Beyond the Screen: A Mixed-Methods Exploration for Guidelines on technical and psychological features of Effective Tele-Exercise Programs

Beyond the Screen: A Mixed-Methods Exploration for Guidelines on technical and psychological features of Effective Tele-Exercise Programs | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Beyond the Screen: A Mixed-Methods Exploration for Guidelines on technical and psychological features of Effective Tele-Exercise Programs Manuela Cantoia, Giovanna Zimatore, Barbara Matteo, Martina Sausa, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6427175/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Tele-exercise has significant potential as a tool to promote physical activity, particularly for individuals facing barriers to accessing gyms or sports centres due to geographical, physical, or financial constraints. While tele-exercise derives from telemedicine, it remains a less defined field with no established guidelines to regulate or standardize its implementation. This gap highlights the need for structured frameworks to ensure the safety, effectiveness, and accessibility of tele-exercise. This study aimed to establish a consensus on some fundamental aspects of tele-exercise through a structured four-round process. Methods: This mixed-method approach combined analyses of scientific literature with experts’ opinions collected via focus groups and an ad hoc questionnaire. In detail, the paper focused on the following fundamental aspects: 1) operative definitions of tele-exercise, 2) fitness training programs design, 3) requirements for spaces and equipment, 4) safety protocols for remote exercise, 5) the role and impact of technology, 6) relational and communication strategies to enhance engagement, and 7) monitoring methods for asynchronous and synchronous training sessions. Results: The guidelines provide a comprehensive examination of these aspects, addressing current gaps and limitations while outlining opportunities for improvement. The study underscores the importance of developing standardized practices to ensure safe and effective implementation of tele-exercise. Conclusions: By addressing these challenges, tele-exercise can evolve into an inclusive, scalable tool for promoting physical activity, paving the way for broader access and participation in fitness activities. Biological sciences/Psychology Health sciences/Health care Health sciences/Health care/Quality of life Remote training eHealth tele-fitness tele-coaching home-based exercise synchronous and asynchronous mode Figures Figure 1 Background Tele-exercise has been long practised with rehabilitation and telemedicine purposes with positive and promising results ( 1 ). The words "tele-exercise" appeared for the first time on PubMed database in the title of a scientific paper in 2006 ( 2 ), and it spread in the past ten years with a dramatic increase in the last few years. Since the Pandemic of COVID-19 many healthy people started to workout at home ( 3 – 6 ). While there is quite a corpus of studies on medical use of tele-exercise, the fitness purpose for healthy people is not yet been studied deeply ( 7 ). In both cases, depending on the specific target and purpose, guidelines are very heterogeneous: exercise may be prescribed for 20 to 90 minutes per session, to be repeated 2 to 7 times a week, for a total of 4 to 16 weeks ( 5 , 6 , 8 – 12 ). The current literature refers to workouts that are either synchronous or asynchronous. In the first case they mostly used general web-based conferencing software such as Zoom, Skype or Teams ( 13 , 14 ); in asynchronous tele-exercise researchers delivered customized videos through email or message application ( 15 ) or broadcasted them on YouTube ( 16 ). In all these studies, the exercise routine was designed by specialized instructors and in a few cases, it was even tailored on the participant’s needs, which is possible in a research context, but harder for a larger audience. Nowadays, tele-exercise for fitness purpose is based on a multitude of online application proposing free, as well charged programs but that in most cases do not provide specifics as to the design of their workout programs or their authors, nor undergone a scientific validation. Moreover, instructors often did not provide evidence of a specific professional experience in remote coaching. There is the need for a more systematic and scientific approach to tele-exercise for fitness and healthy people and to its regulation. This study was aimed at exploring a design procedure for tele-exercise. Reaching a consensus within the scientific community is the premises for reliable and widespread studies on the efficacy of tele-exercise in different modalities (synchronous and asynchronous) and addressing users with a large spectrum of characteristics as to gender, age group, exercise habits, time availability, etc. On the other side, there is a social urgence to clear the efficacy of tele-exercise programs for fitness, because they could be representing an asset to prevent sedentary habits, obesity and increasingly widespread unhealthy lifestyles ( 17 , 18 ) Methods To gather the larger bases of knowledge we started from the review of the literature and proceeded with a mixed methodology, mostly referred to the Delphi technique ( 19 ), aimed at generating consensus through an iterative process of questioning of more rounds. After each round, responses were analysed and redistributed for discussion. The principal pattern of discussion was organized in four rounds of questioning: Round one – The documentary analyses : We started with a review of the scientific literature ( 20 ), and a mapping of the web sites (both scientific and popular ones) and web applications ( 1 , 21 ). Round two - Focus groups I : Interviews and focus groups with the experts from the TeleExe4All project were carried out to discuss the literature and the state of art on tele-exercise. The aim was to define the main areas of further investigation. Finally, five areas of analyses were identified: 1) Fitness training design; 2) Spaces and equipment; 3) Technologies; 4) Relational and communication modalities; 5) Monitoring. Round three – Interviewing of external experts : Experts were contacted via email, signed an informed consent and then filled in an in-depth questionnaire that explored detailed specifics of tele-exercise for fitness. The questionnaire was administered via Computer Assisted Web Interviewing (CAWI) and experts were asked to spread the link among their peers using snowball effect sampling ( 22 ), where new participants are progressively recruited through social networks, facilitating access to groups that are difficult to reach using traditional methods. Round four – Focus group II : the results of the survey were first analysed and then discussed in focus groups with the experts from the ongoing TeleExe4All project to detect the global best level of agreement. Analyses resulted in the final document (see Fig. 1). ***Figure 1 . Graphical illustration of the 4 rounds of the investigation method*** The study was approved by the Ethics Committee of the University of Trás-os-Montes & Alto Douro protocol Doc73-CE-UTAD-2019 (13 January 2020). The study was conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. The experts’ profile Internal experts from TeleExe4All project were seventeen (11 men and 6 women) either academics, or professionals from Croatia, Italy, Latvia and Portugal. Their background was mostly in motor science and sports, but a few were academics in medicine, physics and psychology. Their expertise ranged from children to elderly, from amateur to athletes with or without disabilities. During the focus groups experts were divided into different teams that changed at every round of consultations. A smaller group devised the questionnaire. The panel of experts external to the project was sought among academics, researchers and instructors with experience in tele-exercise, according to the following criteria: Peers (personal acquaintances) Authors of scientific publications Members of research groups or centres Members of training centres Professional instructors Initially, 23 external experts agreed to participate in the survey by signing the informed consent. Five of them dropped out of the study and four were excluded since they did not have adequate experience profile. The final panel consisted of 14 experts (9 men and 5 women) with an average age of 42 ± 8.6 years. Their experience in tele-exercise as academics and/or instructors varied from 1 to 7 years, with an average experience of 2.7 ± 2.0 years. The specific of their experience is described in Table 1 , and ranged among professional athletes, amateur athletes, athletes with disabilities, re-athletization athletes, trained participants, non-athletes, participants with sporadic training, sedentary healthy participants, sedentary participants with disabilities, sedentary participants with pathologies. Table 1 Percentage of external experts’ specific experience in tele-exercise Level of experience Excellent/good Moderate/low None Fitness and physical improvement 85.7% 14.3% - Athletic-sport training 35.7% 42.8% 21.4% Motor rehabilitation with non-athletes 28.6% 35.7% 35.7% Re-athletization 21.4% 35.7% 42.8% Postural activities 35.7% 28.6% 35.7% The questionnaire The questionnaire was devised based on the check list created as outcome of the focus groups and it consisted of seven sections. In order not to lose useful insights from the experts, at the end of each question they could specify or integrate their answers in a free text box. At the end of each area of investigation experts could also evaluate if the questions were exhaustive and eventually suggest further topics of analyses. The thematic sections consisted of a total of 74 questions on synchronous mode and 80 on asynchronous mode, including closed-ended questions, rating scales (five-point Likert scale) and open questions. In detail, the Personal data section gathered questions on demographic (sex, age), professional data (education qualification and duration, licenses or specialization in tele-exercise, years and type of experience), and experts’ experience (duration, type and purpose of their interventions, target population). According to the mode in which they were more experienced (synchronous, asynchronous or both modes), experts accessed three specific paths. In the Glossary Section the most recent and quoted operative definitions on Tele-Exercise, Synchronous Tele-Exercise Mode, Asynchronous Tele-Exercise Mode, Tele-Exercise Instructor (see Table 2 ) were to be assessed according to the expert’s level of agreement. Experts could also propose modifications. This section also explored the main characteristics (major advantages and disadvantages) of the different modes of tele-exercise, the types of users who can most benefit from tele-exercise, and whether tele-exercise may be effective in mixed modes (synchronous and asynchronous; at distance - synchronous or asynchronous modes - and in presence). Table 2 Operative Definitions of tele-exercise originally provided in the questionnaire Tele-exercise: A branch of telemedicine that delivers training programs remotely ( 23 , 24 ), through online media ( 9 , 25 ). Activity mode Synchronous : A real-time approach, in which the service is provided simultaneously by the instructor to the participant via videoconference or telephone conversations, allowing immediate feedback to be provided on the execution of the exercises ( 23 , 26 ). Activity mode Asynchronous : A non-real-time approach in which instructors record educational videos that participants play without direct and simultaneous delivery. This approach allows for greater flexibility in accessing training programs, but not the ability to have immediate feedback on the execution of the exercises ( 23 , 26 ) Tele-exercise instructor : With extensive experience in providing training protocols suitable for a virtual environment, he/she instructs participants on how to perform the exercises so that everyone can participate safely ( 26 ). The Fitness Training Design Section explored the parameters to be evaluated before starting the training, the ideal number of participants, number of sessions and duration of each session (for both trained and untrained participants). Experts also evaluated the type of activity to perform depending on the type of users (young, adults, elderly) and the phases of each training session. The Spaces and Equipment Section investigated the characteristics of the environment where exercises are performed, the equipment for amateur and professional users, the recommended clothing. Recommendations and preventive safety measures were also investigated. In the Technologies Section experts were asked to evaluate the most suitable devices, their technical specifications, the best framing for both the participant and the demonstration monitor depending on the type of exercise and the position (upright, sitting, or prone - supine), and the position of the instructor's monitor to observe the participants while performing the exercise. In the Relational and Communication Modalities Section experts evaluated the language, attitude, general relational modalities and communication management respectively at the beginning of the training session, during the explanation, in the encouragement and motivation phases during physical activity, and at end of the activity. Finally, the Monitoring Section dealt with the techniques and tools for the instructor’s monitoring and trained and untrained participants’ self-monitoring. Data analysis Round one (The documentary analyses) Data obtained in the first round were analysed by three members of the group providing a review of methods, techniques and organizational details that was organized to identify content categories. Round two (Focus groups I), and Round three – Interviewing of external experts A content analysis of data obtained from the focus groups (I) was performed to identify the thematic areas of the survey and the experts’ proposals on the single topics to be explored. Statements that were approved by the majority (minimum 60%) were translated into the items of the questionnaire. Quantitative and qualitative data from the questionnaire were analysed performing mean of the scores to the 5-point Likert response scale. Items with a mean scoring under 2.5 were not considered; items with a mean scoring of 2.5 to 2.9 were submitted to the experts for reconsideration; items scored above 3 were accepted ( 19 , 27 – 29 ). Round four (Focus group II) The qualitative data collected from the open-ended questions by which experts could complete their answers in each section of the questionnaire were also analysed according to content analysis methodology. Results Glossary Section - Operative Definitions Experts agreed on the operative definitions from the literature and enriched them with further details. The experts agreed on the following statements: Tele-exercise, which originally started as a branch of telemedicine, delivers training programs through online media, in context of both rehabilitation and health promotion, eventually using supervision tools that allow the collection of participants’ personal data. Tele-exercise is designed and managed by expert instructors who provide training protocols suitable for a virtual environment. They organize the exercise schedule, explain how to perform the exercises safely and monitor the participants’ progresses. They can also guide participants in the use of new technologies during tele-exercise sessions. Tele-exercise can be approached in Synchronous mode, when provided simultaneously by the instructor to one or more participants via online streaming environments. It can also be approached in Asynchronous mode, when the instructor records educational videos that participants play without direct and simultaneous delivery. There is not an ideal addressee for tele-exercise, everyone can access this activity, regardless of their status as sedentary (healthy, with pathologies or with disabilities) or trained to different extent (from casual trainees to professional athletes) individuals. Activities in synchronous mode allow immediate feedback, the direct relationship between instructor and participant, the possibility of training customization and of better guided training and monitoring, together with a sense of comradeship with other participants that enhances motivation. On the other side, streaming sessions may undergo technical issues (need for high Internet connection, device functionality, access to the platform, etc.) and require quite high levels of familiarity with the technologies, resulting in harder efforts for elderly and persons with disabilities. Trainees and trainers may also have limited perspective access according to the monitor they use or their reciprocal positions. Finally, the live monitoring of multiple participants could be difficult for the instructor. The asynchronous mode generally requires an easier technical management: the trainers provide comprehensive and multimedia video lessons with integrated perspectives, texts, visual effects, etc. and they monitor the participants’ performance through direct contact (by phone or email) or through the analyses of video recorded materials. When practising in asynchronous mode, trainees can autonomously schedule their workout sessions, although they cannot share the experience with a group (unless they practice with other people in presence) and are more likely to suffer from lack of motivation and of support from their peers. Moreover, they could perform the exercises not correctly, due to the lack of both supervision and of movement correction in real-time. Finally, in the long term, it could be difficult to produce video materials tailored to participants improving skills and needs. Experts suggest that mixed mode workouts that balance synchronous and asynchronous, or in-person and tele-exercise sessions can be effective, more flexible and less expensive. In addition, participants could catch up missing workout sessions and be more constant in their training, especially during holidays and work travels, or in case of re-athletization after injuries or pathologies. They could also exercise alone, to improve and consolidate new strategies and exercises. Trainers could picture a more complete idea of the participants’ level of performance and adapt their practices or correct their executions. Fitness training design Experts agreed that ahead of the beginning of the training, regardless of the mode (synchronous or asynchronous), it should be compulsory to gather the following personal data: age, sex, weight, height, waist circumference, medical history and current medication intake, address and emergency contact, lifestyle habits (sleep, type of work, daily stress; movement habits, diet), devices at disposal for the training and internet connection specifics, material and space conditions, training schedules and time available for training. Attitudes and previous experiences should also be assessed: objectives and expectations, previous (tele) exercise experiences and their history, physical exercise preferences, comforts and discomforts in practicing physical exercise, motivation and self-efficacy, familiarity with technologies. The duration of the program should depend on the participants’ goals, characteristics, levels of ability, preferences, and on the intensity of the training. Details on the number of participants and the number of sessions a week are provided in Table 3 . Technical details on the exercises for the fitness training also should depend on various factors including avoiding expensive or bulky equipment. Some recreational activity during the workout is recommended to keep the participants motivated. Table 3 Fitness training design in tele-exercise Synchronous mode Asynchronous mode Participants per session 2 to 10 Maximum 50 (to monitor the group at distance) Workouts per week Not trained participants : 2–3 times of 45–60 min each Trained participants : 3 times of 45–75 min each 3–5 times a week for 45–60 min, regardless of training level. Workout phases^ Welcoming and explanation phase; warm-up; the real exercise sequence; the cool-down; the closing, with feedback and information on the following steps Exercises^ Regardless of the participants’ age and training mode : Aerobic activity, Muscle strength improvement activities, Coordination-based activities, Proprioceptive activities, Mixed activities, Joint mobility, flexibility, stretching, recreational activities Suggested for young and adults : High-intensity cardiovascular exercise Suggested for elderly : Balance activities ^ for both synchronous and asynchronous mode Spaces and equipment Experts highlighted that exercise in a home-based environment requires a space with no potential risk to the individual's safety. The space should be lit and ventilated. Participants also need a good Internet equipment and devices to connect to the platform (see next sections). Not trained and amateur trainees can perform bodyweight exercises with a mat, a chair, weights (or similar objects, e.g., bottles). A more professional training could benefit from the use of a step platform, resistance bands and fit balls. In synchronous mode, participants should wear form-fitting non-restrictive attire to allow the monitoring of their movements by the instructor. Breathable fabric shirt and shorts are suggested as well as footwear suitable for the type of activity. Safety In tele-exercise participants perform the exercises in their homes or in facilities, far from the immediate and direct control of a professional instructor. Experts agreed that regardless of the training mode, elderly trainees and participants with motor difficulties could benefit from another person’s presence in the same site, in case of problems during or after the workout. Participants in asynchronous sessions should also provide an emergency contact. The environment should be spacious and safe, to avoid possible interference from other participants (e.g., roommates) or objects (walls, furniture, etc.). There should be also available attachment points. A mandatory written consent form and written disclosure of liability must be gathered before starting the training. The need for health certificates for non-competitive or competitive sports practice as well as for specific insurance programs should also be checked since those topics are regulated in different ways throughout different Countries. In the light of the participants’ health and medical history, it should be recommended to monitor or to suggest participants to monitor blood pressure and heart rate before and after the workout. Technologies According to the experts, the fundamental criteria as to technologies are portability and easy access and, for the synchronous mode, good wi-fi connection. Big screens (at least 12–13’’, full HD, such as TV monitors or laptops) and devices with good sound system and cameras are preferable; tablets and smartphone, although often used, provide a less easy access to visual information. In synchronous mode, for an effective experience devices should be set near to the participant and both participants and instructors should check to have a complete and mutual framing. The camera should be set frontal or lateral, with perspective from 90° and 45° for upright, sitting, or prone workout; exercises in prone position might benefit from a view from above. In the asynchronous mode the instructor must focus on the quality and completeness of information of the instructional videos, adding texts, notes, visual effects and augmented reality elements through thoughtful video editing. Videos recorded specifically with special editing are more suitable than videos recorded in live sessions, nonetheless, the instructor can add frames from live training sessions for more realistic and immersive effect. Relational and communicative methods In tele-exercise, the direct physical interaction is missing, and nonverbal communication may be hard to detect. Experts suggested that communication should be kept simple, clear, friendly and adapt to the groups, according to their age, goals, level of skills, etc. It is also important to share a common technical vocabulary and avoid the use of acronyms and unfamiliar or foreign language. In the interaction with the participants, the instructor should have an empathetic, engaging, motivating, encouraging attitude, maintaining a professional tone, eventually accompanied by some polite humour. Regardless of the mode of training, the session should start welcoming the participants and assessing their well-being and psycho-physical conditions (pain, tension, fatigue, restlessness, etc.) since the previous workout. In the asynchronous mode this phase can be suggested as a form of self-assessment. Then, the instructor should provide a brief recap of the aims of the training (referring also to the previous lessons), introduce the goals of the current session, and explain the planned activities. If needed, in the synchronous mode they could reinforce technical information for the Internet connection. In asynchronous mode they could make the explanation clearer by using clips or images of movements. The explanation of the exercise should start from the objectives and outcomes of the exercise, followed by the demonstration of the movement. This demonstration should be given before or along with its verbal description, because starting from the description would lead to a less effective understanding. The disclosure of possible errors in the movement or of general critical issues in advance may be effective for the participants to avoid them. Instructors should also provide information on timing, repetitions, sequences and describe what psycho-physical reactions to expect during the execution (fatigue, muscle tension, changes in breathing, etc.). At the end of the session, still regardless of the specific mode of training, the instructor should check (directly or indirectly) the well-being status of the participants, then provide a summary of the workout activities and contextualize it within the perspective of overall goals. Upcoming appointments should be reminded, along with a preview of the objectives for the next workout session or suggestions for future workout. The instructor should also acknowledge the participants’ progress and eventual issues. Participants keep their motivation when they are given realistic goals: they need continuous feedback, encouragement and realistic expectations on their improvements. Their focus should be set on the overall final goal and as they approach it, the instructor should acknowledge their different emotions: their effort, their improvements, but also their fatigue or eventual negative emotions (“I know it may be hard on you but keep going!”). The instructor should reinforce and praise their correct behaviours, fostering also a sense of belonging to the group. In the asynchronous settings, those feedback and praise could be given through general references in the videos or through the platform, video submission, or other forms of direct contact (phone calls, emails, etc.) and stimulating the participants’ self-monitoring abilities. Monitoring in synchronous mode training Experts agreed that monitoring is an essential process in tele-exercise that should consist in both monitoring by the instructor and self-monitoring by the participants. In the synchronous mode, when participants are well trained, live monitoring is more motivating and it provides rapid feedback and control on the commitment, as well as on the effort intensity and movement adjustment to improve the performance and revise the training plans. Open discussions and engagement activities also increase the participants’ collaboration, even in the case of untrained participants. To autonomously correct the technical gesture, regulate the intensity of the execution or sustain one’s motivation may be objectively difficult as self-monitoring activity, even for trained participants, the risk to underestimate eventual problems could also occur. Trained participants know their physical reactions and limits, and they might be able to improve their performance and training their effort management skills, which is not the case for untrained participants. The monitoring process should focus on a) the satisfaction; b) the perceived intensity of the workout; c) the ability to perform movements; d) participants’ reactions during the training (breathing, spatial orientation, emotional reactions); e) their motivation and self-efficacy; f) attendance frequency and connection-related data (connection times, etc.). Before starting the training program, it is recommended to assess the familiarity with the device and to administer physical tests to be repeated every now and again. As to the self-monitoring by the participants, both in synchronous and asynchronous mode, the focus should be put on the ability to perform movements during the training, personal well-being signs before and after the training session, the perceived training intensity and, more generally, the awareness of personal physiological (heart rate, respiratory rate, range of motion, spatial orientation, etc.) and psychological (emotions) reactions. As to the tools, experts suggested that direct observation might be integrated by grids and measures as field and in-session tests (number of push-ups, crunches, etc.). In addition, while a video shows the repeated projection of the exercise, the instructor could observe and correct the participants, or there could be a second instructor to compare the observations. Participants could self-monitor their performance through heart rate devices, smartwatches, questionnaires and scales or a register to keep notes of their training log. Monitoring in asynchronous mode training Feedback from the instructor improve the participant’s efficacy, although in the asynchronous mode training the communication in neither direct nor customised. The instructor should request feedback through interviewing and questionnaires (by phone or email) or video viewing, to evaluate the fitness level, motivation, self-efficacy and satisfaction. They should also keep track of the attendance frequency and the connection-related data and request periodically the submission of physical test results. The more trained the participant, the more effective is their self-monitoring to improve their performance autonomously. On the contrary with untrained participants, a post training monitoring by the instructor is preferable. Self-monitoring should detect the already stated aspects; self-reported data and measures detected from devices should complement. Discussion Nowadays the availability of tele-exercise training programs is widespread, nonetheless there are no formal guidelines as to the way it must be managed and organised by instructors. The diverse applications of tele-exercise, such as in rehabilitation, athletic training, or postural activities, create challenges in establishing clear and consistent parameters for defining the essential aspects of tele-exercise practices because these parameters differ depending on the aim of the tele-exercise and on the trainees. This study aimed at defining consensus in guidelines for instructors of tele-exercise for fitness purposes with healthy trainees. Despite its recent development, this way to exercise has been proving its effectiveness ( 6 , 7 , 25 , 30 ) and it is more and more popular. Nonetheless, since technologies are developing continuously, it is difficult to have long term expertise in this field and there is also a lack of certified expertise. Even the experts who took part in the panel of this study were experts in physical exercise who gained experience in remote exercise delivery through direct practice or research. Fitness training design; space and equipment; technologies relational and communication modalities; monitoring were the five areas of analyses identified. Further topics such as insurance and legal issues, could not be considered because of the consistent differences among countries and their still not sufficiently defined status. Other topics, such as the use of highly advanced technological devices, were only mentioned because of their sudden and continuous evolution which would require specific separate studies. All these areas will require further exploration. A limitation of this study is that it cannot be properly referred to as a Delphi study. A mixed methodology was used, involving repeated questioning of experts. Due to the novelty of the research field on tele-exercise for healthy people, consensus was first developed through a systematic review, followed by multiple inquiries conducted via focus groups and a questionnaire. As tele-exercise for healthy people with fitness purposes becomes more widely adopted and regulated, a wider consensus will be needed to explore even more new facets. Conclusions Tele-exercise has several benefits, such as personalized programs, remote monitoring, increased accessibility and low costs, with case studies showcasing its potential to improve wellbeing and wellness among healthy people. It also presents potential benefits and challenges that need to be managed and explored such as the potential impact of integrating Artificial Intelligence, enhancement of data security, mental health support, and the dissemination of its use in schools and workplaces. Also, as tele-exercise continues to evolve, it is important to continue conducting high-quality research to obtain increasingly clear evidence, guiding trainers and users toward the most effective and safe practices. This paper represents a first attempt to define the current effective and safe practices to make tele-exercise for fitness purposes in healthy people become a lasting tool for global health and well-being. Declarations Ethics approval and consent to participate The study was conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individuals for the publication of any potentially identifiable images or data included in this article. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was funded by the European Union, grant number: 101089869—TELEexe4ALL—ERASMUS-SPORT-2022-SCP. The views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them. Nuno Garrido, Victor Machado Reis, José Vilaça-Alves and Rafael Peixoto were also funded by the Portuguese Foundation for Science and Technology (FCT), I.P., project number UIDB/04045/2020. Authors' contributions MC, FM, CB, Afu, and EI contribute to the conception of the study; MC, Afu, NDG, VMR and EI designed the work; MC, BM, AS, GCL, RP and EI developed the materials used in the procedures; MC, ADG, MS and JMVA acquired and analysed the data; MC, AFa, AFu, FM and GZ interpreted the data; MC, BM, FM, CB, AFu and EI have drafted the work or substantively revised it; FM and AFu administered the project; MC, CB and EI supervised the project. All authors read and approved the final manuscript. Acknowledgements None. References Fucarino A, Fabbrizio A, Garrido ND, Iuliano E, Reis VM, Sausa M, et al. Emerging Technologies and Open-Source Platforms for Remote Physical Exercise: Innovations and Opportunities for Healthy Population—A Narrative Review. Healthcare. 2024;12(15):1466. Wu G, Keyes LM. Group Tele-Exercise for Improving Balance in Elders. Telemed e-Health. 2006;12(5):561–70. 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JMIR Aging. 2022 Apr 13;5(2):e33165. Gomes Costa RR, Ribeiro Neto F, Winckler C. Tele-health, tele-exercise and tele-assessment: an example of a fitness app for individuals with spinal cord injury. Mhealth. 2023;9:20. Giuiani FNG, Jacobino NR, Vilaça KHC. Synchronous and asynchronous tele-exercise for older adults: study protocol for a randomized clinical trial. Health Sci J. 2024;14:e1550. Gallotta MC, Bonavolontà V, Zimatore G, Curzi D, Falcioni L, Migliaccio S, et al. Academic achievement and healthy lifestyle habits in primary school children: an interventional study. Front Psychol. 2024;15: 1412266. Cuccia F, Fiorentino A, Corrao S, Mortellaro G, Valenti V, Tripoli A, et al. Moderate hypofractionated helical tomotherapy for prostate cancer in a cohort of older patients: a mono-institutional report of toxicity and clinical outcomes. Aging Clin Exp Res. 2020;32(4):747–53. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, et al. Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67(4):401–9. Garrido ND, Reis VM, Vilaça-Alves JM, Chaves Lucas G, Godinho IL, Peixoto R, et al. Impact of tele-exercise on quality of life, physical fitness, functional capacity and strength in different adult populations: a systematic review of clinical trials. Front Sports Act Living. 2025;7:1505826. Fabbrizio A, Fucarino A, Cantoia M, De Giorgio A, Garrido ND, Iuliano E, et al. Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI. Healthcare. 2023;11(12):1805. Morgan D. Snowball Sampling. In: Given L, editor. The SAGE Encyclopedia of Qualitative Research Methods. Thousand Oaks, CA, USA: SAGE Publications Inc; 2008. p. 816–7. Costa RRG, Dorneles JR, Veloso JH, Gonçalves CW, Neto FR. Synchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: Comparisons of implementation and training load in individuals with spinal cord injury. J Telemed Telecare. 2023;29(4):308–17. Lai B, Rimmer J, Barstow B, Jovanov E, Bickel CS. Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series. JMIR Rehabil Assist Technol. 2016;3(2):e8. Kuswari M, Rimbawan H, Dewi M, Gifari N. The Effect Differences Of 30-Minutes Versus 60-Minutes Tele-exercise On Fitness Level Of Obese Employees. Media Gizi Indonesia. 2022;17(3):243–9. Divecha AA, Bialek A, Kumar DS, Garn RM, Currie LEJ, Campos T, et al. Effects of a 12-week, seated, virtual, home-based tele-exercise programme compared with a prerecorded video-based exercise programme in people with chronic neurological impairments: protocol for a randomised controlled trial. BMJ Open. 2023;13(1):e065032. Hsu C, Sandford BA. The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research, and Evaluation. 2007;12(1):10. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38:655–62. Jiménez-Rodríguez D, Ruiz-Salvador D, Rodríguez Salvador M del M, Pérez-Heredia M, Muñoz Ronda FJ, Arrogante O. Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study. Int J Environ Res Public Health. 2020;17(15):5396. Iuliano E, Zimatore G, Fabbrizio A, De Giorgio A, Sausa M, Matteo BM, et al. Tele-Exercise for Fitness: Physical and Psychological Outcomes in Athletes and Non-Athletes’ Trainees. Healthcare. 2025;13(4):354. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Carlo","middleName":"","lastName":"Baldari","suffix":""},{"id":451256141,"identity":"9467a5af-cfe3-4aa3-89ee-7690b85bbf88","order_by":14,"name":"Alberto Fucarino","email":"","orcid":"","institution":"eCampus University","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"","lastName":"Fucarino","suffix":""},{"id":451256142,"identity":"7f1b050c-807b-45d5-a4f3-aaf619e8e842","order_by":15,"name":"Enzo Iuliano","email":"","orcid":"","institution":"eCampus University","correspondingAuthor":false,"prefix":"","firstName":"Enzo","middleName":"","lastName":"Iuliano","suffix":""}],"badges":[],"createdAt":"2025-04-11 09:53:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6427175/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6427175/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-10697-5","type":"published","date":"2025-07-24T15:58:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81994764,"identity":"b10628d4-8d03-4d79-87c3-c9a633aae0f4","added_by":"auto","created_at":"2025-05-05 17:33:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":438247,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical illustration of the 4 rounds of the investigation method\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6427175/v1/f42b0ba48750e28b801c4e56.png"},{"id":87756766,"identity":"68eca8c9-8d1b-4e20-91aa-7b7b6ccafd22","added_by":"auto","created_at":"2025-07-28 16:09:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1502809,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6427175/v1/ad069a72-6e9f-4b08-9ea7-f0ac1e570e96.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond the Screen: A Mixed-Methods Exploration for Guidelines on technical and psychological features of Effective Tele-Exercise Programs","fulltext":[{"header":"Background","content":"\u003cp\u003eTele-exercise has been long practised with rehabilitation and telemedicine purposes with positive and promising results (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The words \"tele-exercise\" appeared for the first time on PubMed database in the title of a scientific paper in 2006 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and it spread in the past ten years with a dramatic increase in the last few years. Since the Pandemic of COVID-19 many healthy people started to workout at home (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). While there is quite a corpus of studies on medical use of tele-exercise, the fitness purpose for healthy people is not yet been studied deeply (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn both cases, depending on the specific target and purpose, guidelines are very heterogeneous: exercise may be prescribed for 20 to 90 minutes per session, to be repeated 2 to 7 times a week, for a total of 4 to 16 weeks (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The current literature refers to workouts that are either synchronous or asynchronous. In the first case they mostly used general web-based conferencing software such as Zoom, Skype or Teams (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e); in asynchronous tele-exercise researchers delivered customized videos through email or message application (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) or broadcasted them on YouTube (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In all these studies, the exercise routine was designed by specialized instructors and in a few cases, it was even tailored on the participant\u0026rsquo;s needs, which is possible in a research context, but harder for a larger audience.\u003c/p\u003e \u003cp\u003eNowadays, tele-exercise for fitness purpose is based on a multitude of online application proposing free, as well charged programs but that in most cases do not provide specifics as to the design of their workout programs or their authors, nor undergone a scientific validation. Moreover, instructors often did not provide evidence of a specific professional experience in remote coaching.\u003c/p\u003e \u003cp\u003eThere is the need for a more systematic and scientific approach to tele-exercise for fitness and healthy people and to its regulation.\u003c/p\u003e \u003cp\u003eThis study was aimed at exploring a design procedure for tele-exercise. Reaching a consensus within the scientific community is the premises for reliable and widespread studies on the efficacy of tele-exercise in different modalities (synchronous and asynchronous) and addressing users with a large spectrum of characteristics as to gender, age group, exercise habits, time availability, etc.\u003c/p\u003e \u003cp\u003eOn the other side, there is a social urgence to clear the efficacy of tele-exercise programs for fitness, because they could be representing an asset to prevent sedentary habits, obesity and increasingly widespread unhealthy lifestyles (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo gather the larger bases of knowledge we started from the review of the literature and proceeded with a mixed methodology, mostly referred to the Delphi technique (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), aimed at generating consensus through an iterative process of questioning of more rounds. After each round, responses were analysed and redistributed for discussion.\u003c/p\u003e \u003cp\u003eThe principal pattern of discussion was organized in four rounds of questioning:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eRound one \u0026ndash; The documentary analyses\u003c/em\u003e: We started with a review of the scientific literature (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and a mapping of the web sites (both scientific and popular ones) and web applications (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eRound two - Focus groups I\u003c/em\u003e: Interviews and focus groups with the experts from the \u003cem\u003eTeleExe4All\u003c/em\u003e project were carried out to discuss the literature and the state of art on tele-exercise. The aim was to define the main areas of further investigation. Finally, five areas of analyses were identified: 1) Fitness training design; 2) Spaces and equipment; 3) Technologies; 4) Relational and communication modalities; 5) Monitoring.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eRound three \u0026ndash; Interviewing of external experts\u003c/em\u003e: Experts were contacted via email, signed an informed consent and then filled in an in-depth questionnaire that explored detailed specifics of tele-exercise for fitness. The questionnaire was administered via Computer Assisted Web Interviewing (CAWI) and experts were asked to spread the link among their peers using snowball effect sampling (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), where new participants are progressively recruited through social networks, facilitating access to groups that are difficult to reach using traditional methods.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eRound four \u0026ndash; Focus group II\u003c/em\u003e: the results of the survey were first analysed and then discussed in focus groups with the experts from the ongoing \u003cem\u003eTeleExe4All\u003c/em\u003e project to detect the global best level of agreement. Analyses resulted in the final document (see Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e***Figure 1\u003c/b\u003e. Graphical illustration of the 4 rounds of the investigation method***\u003c/p\u003e \u003cp\u003eThe study was approved by the Ethics Committee of the University of Tr\u0026aacute;s-os-Montes \u0026amp; Alto Douro protocol Doc73-CE-UTAD-2019 (13 January 2020). The study was conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe experts\u0026rsquo; profile\u003c/h2\u003e \u003cp\u003eInternal experts from \u003cem\u003eTeleExe4All\u003c/em\u003e project were seventeen (11 men and 6 women) either academics, or professionals from Croatia, Italy, Latvia and Portugal. Their background was mostly in motor science and sports, but a few were academics in medicine, physics and psychology. Their expertise ranged from children to elderly, from amateur to athletes with or without disabilities. During the focus groups experts were divided into different teams that changed at every round of consultations. A smaller group devised the questionnaire.\u003c/p\u003e \u003cp\u003eThe panel of experts external to the project was sought among academics, researchers and instructors with experience in tele-exercise, according to the following criteria:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePeers (personal acquaintances)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAuthors of scientific publications\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMembers of research groups or centres\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMembers of training centres\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eProfessional instructors\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e Initially, 23 external experts agreed to participate in the survey by signing the informed consent. Five of them dropped out of the study and four were excluded since they did not have adequate experience profile. The final panel consisted of 14 experts (9 men and 5 women) with an average age of 42\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6 years. Their experience in tele-exercise as academics and/or instructors varied from 1 to 7 years, with an average experience of 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 years. The specific of their experience is described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and ranged among professional athletes, amateur athletes, athletes with disabilities, re-athletization athletes, trained participants, non-athletes, participants with sporadic training, sedentary healthy participants, sedentary participants with disabilities, sedentary participants with pathologies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of external experts\u0026rsquo; specific experience in tele-exercise\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eLevel of experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent/good\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate/low\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFitness and physical improvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAthletic-sport training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotor rehabilitation with non-athletes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRe-athletization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostural activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe questionnaire\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was devised based on the check list created as outcome of the focus groups and it consisted of seven sections. In order not to lose useful insights from the experts, at the end of each question they could specify or integrate their answers in a free text box. At the end of each area of investigation experts could also evaluate if the questions were exhaustive and eventually suggest further topics of analyses.\u003c/p\u003e \u003cp\u003eThe thematic sections consisted of a total of 74 questions on synchronous mode and 80 on asynchronous mode, including closed-ended questions, rating scales (five-point Likert scale) and open questions.\u003c/p\u003e \u003cp\u003eIn detail, the Personal data section gathered questions on demographic (sex, age), professional data (education qualification and duration, licenses or specialization in tele-exercise, years and type of experience), and experts\u0026rsquo; experience (duration, type and purpose of their interventions, target population). According to the mode in which they were more experienced (synchronous, asynchronous or both modes), experts accessed three specific paths.\u003c/p\u003e \u003cp\u003eIn the Glossary Section the most recent and quoted operative definitions on Tele-Exercise, Synchronous Tele-Exercise Mode, Asynchronous Tele-Exercise Mode, Tele-Exercise Instructor (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) were to be assessed according to the expert\u0026rsquo;s level of agreement. Experts could also propose modifications. This section also explored the main characteristics (major advantages and disadvantages) of the different modes of tele-exercise, the types of users who can most benefit from tele-exercise, and whether tele-exercise may be effective in mixed modes (synchronous and asynchronous; at distance - synchronous or asynchronous modes - and in presence).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOperative Definitions of tele-exercise originally provided in the questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTele-exercise:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA branch of telemedicine that delivers training programs remotely (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), through online media (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActivity mode Synchronous\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA real-time approach, in which the service is provided simultaneously by the instructor to the participant via videoconference or telephone conversations, allowing immediate feedback to be provided on the execution of the exercises (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActivity mode Asynchronous\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA non-real-time approach in which instructors record educational videos that participants play without direct and simultaneous delivery. This approach allows for greater flexibility in accessing training programs, but not the ability to have immediate feedback on the execution of the exercises (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTele-exercise instructor\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith extensive experience in providing training protocols suitable for a virtual environment, he/she instructs participants on how to perform the exercises so that everyone can participate safely (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Fitness Training Design Section explored the parameters to be evaluated before starting the training, the ideal number of participants, number of sessions and duration of each session (for both trained and untrained participants). Experts also evaluated the type of activity to perform depending on the type of users (young, adults, elderly) and the phases of each training session.\u003c/p\u003e \u003cp\u003eThe Spaces and Equipment Section investigated the characteristics of the environment where exercises are performed, the equipment for amateur and professional users, the recommended clothing. Recommendations and preventive safety measures were also investigated.\u003c/p\u003e \u003cp\u003eIn the Technologies Section experts were asked to evaluate the most suitable devices, their technical specifications, the best framing for both the participant and the demonstration monitor depending on the type of exercise and the position (upright, sitting, or prone - supine), and the position of the instructor's monitor to observe the participants while performing the exercise.\u003c/p\u003e \u003cp\u003eIn the Relational and Communication Modalities Section experts evaluated the language, attitude, general relational modalities and communication management respectively at the beginning of the training session, during the explanation, in the encouragement and motivation phases during physical activity, and at end of the activity.\u003c/p\u003e \u003cp\u003eFinally, the Monitoring Section dealt with the techniques and tools for the instructor\u0026rsquo;s monitoring and trained and untrained participants\u0026rsquo; self-monitoring.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eRound one (The documentary analyses)\u003c/strong\u003e \u003cp\u003eData obtained in the first round were analysed by three members of the group providing a review of methods, techniques and organizational details that was organized to identify content categories.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRound two (Focus groups I), and Round three \u0026ndash; Interviewing of external experts\u003c/strong\u003e \u003cp\u003eA content analysis of data obtained from the focus groups (I) was performed to identify the thematic areas of the survey and the experts\u0026rsquo; proposals on the single topics to be explored. Statements that were approved by the majority (minimum 60%) were translated into the items of the questionnaire. Quantitative and qualitative data from the questionnaire were analysed performing mean of the scores to the 5-point Likert response scale. Items with a mean scoring under 2.5 were not considered; items with a mean scoring of 2.5 to 2.9 were submitted to the experts for reconsideration; items scored above 3 were accepted (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRound four (Focus group II)\u003c/strong\u003e \u003cp\u003eThe qualitative data collected from the open-ended questions by which experts could complete their answers in each section of the questionnaire were also analysed according to content analysis methodology.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGlossary Section - Operative Definitions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExperts agreed on the operative definitions from the literature and enriched them with further details. The experts agreed on the following statements: Tele-exercise, which originally started as a branch of telemedicine, delivers training programs through online media, in context of both rehabilitation and health promotion, eventually using supervision tools that allow the collection of participants\u0026rsquo; personal data. Tele-exercise is designed and managed by expert instructors who provide training protocols suitable for a virtual environment. They organize the exercise schedule, explain how to perform the exercises safely and monitor the participants\u0026rsquo; progresses. They can also guide participants in the use of new technologies during tele-exercise sessions. Tele-exercise can be approached in Synchronous mode, when provided simultaneously by the instructor to one or more participants via online streaming environments. It can also be approached in Asynchronous mode, when the instructor records educational videos that participants play without direct and simultaneous delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is not an ideal addressee for tele-exercise, everyone can access this activity, regardless of their status as sedentary (healthy, with pathologies or with disabilities) or trained to different extent (from casual trainees to professional athletes) individuals.\u003c/p\u003e\n\u003cp\u003eActivities in synchronous mode allow immediate feedback, the direct relationship between instructor and participant, the possibility of training customization and of better guided training and monitoring, together with a sense of comradeship with other participants that enhances motivation. On the other side, streaming sessions may undergo technical issues (need for high Internet connection, device functionality, access to the platform, etc.) and require quite high levels of familiarity with the technologies, resulting in harder efforts for elderly and persons with disabilities. Trainees and trainers may also have limited perspective access according to the monitor they use or their reciprocal positions. Finally, the live monitoring of multiple participants could be difficult for the instructor.\u003c/p\u003e\n\u003cp\u003eThe asynchronous mode generally requires an easier technical management: the trainers provide comprehensive and multimedia video lessons with integrated perspectives, texts, visual effects, etc. and they monitor the participants\u0026rsquo; performance through direct contact (by phone or email) or through the analyses of video recorded materials. When practising in asynchronous mode, trainees can autonomously schedule their workout sessions, although they cannot share the experience with a group (unless they practice with other people in presence) and are more likely to suffer from lack of motivation and of support from their peers. Moreover, they could perform the exercises not correctly, due to the lack of both supervision and of movement correction in real-time. Finally, in the long term, it could be difficult to produce video materials tailored to participants improving skills and needs.\u003c/p\u003e\n\u003cp\u003eExperts suggest that mixed mode workouts that balance synchronous and asynchronous, or in-person and tele-exercise sessions can be effective, more flexible and less expensive. In addition, participants could catch up missing workout sessions and be more constant in their training, especially during holidays and work travels, or in case of re-athletization after injuries or pathologies. They could also exercise alone, to improve and consolidate new strategies and exercises. Trainers could picture a more complete idea of the participants\u0026rsquo; level of performance and adapt their practices or correct their executions.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eFitness training design\u003c/h3\u003e\n\u003cp\u003eExperts agreed that ahead of the beginning of the training, regardless of the mode (synchronous or asynchronous), it should be compulsory to gather the following personal data: age, sex, weight, height, waist circumference, medical history and current medication intake, address and emergency contact, lifestyle habits (sleep, type of work, daily stress; movement habits, diet), devices at disposal for the training and internet connection specifics, material and space conditions, training schedules and time available for training.\u003c/p\u003e \u003cp\u003eAttitudes and previous experiences should also be assessed: objectives and expectations, previous (tele) exercise experiences and their history, physical exercise preferences, comforts and discomforts in practicing physical exercise, motivation and self-efficacy, familiarity with technologies.\u003c/p\u003e \u003cp\u003eThe duration of the program should depend on the participants\u0026rsquo; goals, characteristics, levels of ability, preferences, and on the intensity of the training. Details on the number of participants and the number of sessions a week are provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTechnical details on the exercises for the fitness training also should depend on various factors including avoiding expensive or bulky equipment. Some recreational activity during the workout is recommended to keep the participants motivated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFitness training design in tele-exercise\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSynchronous mode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsynchronous mode\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipants per session\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 to 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum 50 (to monitor the group at distance)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorkouts per week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNot trained participants\u003c/b\u003e: 2\u0026ndash;3 times of 45\u0026ndash;60 min each\u003c/p\u003e \u003cp\u003e\u003cb\u003eTrained participants\u003c/b\u003e: 3 times of 45\u0026ndash;75 min each\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026ndash;5 times a week for 45\u0026ndash;60 min, regardless of training level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorkout phases^\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWelcoming and explanation phase; warm-up; the real exercise sequence; the cool-down; the closing, with feedback and information on the following steps\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExercises^\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRegardless of the participants\u0026rsquo; age and training mode\u003c/b\u003e: Aerobic activity, Muscle strength improvement activities, Coordination-based activities, Proprioceptive activities, Mixed activities, Joint mobility, flexibility, stretching, recreational activities\u003c/p\u003e \u003cp\u003e\u003cb\u003eSuggested for young and adults\u003c/b\u003e: High-intensity cardiovascular exercise\u003c/p\u003e \u003cp\u003e\u003cb\u003eSuggested for elderly\u003c/b\u003e: Balance activities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003e^\u003c/b\u003e for both synchronous and asynchronous mode\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSpaces and equipment\u003c/h2\u003e \u003cp\u003eExperts highlighted that exercise in a home-based environment requires a space with no potential risk to the individual's safety. The space should be lit and ventilated. Participants also need a good Internet equipment and devices to connect to the platform (see next sections).\u003c/p\u003e \u003cp\u003eNot trained and amateur trainees can perform bodyweight exercises with a mat, a chair, weights (or similar objects, e.g., bottles).\u003c/p\u003e \u003cp\u003eA more professional training could benefit from the use of a step platform, resistance bands and fit balls. In synchronous mode, participants should wear form-fitting non-restrictive attire to allow the monitoring of their movements by the instructor. Breathable fabric shirt and shorts are suggested as well as footwear suitable for the type of activity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSafety\u003c/h3\u003e\n\u003cp\u003eIn tele-exercise participants perform the exercises in their homes or in facilities, far from the immediate and direct control of a professional instructor. Experts agreed that regardless of the training mode, elderly trainees and participants with motor difficulties could benefit from another person\u0026rsquo;s presence in the same site, in case of problems during or after the workout. Participants in asynchronous sessions should also provide an emergency contact.\u003c/p\u003e \u003cp\u003eThe environment should be spacious and safe, to avoid possible interference from other participants (e.g., roommates) or objects (walls, furniture, etc.). There should be also available attachment points.\u003c/p\u003e \u003cp\u003eA mandatory written consent form and written disclosure of liability must be gathered before starting the training. The need for health certificates for non-competitive or competitive sports practice as well as for specific insurance programs should also be checked since those topics are regulated in different ways throughout different Countries.\u003c/p\u003e \u003cp\u003eIn the light of the participants\u0026rsquo; health and medical history, it should be recommended to monitor or to suggest participants to monitor blood pressure and heart rate before and after the workout.\u003c/p\u003e\n\u003ch3\u003eTechnologies\u003c/h3\u003e\n\u003cp\u003eAccording to the experts, the fundamental criteria as to technologies are portability and easy access and, for the synchronous mode, good wi-fi connection. Big screens (at least 12\u0026ndash;13\u0026rsquo;\u0026rsquo;, full HD, such as TV monitors or laptops) and devices with good sound system and cameras are preferable; tablets and smartphone, although often used, provide a less easy access to visual information.\u003c/p\u003e \u003cp\u003eIn synchronous mode, for an effective experience devices should be set near to the participant and both participants and instructors should check to have a complete and mutual framing. The camera should be set frontal or lateral, with perspective from 90\u0026deg; and 45\u0026deg; for upright, sitting, or prone workout; exercises in prone position might benefit from a view from above.\u003c/p\u003e \u003cp\u003eIn the asynchronous mode the instructor must focus on the quality and completeness of information of the instructional videos, adding texts, notes, visual effects and augmented reality elements through thoughtful video editing. Videos recorded specifically with special editing are more suitable than videos recorded in live sessions, nonetheless, the instructor can add frames from live training sessions for more realistic and immersive effect.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRelational and communicative methods\u003c/h2\u003e \u003cp\u003eIn tele-exercise, the direct physical interaction is missing, and nonverbal communication may be hard to detect. Experts suggested that communication should be kept simple, clear, friendly and adapt to the groups, according to their age, goals, level of skills, etc. It is also important to share a common technical vocabulary and avoid the use of acronyms and unfamiliar or foreign language.\u003c/p\u003e \u003cp\u003e In the interaction with the participants, the instructor should have an empathetic, engaging, motivating, encouraging attitude, maintaining a professional tone, eventually accompanied by some polite humour.\u003c/p\u003e \u003cp\u003eRegardless of the mode of training, the session should start welcoming the participants and assessing their well-being and psycho-physical conditions (pain, tension, fatigue, restlessness, etc.) since the previous workout. In the asynchronous mode this phase can be suggested as a form of self-assessment. Then, the instructor should provide a brief recap of the aims of the training (referring also to the previous lessons), introduce the goals of the current session, and explain the planned activities. If needed, in the synchronous mode they could reinforce technical information for the Internet connection. In asynchronous mode they could make the explanation clearer by using clips or images of movements.\u003c/p\u003e \u003cp\u003eThe explanation of the exercise should start from the objectives and outcomes of the exercise, followed by the demonstration of the movement. This demonstration should be given before or along with its verbal description, because starting from the description would lead to a less effective understanding. The disclosure of possible errors in the movement or of general critical issues in advance may be effective for the participants to avoid them. Instructors should also provide information on timing, repetitions, sequences and describe what psycho-physical reactions to expect during the execution (fatigue, muscle tension, changes in breathing, etc.).\u003c/p\u003e \u003cp\u003eAt the end of the session, still regardless of the specific mode of training, the instructor should check (directly or indirectly) the well-being status of the participants, then provide a summary of the workout activities and contextualize it within the perspective of overall goals. Upcoming appointments should be reminded, along with a preview of the objectives for the next workout session or suggestions for future workout. The instructor should also acknowledge the participants\u0026rsquo; progress and eventual issues.\u003c/p\u003e \u003cp\u003eParticipants keep their motivation when they are given realistic goals: they need continuous feedback, encouragement and realistic expectations on their improvements. Their focus should be set on the overall final goal and as they approach it, the instructor should acknowledge their different emotions: their effort, their improvements, but also their fatigue or eventual negative emotions (\u0026ldquo;I know it may be hard on you but keep going!\u0026rdquo;). The instructor should reinforce and praise their correct behaviours, fostering also a sense of belonging to the group. In the asynchronous settings, those feedback and praise could be given through general references in the videos or through the platform, video submission, or other forms of direct contact (phone calls, emails, etc.) and stimulating the participants\u0026rsquo; self-monitoring abilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMonitoring in synchronous mode training\u003c/h2\u003e \u003cp\u003eExperts agreed that monitoring is an essential process in tele-exercise that should consist in both monitoring by the instructor and self-monitoring by the participants.\u003c/p\u003e \u003cp\u003e In the synchronous mode, when participants are well trained, live monitoring is more motivating and it provides rapid feedback and control on the commitment, as well as on the effort intensity and movement adjustment to improve the performance and revise the training plans. Open discussions and engagement activities also increase the participants\u0026rsquo; collaboration, even in the case of untrained participants.\u003c/p\u003e \u003cp\u003eTo autonomously correct the technical gesture, regulate the intensity of the execution or sustain one\u0026rsquo;s motivation may be objectively difficult as self-monitoring activity, even for trained participants, the risk to underestimate eventual problems could also occur. Trained participants know their physical reactions and limits, and they might be able to improve their performance and training their effort management skills, which is not the case for untrained participants.\u003c/p\u003e \u003cp\u003eThe monitoring process should focus on a) the satisfaction; b) the perceived intensity of the workout; c) the ability to perform movements; d) participants\u0026rsquo; reactions during the training (breathing, spatial orientation, emotional reactions); e) their motivation and self-efficacy; f) attendance frequency and connection-related data (connection times, etc.). Before starting the training program, it is recommended to assess the familiarity with the device and to administer physical tests to be repeated every now and again.\u003c/p\u003e \u003cp\u003e As to the self-monitoring by the participants, both in synchronous and asynchronous mode, the focus should be put on the ability to perform movements during the training, personal well-being signs before and after the training session, the perceived training intensity and, more generally, the awareness of personal physiological (heart rate, respiratory rate, range of motion, spatial orientation, etc.) and psychological (emotions) reactions.\u003c/p\u003e \u003cp\u003eAs to the tools, experts suggested that direct observation might be integrated by grids and measures as field and in-session tests (number of push-ups, crunches, etc.). In addition, while a video shows the repeated projection of the exercise, the instructor could observe and correct the participants, or there could be a second instructor to compare the observations.\u003c/p\u003e \u003cp\u003eParticipants could self-monitor their performance through heart rate devices, smartwatches, questionnaires and scales or a register to keep notes of their training log.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMonitoring in asynchronous mode training\u003c/h2\u003e \u003cp\u003e Feedback from the instructor improve the participant\u0026rsquo;s efficacy, although in the asynchronous mode training the communication in neither direct nor customised. The instructor should request feedback through interviewing and questionnaires (by phone or email) or video viewing, to evaluate the fitness level, motivation, self-efficacy and satisfaction. They should also keep track of the attendance frequency and the connection-related data and request periodically the submission of physical test results.\u003c/p\u003e \u003cp\u003eThe more trained the participant, the more effective is their self-monitoring to improve their performance autonomously. On the contrary with untrained participants, a post training monitoring by the instructor is preferable. Self-monitoring should detect the already stated aspects; self-reported data and measures detected from devices should complement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e Nowadays the availability of tele-exercise training programs is widespread, nonetheless there are no formal guidelines as to the way it must be managed and organised by instructors. The diverse applications of tele-exercise, such as in rehabilitation, athletic training, or postural activities, create challenges in establishing clear and consistent parameters for defining the essential aspects of tele-exercise practices because these parameters differ depending on the aim of the tele-exercise and on the trainees.\u003c/p\u003e \u003cp\u003e This study aimed at defining consensus in guidelines for instructors of tele-exercise for fitness purposes with healthy trainees. Despite its recent development, this way to exercise has been proving its effectiveness (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and it is more and more popular. Nonetheless, since technologies are developing continuously, it is difficult to have long term expertise in this field and there is also a lack of certified expertise. Even the experts who took part in the panel of this study were experts in physical exercise who gained experience in remote exercise delivery through direct practice or research.\u003c/p\u003e \u003cp\u003eFitness training design; space and equipment; technologies relational and communication modalities; monitoring were the five areas of analyses identified. Further topics such as insurance and legal issues, could not be considered because of the consistent differences among countries and their still not sufficiently defined status. Other topics, such as the use of highly advanced technological devices, were only mentioned because of their sudden and continuous evolution which would require specific separate studies. All these areas will require further exploration.\u003c/p\u003e \u003cp\u003eA limitation of this study is that it cannot be properly referred to as a Delphi study. A mixed methodology was used, involving repeated questioning of experts. Due to the novelty of the research field on tele-exercise for healthy people, consensus was first developed through a systematic review, followed by multiple inquiries conducted via focus groups and a questionnaire. As tele-exercise for healthy people with fitness purposes becomes more widely adopted and regulated, a wider consensus will be needed to explore even more new facets.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTele-exercise has several benefits, such as personalized programs, remote monitoring, increased accessibility and low costs, with case studies showcasing its potential to improve wellbeing and wellness among healthy people. It also presents potential benefits and challenges that need to be managed and explored such as the potential impact of integrating Artificial Intelligence, enhancement of data security, mental health support, and the dissemination of its use in schools and workplaces. Also, as tele-exercise continues to evolve, it is important to continue conducting high-quality research to obtain increasingly clear evidence, guiding trainers and users toward the most effective and safe practices. This paper represents a first attempt to define the current effective and safe practices to make tele-exercise for fitness purposes in healthy people become a lasting tool for global health and well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individuals for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the European Union, grant number: 101089869\u0026mdash;TELEexe4ALL\u0026mdash;ERASMUS-SPORT-2022-SCP. The views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them. Nuno Garrido, Victor Machado Reis, Jos\u0026eacute; Vila\u0026ccedil;a-Alves and Rafael Peixoto were also funded by the Portuguese Foundation for Science and Technology (FCT), I.P., project number UIDB/04045/2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMC, FM, CB, Afu, and EI contribute to the conception of the study; MC, Afu, NDG, VMR and EI designed the work; MC, BM, AS, GCL, RP and EI developed the materials used in the procedures; MC, ADG, MS and JMVA acquired and analysed the data; MC, AFa, AFu, FM and GZ interpreted the data; MC, BM, FM, CB, AFu and EI have drafted the work or substantively revised it; FM and AFu administered the project; MC, CB and EI supervised the project. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFucarino A, Fabbrizio A, Garrido ND, Iuliano E, Reis VM, Sausa M, et al. Emerging Technologies and Open-Source Platforms for Remote Physical Exercise: Innovations and Opportunities for Healthy Population\u0026mdash;A Narrative Review. Healthcare. 2024;12(15):1466. \u003c/li\u003e\n\u003cli\u003eWu G, Keyes LM. Group Tele-Exercise for Improving Balance in Elders. Telemed e-Health. 2006;12(5):561\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eTeixeira do Amaral V, Roque Mar\u0026ccedil;al I, da Cruz Silva T, Bianchi Souza F, Volpato Munhoz Y, Witzler PHC, et al. Home confinement during COVID-19 pandemic reduced physical activity but not health-related quality of life in previously active older women. Educ Gerontol. 2022;48(6):250\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePoon ETC, Sun F, Tse ACY, Tsang JH, Chung AYH, Lai YYY, et al. Effectiveness of tele-exercise training on physical fitness, functional capacity, and health-related quality of life in non-hospitalized individuals with COVID-19: The COFIT-HK study. J Exerc Sci Fit. 2024;22(2):134\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eJain Shrimal P, Maharana S, Dave A, Raghuram N, Thulasi A. Efficacy of Integrated Tele-Yoga Intervention on Physiological and Psychological Variables in Asymptomatic COVID-19 Positive Patients: A Confirmatory Randomized Control Trial. Complement Med Res. 2023;30(2):151\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eWilke J, Mohr L, Yuki G, Bhundoo AK, Jim\u0026eacute;nez-Pav\u0026oacute;n D, Lai\u0026ntilde;o F, et al. Train at home, but not alone: a randomised controlled multicentre trial assessing the effects of live-streamed tele-exercise during COVID-19-related lockdowns. Br J Sports Med. 2022;56(12):667\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eFucarino A, Zimatore G, Fabbrizio A, Garrido ND, Reis VM, Vila\u0026ccedil;a-Alves J, et al. Fitness and psychological effects of tele-exercise in healthy populations. Preliminary study. Front Digit Health. 2024;6:1496196. \u003c/li\u003e\n\u003cli\u003eSelman L, McDermott K, Donesky D, Citron T, Howie-Esquivel J. Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study. BMC Complement Altern Med. 2015;15(1):21. \u003c/li\u003e\n\u003cli\u003eHong J, Kim J, Kim SW, Kong HJ. Effects of home-based tele-exercise on sarcopenia among community-dwelling elderly adults: Body composition and functional fitness. Exp Gerontol. 2017;87:33\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGell NM, Dittus K, Caefer J, Martin A, Bae M, Patel K V. Remotely delivered exercise to older rural cancer survivors: a randomized controlled pilot trial. J Cancer Surviv. 2024;18(2):596\u0026ndash;605. \u003c/li\u003e\n\u003cli\u003eCerd\u0026aacute;n-de-las-Heras J, Balbino F, L\u0026oslash;kke A, Catal\u0026aacute;n-Matamoros D, Hilberg O, Bendstrup E. Tele-Rehabilitation Program in Idiopathic Pulmonary Fibrosis\u0026mdash;A Single-Center Randomized Trial. Int J Environ Res Public Health. 2021;18(19):10016. \u003c/li\u003e\n\u003cli\u003eCardinali L, Curzi D, Maccarani E, Falcioni L, Campanella M, Ferrari D, et al. Live Streaming vs. Pre-Recorded Training during the COVID-19 Pandemic in Italian Rhythmic Gymnastics. Int J Environ Res Public Health. 2022;19(24):16441. \u003c/li\u003e\n\u003cli\u003eZengin Alpozgen A, Kardes K, Acikbas E, Demirhan F, Sagir K, Avcil E. The effectiveness of synchronous tele-exercise to maintain the physical fitness, quality of life, and mood of older people - a randomized and controlled study. Eur Geriatr Med. 2022;13(5):1177\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eHo V, Merchant RA. The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study. JMIR Aging. 2022 Apr 13;5(2):e33165. \u003c/li\u003e\n\u003cli\u003eGomes Costa RR, Ribeiro Neto F, Winckler C. Tele-health, tele-exercise and tele-assessment: an example of a fitness app for individuals with spinal cord injury. Mhealth. 2023;9:20. \u003c/li\u003e\n\u003cli\u003eGiuiani FNG, Jacobino NR, Vila\u0026ccedil;a KHC. Synchronous and asynchronous tele-exercise for older adults: study protocol for a randomized clinical trial. Health Sci J. 2024;14:e1550. \u003c/li\u003e\n\u003cli\u003eGallotta MC, Bonavolont\u0026agrave; V, Zimatore G, Curzi D, Falcioni L, Migliaccio S, et al. 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Impact of tele-exercise on quality of life, physical fitness, functional capacity and strength in different adult populations: a systematic review of clinical trials. Front Sports Act Living. 2025;7:1505826. \u003c/li\u003e\n\u003cli\u003eFabbrizio A, Fucarino A, Cantoia M, De Giorgio A, Garrido ND, Iuliano E, et al. Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI. Healthcare. 2023;11(12):1805. \u003c/li\u003e\n\u003cli\u003eMorgan D. Snowball Sampling. In: Given L, editor. The SAGE Encyclopedia of Qualitative Research Methods. Thousand Oaks, CA, USA: SAGE Publications Inc; 2008. p. 816\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eCosta RRG, Dorneles JR, Veloso JH, Gon\u0026ccedil;alves CW, Neto FR. Synchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: Comparisons of implementation and training load in individuals with spinal cord injury. J Telemed Telecare. 2023;29(4):308\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eLai B, Rimmer J, Barstow B, Jovanov E, Bickel CS. Teleexercise for Persons With Spinal Cord Injury: A Mixed-Methods Feasibility Case Series. JMIR Rehabil Assist Technol. 2016;3(2):e8. \u003c/li\u003e\n\u003cli\u003eKuswari M, Rimbawan H, Dewi M, Gifari N. The Effect Differences Of 30-Minutes Versus 60-Minutes Tele-exercise On Fitness Level Of Obese Employees. Media Gizi Indonesia. 2022;17(3):243\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eDivecha AA, Bialek A, Kumar DS, Garn RM, Currie LEJ, Campos T, et al. Effects of a 12-week, seated, virtual, home-based tele-exercise programme compared with a prerecorded video-based exercise programme in people with chronic neurological impairments: protocol for a randomised controlled trial. BMJ Open. 2023;13(1):e065032. \u003c/li\u003e\n\u003cli\u003eHsu C, Sandford BA. The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research, and Evaluation. 2007;12(1):10. \u003c/li\u003e\n\u003cli\u003eMcMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38:655\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eJim\u0026eacute;nez-Rodr\u0026iacute;guez D, Ruiz-Salvador D, Rodr\u0026iacute;guez Salvador M del M, P\u0026eacute;rez-Heredia M, Mu\u0026ntilde;oz Ronda FJ, Arrogante O. Consensus on Criteria for Good Practices in Video Consultation: A Delphi Study. Int J Environ Res Public Health. 2020;17(15):5396. \u003c/li\u003e\n\u003cli\u003eIuliano E, Zimatore G, Fabbrizio A, De Giorgio A, Sausa M, Matteo BM, et al. Tele-Exercise for Fitness: Physical and Psychological Outcomes in Athletes and Non-Athletes\u0026rsquo; Trainees. Healthcare. 2025;13(4):354. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Remote training, eHealth, tele-fitness, tele-coaching, home-based exercise, synchronous and asynchronous mode","lastPublishedDoi":"10.21203/rs.3.rs-6427175/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6427175/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Tele-exercise has significant potential as a tool to promote physical activity, particularly for individuals facing barriers to accessing gyms or sports centres due to geographical, physical, or financial constraints. While tele-exercise derives from telemedicine, it remains a less defined field with no established guidelines to regulate or standardize its implementation. This gap highlights the need for structured frameworks to ensure the safety, effectiveness, and accessibility of tele-exercise. This study aimed to establish a consensus on some fundamental aspects of tele-exercise through a structured four-round process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This mixed-method approach combined analyses of scientific literature with experts’ opinions collected via focus groups and an ad hoc questionnaire. In detail, the paper focused on the following fundamental aspects: 1) operative definitions of tele-exercise, 2) fitness training programs design, 3) requirements for spaces and equipment, 4) safety protocols for remote exercise, 5) the role and impact of technology, 6) relational and communication strategies to enhance engagement, and 7) monitoring methods for asynchronous and synchronous training sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The guidelines provide a comprehensive examination of these aspects, addressing current gaps and limitations while outlining opportunities for improvement. The study underscores the importance of developing standardized practices to ensure safe and effective implementation of tele-exercise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e By addressing these challenges, tele-exercise can evolve into an inclusive, scalable tool for promoting physical activity, paving the way for broader access and participation in fitness activities.\u003c/p\u003e","manuscriptTitle":"Beyond the Screen: A Mixed-Methods Exploration for Guidelines on technical and psychological features of Effective Tele-Exercise Programs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 17:33:41","doi":"10.21203/rs.3.rs-6427175/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-26T08:05:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-23T12:55:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-10T19:46:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105215290183311000992556461047769939625","date":"2025-05-01T10:17:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249736524341244037799082302791450656446","date":"2025-04-30T10:32:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-30T06:22:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-30T06:20:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-22T11:56:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-21T08:39:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-11T09:49:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7cbbab65-b2bd-497e-a305-026e969d7082","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":48011584,"name":"Biological sciences/Psychology"},{"id":48011585,"name":"Health sciences/Health care"},{"id":48011586,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2025-07-28T16:03:50+00:00","versionOfRecord":{"articleIdentity":"rs-6427175","link":"https://doi.org/10.1038/s41598-025-10697-5","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-24 15:58:20","publishedOnDateReadable":"July 24th, 2025"},"versionCreatedAt":"2025-05-05 17:33:41","video":"","vorDoi":"10.1038/s41598-025-10697-5","vorDoiUrl":"https://doi.org/10.1038/s41598-025-10697-5","workflowStages":[]},"version":"v1","identity":"rs-6427175","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6427175","identity":"rs-6427175","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}