy.ThesemeasuresweretranslatedandadaptedtoRussianlanguageandculturebyourresearchgroupbyusingthestandardtranslation/bask-translationprocedure.Duringthisprocedureweensuredtoreachsemantic,idiomaticandconceptualequivalencebetweentheoriginalEnglishandfinalRussianversions.Althoughwithoutavalidationstudywecannotbecompletelysurethattheseinstrumentsfullyfitthesocio-economiccharacteristicsofSiberia,webelievethatthestandardprocedureadoptedtotranslatetheseinstrumentsprovidedreliableresults.Thisshouldbeconsideredasthelimitationofthestudy.
ValidityoftheSystemUsabilityscaleTwoquestionswereexcludedfromtheSUSbecauseinthepretestofthepre-finalversionofthescale(duringthetranslation/back-translationprocedure)olderadultsfounddifficulttounderstandthem(“Ifoundthevariousfunctionsinthissystemwerewellintegrated",“Ithoughttherewastoomuchinconsistencyinthissystem").Therefore,whereasintheoriginalscalethetotalSUSscorerangedfrom0to100,inourstudyitrangedfrom0to80.Thisisalimitationofourstudyandcouldmakeitdifficulttointerprettheusabilityresults.However,itisworthnotingthatnousabilityscalesuitableforolderadultsexistedinRussianlanguageandourstudyprovidesthefirstadaptationforthisculture.FuturestudiesshouldinvestigatethevalidityofthisshortversionoftheSUS.
ConclusionTheresultspointtothefeasibilityandeffectivenessoftechnology-supportedphysicalinterventions,andinparticularofonlinegroup-exercising,amongSiberianolderadults.Highcohesiongroupsarepreferableforgroup-exercising,especiallytomitigateeffectsoflowsocialsupportonadherence.Culturaldifferencesmight
explainthepreferenceofprivatemessagesoverpublicones.Resultsintermsofsubjectivewell-beingarepromisingbutenablinginteractionhasprovednottobeenoughtoobserveadecreaseinloneliness.Thus,furtherresearchisneededinordertounderstandhowtobetterenablecommunitybuildinginteractions.
AcknowledgmentsThestudyanddatacollectionwassupportedbytheproject“Evaluationandenhancementofsocial,economicandemotionalwellbeingofolderadults”,undertheagreementNo.14.Z50.31.0029,TomskPolytechnicUniversity.DataanalysiswassupportedbytheTomskPolytechnicUniversitywithintheframeworkofTomskPolytechnicUniversityCompetitivenessEnhancementProgram
References1. ThibaudM,BlochF,Tournoux-FaconC,BrèqueC,RigaudAS,DuguéB,
KemounG.Impactofphysicalactivityandsedentarybehaviouronfallrisksinolderpeople:asystematicreviewandmeta-analysisofobservationalstudies.EuropeanReviewofAgingandPhysicalActivity2011Jun30;9(1):5. doi: 10.1007/s11556-011-0081-1
2. AcreeLS,LongforsJ,FjeldstadAS,FjeldstadC,SchankB,NickelKJ,MontgomeryPS,GardnerAW.Physicalactivityisrelatedtoqualityoflifeinolderadults.Healthandqualityoflifeoutcomes2006Jun30;4(1):37.PMID:16813655
3. StuartM,ChardS,BenvenutiF,SteinwachsS.Communityexercise:avitalcomponenttohealthyaging.Healthcarepapers2008Dec;10(1):23-8.PMID:20057213
4. LandiF,AbbatecolaAM,ProvincialiM,CorsonelloA,BustacchiniS,ManigrassoL,CherubiniA,BernabeiR,LattanzioF.Movingagainstfrailty:doesphysicalactivitymatter?.Biogerontology2010Oct1;11(5):537-45.PMID:20697813
5. BeagleholeR,EbrahimS,ReddyS,VouteJ,LeederS.Preventionofchronicdiseases:acalltoaction.TheLancet2008Jan4;370(9605):2152-7.PMID:18063026
6. YachD,HawkesC,GouldCL,HofmanKJ.Theglobalburdenofchronicdiseases:overcomingimpedimentstopreventionandcontrol.Jama2004Jun2;291(21):2616-22.PMID:15173153
7. PhillipsEM,SchneiderJC,MercerGR.Motivatingelderstoinitiateandmaintainexercise.Archivesofphysicalmedicineandrehabilitation2004Jul31;85:52-7.PMID:15221728
8. DishmanRK,SallisJF,OrensteinDR.Thedeterminantsofphysicalactivityandexercise.Publichealthreports1985Mar;100(2):158.PMID:3920714
9. HarveyJA,ChastinSF,SkeltonDA.Prevalenceofsedentarybehaviorinolderadults:asystematicreview.Internationaljournalofenvironmentalresearchandpublichealth2013Dec2;10(12):6645-61.PMID:24317382
10. El-KhouryF,CassouB,CharlesMA,Dargent-MolinaP.Theeffectoffallpreventionexerciseprogrammesonfallinducedinjuriesincommunity
dwellingolderadults:systematicreviewandmeta-analysisofrandomisedcontrolledtrials.BMj2013Oct29;347:f6234.PMID:24169944
11. deGrootGC,FagerströmL.Olderadults'motivatingfactorsandbarrierstoexercisetopreventfalls.ScandinavianJournalofOccupationalTherapy2011Jun1;18(2):153-60.PMID:20545467
12. FarIK,FerronM,IbarraF,BaezM,TranquilliniS,CasatiF,DoppioN.Theinterplayofphysicalandsocialwellbeinginolderadults:investigatingtherelationshipbetweenphysicaltrainingandsocialinteractionswithvirtualsocialenvironments.PeerJComputerScience2015Nov25;1:e30.doi:10.7717/peerj-cs.30
13. PerryTE.Seasonalvariationandhomes:understandingthesocialexperiencesofolderadults.CareManagementJournals2014Mar1;15(1):3-10.PMID:24761536
14. BirdML,HillKD,RobertsonIK,BallMJ,PittawayJ,WilliamsAD.Serum[25(OH)D]status,anklestrengthandactivityshowseasonalvariationinolderadults:relevanceforwinterfallsinhigherlatitudes.Ageandageing2012May14:afs067.PMID:22585931
15. StickleyA,KoyanagiA,LeinsaluM,FerlanderS,SabawoonW,McKeeM.LonelinessandhealthinEasternEurope:findingsfromMoscow,Russia.Publichealth2015Apr30;129(4):403-10.PMID:25744109
16. YangK,VictorC.Ageandlonelinessin25Europeannations.AgeingandSociety2011Nov1;31(08):1368-88.doi:10.1017/S0144686X1000139X
17. AbbottP,SapsfordR.Life-satisfactioninpost-SovietRussiaandUkraine.JournalofHappinessStudies2006Jun1;7(2):251-87.doi:10.1007/s10902-005-5563-2
18. MüllerAM,KhooS.Non-face-to-facephysicalactivityinterventionsinolderadults:asystematicreview.InternationalJournalofBehavioralNutritionandPhysicalActivity2014Mar10;11(1):35.PMID:24612748
19. VanDerBijAK,LaurantMG,WensingM.Effectivenessofphysicalactivityinterventionsforolderadults:areview.Americanjournalofpreventivemedicine2002Feb28;22(2):120-33.PMID:11818183
20. AtienzaAA.Home-basedphysicalactivityprogramsformiddle-agedandolderadults:Summaryofempiricalresearch.JournalofAgingandPhysicalActivity2001May1.doi:10.1123/japa.9.s1.s38
21. BurkeSM,CarronAV,EysMA,NtoumanisN,EstabrooksPA.Groupversusindividualapproach?Ameta-analysisoftheeffectivenessofinterventionstopromotephysicalactivity.SportandExercisePsychologyReview2006;2(1):19-35
22. Khaghani-FarI,NikitinaS,BaezM,TaranEA,CasatiF.FitnessApplicationsforHome-BasedTraining.IEEEPervasiveComputing2016Oct;15(4):56-65.doi:10.1109/MPRV.2016.76
23. ElderAJ,ScottWS,KlugeMA,ElderCL.CyberExInternet-BasedGroupExerciseforRuralOlderAdults:APilotStudy.Activities,Adaptation&Aging2016Apr2;40(2):107-24.doi:10.1080/01924788.2016.1158597
24. BaezM,FarIK,IbarraF,FerronM,DidinoD,CasatiF.Effectsofonlinegroupexercisesforolderadultsonphysical,psychologicalandsocialwellbeing:apilottrial.arXivpreprintarXiv:1612.02686.2016Dec8.
25. GardnerMM,BuchnerDM,RobertsonMC,CampbellAJ.Practicalimplementationofanexercise-basedfallspreventionprogramme.Ageandageing2001Jan1;30(1):77-83.PMID:11322678
26. BaezM,IbarraF,FarIK,FerronM,CasatiF.OnlineGroup-exercisesforOlderAdultsofDifferentPhysicalAbilities.arXivpreprintarXiv:1609.05329.2016Sep17.
27. FarIK,SilveiraP,CasatiF,BaezM.Unifyingplatformforthephysical,mentalandsocialwell-beingoftheelderly.InEmbeddedandMultimediaComputingTechnologyandService2012:385-392.doi:385-392.10.1007/978-94-007-5076-0_46
28. SteverinkN,SlaetsJP,SchuurmansH,VanLisM.Measuringfrailty.DevelopmentandtestingoftheGroningenFrailtyIndicator(GFI).Gerontologist2001;41(1):236
29. TopolskiTD,LoGerfoJ,PatrickDL,WilliamsB,WalwickJ,PatrickMMB.TheRapidAssessmentofPhysicalActivity(RAPA)AmongOlderAdults.PreventingChronicDisease2006;3(4):A118.PMID:16978493
30. BrookeJ.SUS-Aquickanddirtyusabilityscale.Usabilityevaluationinindustry1996Sep;189(194):4-7.ISBN:0748403140
31. DienerED,EmmonsRA,LarsenRJ,GriffinS.Thesatisfactionwithlifescale.Journalofpersonalityassessment1985Feb1;49(1):71-5. PMID:16367493
32. TuckerKL,OzerDJ,LyubomirskyS,BoehmJK.Testingformeasurementinvarianceinthesatisfactionwithlifescale:AcomparisonofRussiansandNorthAmericans.SocialIndicatorsResearch2006Sep1;78(2):341-60.doi:10.1007/s11205-005-1037-5
33. SherbourneCD,StewartAL.TheMOSsocialsupportsurvey.Socialscience&medicine1991Jan1;32(6):705-14. PMID:2035047
34. MoserA,StuckAE,SillimanRA,GanzPA,Clough-GorrKM.Theeight-itemmodifiedMedicalOutcomesStudySocialSupportSurvey:psychometricevaluationshowedexcellentperformance.Journalofclinicalepidemiology2012Oct31;65(10):1107-16.PMID:22818947
35. RussellD,PeplauLA,CutronaCE.TherevisedUCLALonelinessScale:Concurrentanddiscriminantvalidityevidence.Journalofpersonalityandsocialpsychology1980;39(3):472-80.PMID:7431205
36. HughesME,WaiteLJ,HawkleyLC,CacioppoJT.Ashortscaleformeasuringlonelinessinlargesurveysresultsfromtwopopulation-basedstudies.Researchonaging2004Nov1;26(6):655-72.PMID:18504506
37. KendzierskiD,DeCarloKJ.Physicalactivityenjoymentscale:Twovalidationstudies.JournalofSportandExercisePsychology1991Mar;13(1):50-64. doi:10.1123/jsep.13.1.50
38. BeatonDE,BombardierC,GuilleminF,FerrazMB.Guidelinesfortheprocessofcross-culturaladaptationofself-reportmeasures.Spine2000Dec15;25(24):3186-91.PMID:11124735
39. JonesCJ,RikliRE,BeamWC.A30-schair-standtestasameasureoflowerbodystrengthincommunity-residingolderadults.Researchquarterlyforexerciseandsport1999Jun1;70(2):113-9.PMID:10380242
40. TeamRC.R:Alanguageandenvironmentforstatisticalcomputing.RFoundationforStatisticalComputing;2014. ISBN3900051070
41. WickhamH.ggplot2:elegantgraphicsfordataanalysis.Springer;2016.ISBN:978-3-319-24275-0
42. WankelLM.Theimportanceofenjoymenttoadherenceandpsychologicalbenefitsfromphysicalactivity.InternationalJournalofSportPsychology1993Apr.
43. RichardM,ChristinaMF,DEBORAHLS,RubioN,KENNONMS.Intrinsicmotivationandexerciseadherence.IntJSportPsychol.1997;28(4):335-54.
44. McAuleyE,KonopackJF,MotlRW,MorrisKS,DoerksenSE,RosengrenKR.Physicalactivityandqualityoflifeinolderadults:influenceofhealthstatusandself-efficacy.AnnalsofbehavioralMedicine2006Feb1;31(1):99.PMID:16472044
45. VagettiGC,BarbosaFilhoVC,MoreiraNB,OliveiraVD,MazzardoO,CamposWD.Associationbetweenphysicalactivityandqualityoflifeintheelderly:asystematicreview,2000-2012.RevistaBrasileiradePsiquiatria2014Mar;36(1):76-88.PMID:24554274
46. WorldHealthOrganization.(2015).GlobalHealthObservatoryDataRepository:Lifeexpectancy–Databycountry.Retrievedfromhttp://apps.who.int/gho/data/view.main.SDG2016LEXv?lang=en(accessedonJune2016)
47. Koivula,N.(1999).Sportparticipation:Differencesinmotivationandactualparticipationduetogendertyping.JournalofSportBehavior,22(3),360.
48. Richard,M.,Christina,M.F.,Deborah,L.S.,Rubio,N.,&Kennon,M.S.(1997).Intrinsicmotivationandexerciseadherence.IntJSportPsychol,28(4),335-354.
49. C.W.Phang,J.Sutanto,A.Kankanhalli,Y.Li,B.C.Tan,andH.-H.Teo,“Seniorcitizens’acceptanceofinformationsystems:Astudyinthecontextofe-governmentservices,”EngineeringManagement,IEEETransactionson,vol.53,no.4,pp.555–569,2006.