Synchronous Group-Based Tele-Exercise versus Community-Based Interventions: Effects on Physical Functioning and Adherence in Older Adults at Risk of Falls - A Randomized Controlled Trial

Background Falls are common in older adults and can cause serious harm. Tele-exercise offers a promising alternative to traditional programmes, especially for those with mobility or access limitations. However, existing studies are limited by high-risk-of-bias, non-representative samples and inadequate sample size estimation, necessitating rigorous research. This study addressed these gaps by evaluating the effectiveness of synchronous group-based tele-exercise (TE) versus community-based (CB) exercise in improving physical function, exercise adherence and maintenance among older adults at risk of falls. Methods Ninety-four community-dwelling older adults from 10 Hong Kong community centres were randomized to TE or CB groups. Both received modified Otago exercise training for 3 months with 9-month follow-up. Fall and functional outcomes included Fall Efficacy Scale-International (FES-I), 6-meter walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), Functional Reach Test (FRT), and Appendicular Skeletal Muscle Mass Index (ASMI), assessed at baseline, 3, 6, and 12 months. Exercise experience and maintenance outcomes included exercise adherence and Physical Activity Scale for the Elderly (PASE-C) and physical activity level. Analysis used a modified intention-to-treat approach. Results Between group analysis revealed that TE had significantly higher PASE-C scores at 12 months (p<0.05, ES=0.37) and greater light activity minutes at 6 months (p<0.05, ES=0.33). In contrast, CB demonstrated significantly higher adherence (90% vs. 80%, p=0.01) and lower dropout rate (0% vs. 10.4%, p<0.01). No significant between-group differences were observed in fall risk or physical function outcomes. Within group analysis revealed that both groups improved in fall risk and physical function to varying extents. No serious adverse events occurred. Conclusions Synchronous group-based tele-exercise is as effective as face-to-face community training for improving fall risk and physical function among older adults at risk of falls. Notably, tele-exercise demonstrated a slight advantage in sustaining long-term exercise maintenance. This may be attributed to participants becoming accustomed to exercising at home during the initial three-month intervention, making it easier to continue training independently over the following nine months. However, the higher dropout rate in the tele-exercise group raises concerns. These findings support tele-exercise as a viable and accessible alternative for promoting long-term physical activity in older adults. Trial registration number ChiCTR2200063370