Digital Health Technologies and Aerobic Exercise
Given the considerable barriers for adherence to aerobic exercise guidelines, digital health technologies, such as wearable activity tracking devices and mobile health (mHealth) apps, have been pursued as potential tools to promote higher levels of physical activity among midlife and older adults. Digital health technologies are promising as they may overcome barriers to physical activity, such as facility access, transportation, geographic location, and availability of community-based programs. Select exercise interventions administered via mHealth technologies increase physical activity levels and reduce sedentary behaviors in individuals across the lifespan,[48,49] as well as in older populations. There is a wide range of mHealth interventions for promoting physical activity in midlife/older adults. Examples of these diverse strategies include use of accelerometers and pedometers, text messaging reminders, Internet-delivered interventions, interactive applications, exergaming, and online professional and peer support.[51,52]
In general, physical activity monitors, such as accelerometers and pedometers, increase physical activity by 1000 to 1500 steps per day over short-term intervention periods. Accelerometers appear to increase physical activity to a greater extent than pedometers, which may be due to differences in the accuracy of step detection between these types of devices. Internet-based (eHealth) physical activity interventions also increase steps per day, minutes of moderate-to-vigorous physical activity per day, and overall minutes per week of physical activity. Importantly, theory-based interventions (e.g., those interventions that increase motivation and include behavior change techniques) are more effective, regardless of the method of administration.
Others have shown positive trends, but no significant effects, of app-based interventions on improving physical activity levels in older adults, likely due to the small sample sizes of most current trials.[56,57] App features, such as syncing to smartwatches or activity monitors, instructions, goal setting, self-monitoring, and social support, are commonly successful features in mHealth-based interventions in which trends for improving physical activity levels are observed.[56,57]
Overall, digital health technologies have shown benefits for promoting physical activity in older populations, increasing physical activity on average by 28% compared with control groups without digital health support tools. This has led certain working groups, such as the Community Preventive Services Task Force, to recommend the use of digital health technologies to deliver physical activity interventions in adults 55 yr and older. However, even with the ability of digital health technologies to increase physical activity over initial levels, midlife and older adults still struggle to accrue enough activity to meet guideline recommendations. This indicates that there are additional barriers to performing adequate amounts of aerobic exercise, even when digital health technologies are in use.
Unexplained heterogeneity, bias, and lack of rigorous methodology limit the ability to compare studies and draw strong conclusions regarding the effectiveness of physical activity monitors and digital health technologies for increasing physical activity in older populations. Larger-scale trials with longer-term intervention and follow-up durations are warranted to provide a better understanding of mHealth physical activity interventions for improving exercise adherence in midlife/older adults.[53,56] Additionally, studies that employ rigorous and objective measures of adherence to home-based mHealth exercise interventions for midlife/older adults are necessary.
Exerc Sport Sci Rev. 2022;50(3):107-117. © 2022 American College of Sports Medicine