Feasibility and Acceptability of an Online Daily Exercise Program for Community-Dwelling Older Adults: A Randomized Controlled Trial

Feasibility and Acceptability of an Online Daily Exercise Program for Community-Dwelling Older Adults: A Randomized Controlled Trial | 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 Research Article Feasibility and Acceptability of an Online Daily Exercise Program for Community-Dwelling Older Adults: A Randomized Controlled Trial Katerina Machacova, Michal Steffl, Alzbeta Bartova, Blanka Novotná, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4502772/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: We all know how important it is to stay physically active, especially in later life. However, the majority of the population, including older adults, remains sedentary and lacks regular physical activity. The aim of this study was to assess the feasibility and acceptability of a home-based online education and exercise program inspired by developmental kinesiology that was designed for daily use to support functional capacity and an active lifestyle. Methods: Eighty-two community-dwelling older adults (mean ± SD age 73.7 ± 3.4, 77% female) were randomized into intervention (n = 45) and control (n = 37) groups. Participants in the intervention group followed a 12-week home-based exercise program of 15 minutes per day for at least 6 days a week. Adherence was assessed using a diary, and acceptability was assessed using a postintervention questionnaire. Functional status was examined by performance tests (Timed Up and Go Test, Single Leg Stance Test, and Hand Grip) and a single-item question ("How would you rate your functional status from excellent to poor?") at baseline and postintervention. The data were analysed in SPSS using descriptive statistics, t tests, chi-square tests, and ANOVA. Results: The intervention was feasible and acceptable. The retention rate in the experimental group was 100%, and the adherence rate was 99.9%. The program was rated on a 5-point Likert scale as clear (87% considered the program excellent), meaningful (80%), or manageable (71%). All participants (100%) in the experimental group would recommend the program to peers, and 91% expressed a willingness to continue. Additionally, participants felt more fit postintervention (T = 4.96, p < .001; F = 4.83, p < .05) and demonstrated improved one-leg stability (T = -3.45, p = .001). The improvement in agility was not statistically significant but was slightly clinically significant (ES = .05), and grip strength was not affected by the intervention. Conclusions: We conclude that the designed program has great potential to become a welcome part of everyday life among older adults, providing many benefits for this population. It is evident that older generations can follow online exercise programs and improve their health habits in the long term. Trial Registration: The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894). Funding: This research was funded by #NU22-09-00447: 2022-2025. Community-dwelling older adults Online programme Education Exercise Feasibility Acceptability Exercise adherence Figures Figure 1 Summary of Key Findings Feasibility and High Adherence: The study demonstrated high feasibility and adherence rates (99.9%) among participants, indicating that the online exercise program is practical and well received. Acceptability: The Permanento program received high ratings for clarity, meaningfulness, and manageability, with 100% of participants willing to recommend the program to others. Improved Balance and Functional Status: Participants in the intervention group showed significant improvements in single-leg stability and self-rated functional status, although improvements in agility were not statistically significant. Potential for Long-term Adoption: Over 90% of participants expressed a desire to continue exercising postintervention, indicating the program’s potential for long-term sustainability. Trial Registration: The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894). Funding: This research was funded by #NU22-09-00447: 2022-2025. Background Demographic changes are undeniable ( 1 ). The increasing proportion of older adults brings about challenges and necessitates actions at both the global and personal levels. Being physically active on a daily basis can prevent various negative consequences associated with aging, including a lower risk of cardiovascular disease, diabetes, frailty, and mental health issues, as well as reduced mortality ( 2 – 6 ). Conversely, insufficient physical activity is a leading risk factor for these issues ( 7 – 9 ). Evidently, movement is a biological necessity essential for thriving in life ( 10 ). However, the population, including older adults, is moving less while living longer. The combination of decreased physical activity and increased life expectancy makes this issue rather urgent ( 11 ). To date, strategies to reverse the trend of diminishing daily activity have been unsuccessful. Conclusions drawn from pooled analyses of population-based surveys suggest that the 2025 global physical activity target of a 10% reduction in insufficient physical activity will not be met ( 12 ). The gap between the amount of physical activity our bodies need to perform and the amount they actually engage in is still growing. This should raise alarms, especially as we age, because prevalent inactivity can significantly affect the ability to perform daily activities independently in late life ( 13 ). Therefore, the need to counteract the impacts of the modern lifestyle and move consciously and purposefully is undeniable. Public health prevention strategies should promote the importance of physical activity and encourage everyone to move more and permanently ( 14 – 16 ). The current array of exercise programs is vast and diverse, yet comprehensive preventive programs designed for daily use are either lacking or only short-term. Recently, attention has shifted from structured exercises, including training sessions that support individual components of functional fitness, such as strength, mobility, balance, and aerobic capacity, to alternative functional exercises aimed at more complex, lifestyle-integrated movements ( 17 ). Although the majority of interventions have proven to be effective, they fail to be sustainable and thus do not fully address the challenges we face as a society. The need to find a solution that would encourage the entire population, including older adults, to be more active is up-to-date. However, what constitutes the best exercise practice? Each individual has different preferences, capabilities, functional levels, or goals. There cannot be a single program that fits all. However, there is a universal condition: any individual must feel comfortable, strong, and safe when performing any type of physical activity, from self-care to leisure activities or sports. Therefore, we decided to design a preventive program that supports the very foundation of movement using developmental kinesiology ( 18 ). Since early childhood developmental motor patterns can be used in rehabilitation and treatment of the locomotor system ( 19 , 20 ), it can be assumed that these same patterns can also be effective in prevention. The application of principals of developmental kinesiology to exercise practice among older adults is both unique and promising. When designing the preventive program, we opted for a minimalist approach inspired by the concept of “exercise snacking,” applied daily and delivered online ( 21 ). Familiar digital platforms provide an opportunity to deliver personalized, evidence-based exercise programs to anyone at any time ( 22 ). Such exercise programs have proven to be acceptable ( 23 – 25 ) and effective ( 26 ). This shows potential, as technology-based exercise interventions may increase both participation and long-term adherence. Additionally, these important attributes may be bolstered by understanding the benefits of physical activity ( 27 ), valuing one's health, and perceiving positive responses to the activity ( 28 ). In line with our intent to assist older adults in preserving their functional ability to move with strength, comfort, and safety and promoting an active lifestyle for as long as possible, we created a distinctive home education and exercise program named Permanento. Our aim was to trigger intrinsic motivation to be active (through education) and to offer an easy-to-follow, effective tool for minimalistic home exercise that would maintain the foundation of functional capacity necessary for the enjoyable performance of preferred activities or sports. It is hypothesized that enhanced functional capacity leads to increased engagement in other activities. The objective of this randomized controlled trial was to evaluate the feasibility and acceptability of this program and to empirically examine its impact on perceived and objective functional fitness among eighty-two community-dwelling older adults over 70 years of age. Methods Study Design and Setting This study was a 12-week randomized controlled trial conducted among community-dwelling older adults. This study aimed to determine the feasibility and acceptability of an education-exercise program called Permanento and to evaluate its effect on determinants of physical functioning components. The study was conducted between February and May 2023 in Prague, Czech Republic. The exercise intervention was delivered online via a platform developed specifically for this study. All participants were briefed and instructed on how to access the videos and follow the exercise sessions. Pretest and posttest data were collected in person at the Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University. The research assistants who collected the data were blinded to the group assignments. Informal consent was granted by the Ethical Committee of the Faculty of Humanities, Charles University, and all participants provided written informed consent. The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894) on November 14th 2023. Participants and Recruitment Statulator software (available at https://statulator.com/about.html ) was used to estimate the sample size. The effect size was set at 0.20, and the α error was set at 0.05. A statistical power of 0.95 could be achieved with 72 subjects. To account for expected withdrawals during the trial, a total of 98 community-dwelling volunteers aged between 70 and 82 years were recruited. Information about the opportunity to participate in the study was disseminated through organizations providing activities for older adults in Prague from September to December 2022 (Život 90, Senior Fitness, Elpida, Právě teď, Inbaze, and Universities of the Third Age). All participants met the eligibility criteria, which included ( 1 ) being 70 years or older, ( 2 ) having online access and a device to play and follow exercise videos, ( 3 ) living independently at home, and ( 4 ) not having any chronic or acute health conditions that would prevent participation in very simple exercises. Screening was performed over a phone call with one of the research assistants during the application process. A total of 104 older adults were screened, resulting in six exclusions due to low age ( 1 ) or lack of online access ( 5 ), as shown in Fig. 1 ( 29 ). All eligible participants (N = 98) were invited to participate in pretests; however, only 84 successfully completed the baseline test. Nine of the invited participants withdrew due to illness or a change of mind, and five did not appear without notice. The 84 tested participants were randomized into equal intervention and control groups. Group randomization was performed electronically using Microsoft Excel by an independent person not involved in the study. However, three participants did not respect the results of the randomization and relocated themselves from the control group to the intervention group. The intervention group (n = 45) underwent the introductory and educational parts of the intervention and initiated the exercise plan. The control group (N = 37) continued with their everyday activities as usual for 12 weeks and was instructed not to start any new activities. After the research trial, all participants in the control group followed the same program, including both the educational and exercise components, to ensure that they received the same procedures and benefits as the intervention group. Education and Exercise Intervention The program consists of educational and exercise components to provide comprehensive information and trigger enthusiasm and intrinsic motivation to exercise. The educational section includes relevant topics necessary to understand the wider context of aging in the current world with the aim of ( 1 ) providing clear reasons for being physically active and ( 2 ) offering simple guidelines for maintaining functional fitness through minimalistic daily exercise. The goal is to change the traditional “I should exercise” mindset to “I want to exercise”. For the purposes of the study, this educational component was delivered to the intervention group during a 3-hour workshop, but the same information was available on the online platform in the first 10 chapters. Each chapter includes text, audio, and introductory videos, allowing participants to refresh their memory at any time during or after the trial. The exercise component of the platform is divided into nine chapters, each containing one video routine ranging from 12 to 17 minutes. Each routine consists of a few welcoming words and explanations of the most important issues to be aware of during the exercise, such as correct positioning, various modifications of range of motion or intensity, and the importance of perceiving and listening to one's body during the exercise. Each exercise routine results in approximately 10 minutes of continuous physical activity. The program consists of nine simple exercise routines ( 1 – 9 ) that can be performed while sitting on a chair (#1, 2, 3), standing by a chair (#5, 6), or lying on a mat (#4) or bed (#7, 8, 9). The exercises are inspired by developmental kinesiology and follow completely natural principles that are simple but effective, especially when applied daily. The main principles include activation of the diaphragm through breathing, activation of the vestibular apparatus through head movements, and contralateral movements ( 18 ). These principles are performed in a set of varying movements enriched by other gentle motions supporting proper posture and functional components necessary for the safe and confident performance of daily activities, such as strengthening phasic muscles, stretching postural muscles, and joint movements. All principles can be applied while sitting, standing, or lying down and are easy to perform, modify, and enjoy daily. The exercise plan was to exercise at least six days a week. Participants had flexibility in selecting a routine according to their current state of mind, but they had to follow certain rules to avoid performing the same routine the entire week. The weekly routine selection rules included performing only one bed exercise (#7, 8, 9) and at least three different routines from #1 to #6. The time of day for daily exercise was unrestricted, and participants were free to exercise more than the minimum. Participants maintained a diary to log their daily exercise routines, mood before and after exercising, and any additional comments. Adverse Events An adverse event was defined as any event or occasion that prevented the participant from performing the day's exercise. Such events were expected given the length of the intervention and the time of year when minor health complications such as flu are common. Adverse events also included vacations or other commitments that prevented following the exercise plan, such as babysitting grandchildren. Successful completion of the program was considered when a participant completed at least 10 out of the 12 weeks of the intervention period. Assessment All assessments were performed at the Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic. Physiotherapy students served as research assistants and collected all the data before and after the trial. All research assistants were blinded. Actual and Perceived Physical Functioning: The multidimensional timed up-and-go (TUG) test was used to measure mobility skills, combining gait speed, balance, and overall functional capacity ( 30 ). The single-leg stance test was used to assess static postural and balance control ( 31 ). Grip strength was measured using a hand-grip dynamometer (Takei TKK A5401 Digital Hand-Grip Dynamometer). Standardized protocols were followed to test grip strength separately for the right and left hands, with the elbow extended to 90 degrees and the humerus positioned beside the body (Fess & Moran, 1981). The subjects were instructed to push the dynamometer for two to three seconds at their maximum effort for each trial. Each hand was tested in three consecutive trials, with short rests in between trials, and the strongest recording was noted for both hands. The cut-off points by sex were < 30 kg for men and < 20 kg for women ( 32 ). Perceived physical functioning was assessed using a single item: “How is your functional status in general? Would you say your functional status is …”, with response categories on a 5-point Likert scale. Acceptability of the Intervention Acceptability was assessed using a custom-designed questionnaire completed by each participant postintervention to evaluate their perception of the program. Participants were asked to rate the clarity, meaningfulness, and manageability of the program on a 5-point Likert scale (from 1 being the most negative to 5 being the most positive). Participants were also asked if they would recommend the program to family or friends. The questionnaire included open-ended questions to provide more detailed feedback regarding likes and dislikes during the intervention period. Perceived and Actual Sustainability of Home Exercising The main mission of this program is to create a sustainable, long-term exercise routine that becomes a permanent and welcome part of older adults’ daily lives. Expected sustainability was assessed at the end of the intervention with a simple question: “Do you plan to continue daily exercise according to the program?” followed by the open-ended question “Why?” Data Analysis The data were analysed using SPSS for Windows, Version 24 (Armonk, NY, United States: IBM Corp.). The descriptive statistics for continuous data are presented as the means and standard deviations, and those for categorical data are presented as counts and percentages. The data regarding adherence, acceptance, and sustainability were descriptive in nature and were presented as counts and percentages for the intervention group and where possible for the complete sample. Within-group changes were considered explanatory; thus, sample t tests or chi-square tests, depending on the data type, were calculated. The effect size (Cohen's d) for within-group changes pre- and postintervention was calculated as the mean posttest score minus the mean pretest score divided by the pretest standard deviation. Effect sizes were categorized as follows: <0.2 trivial, 0.2 to < 0.5 small, 0.5 to 0.8 moderate, and ≥ 0.8 large (Cohen, 1988). Results Baseline characteristics The baseline demographic characteristics of the participants are presented in Table 1 for the complete sample and separately for the two groups. There were no statistically significant differences between the control and experimental groups. The mean age at the time of data collection was approximately 74 years. Participants were primarily female (77.4%) and highly educated (53.7%). The health status, assessed by the number of chronic conditions, was very good considering the age of the participants; only 12.2% reported three or more chronic conditions. Surprisingly, the same number of participants reported no medication usage at all. However, the number of medical visits was considerably high; almost one-fifth of the participants visited a medical specialist 8 or more times per year (mean of 5 visits, ranging from 1 to 20). The majority of the participants (93.3%) adhered to the exercise plan as recommended, following the program on a daily basis for 10 or more weeks out of the 12-week intervention. Only three participants exercised for nine weeks or less, but they still completed at least 65% of the exercise units and were thus not excluded from the analysis. Table 1 Demographic characteristic of the total of participants and according allocation to the groups. Variable Categories (count, %) or continuous variable (mean, SD) All (n= 82) Experimental group (n=45) Control group (n=37) X 2 or F p Age (years) 73.7 (3.43) 73.0 (3.21) 74.7 (3.49) 1.263 0.264 Gender Female Male 65 (77.4%) 19 (22.6%) 32 (71.1%) 13 (28.9%) 31 (83.8%) 6 (16.2%) 1.832 0.176 Education Basic Secondary Higher 0 (0%) 35 (42.7%) 47 (53.7%) 0 (0%) 19 (42.2%) 26 (57.8%) 0 (0%) 16 (43.2%) 21 56.8%) 0.009 0.926 Marital status Married Widowed Single Divorces 40 (48.8%) 21 (25.6%) 2 (2.4%) 19 (23.2%) 25 (55.6%) 10 (22.2%) 2 (4.4%) 8 (17.8%) 15 (40.5%) 11 (29.7%) 0 (0%) 11 (29.7%) 4.282 0.233 Health status (No. of chronic conditions) 0 1-2 ≥ 3 24 (29.3%) 48 (58.5%) 10 (12.2%) 13 (28.9%) 26 (57.8%) 6 (13.3%) 11 (29.7%) 22 (59.5%) 4 (10.8%) 0.121 0.941 Medication (No. of pills) 0 1-2 ≥ 3 10 (12.2%) 42 (51.2%) 30 (36.6%) 5 (11.1%) 22 (48.9%) 18 (40.0%) 5 (13.5%) 20 (54.1%) 12 (32.4%) 0.520 0.771 Medical visits (No. per year) ≤ 2 3-7 ≥ 8 22 (26.8%) 45 (54.9%) 15 (18.3%) 12 (26.7%) 25 (55.6%) 8 (17.8%) 10 (27.0%) 20 (54.1%) 7 (18.9%) 0.024 0.988 Adherence to exercise plan ≥ 11 weeks Yes No NA 42 (93.3%) 3 (6.7%) NA _ _ Feasibility of the Online Exercise Intervention Adherence The recommendation was to exercise at least 6 days a week according to the video routines for a minimum of 10 weeks, ensuring an 85% adherence rate. We expected some sick and vacation time and thus tolerated up to 2 weeks without exercise. Only three participants exercised for 9 or fewer weeks, but their adherence rate was over 65%, so they were included in the data analysis. Some participants were highly motivated and decided to exercise daily. The overall adherence to the exercise program for the intervention group was 99.9%, ranging from 65% to 117%, as 18 participants (40%) exercised more than the recommended 72 units (12 weeks/6 exercise sessions per week). The retention rate for the intervention group was 100%, while for the control group, it was 95%, as 2 out of 39 participants did not complete the posttest. One participant withdrew due to health issues, and another withdrew due to long-term travel plans (Table 2). Acceptability and Satisfaction More than eighty-six percent (39/45) of the participants in the experimental group evaluated the program as excellent, while the rest rated it as very good (4/45). Two participants (2.2%) did not respond. Eighty percent considered the program highly meaningful (36/45), five rated its meaningfulness as very good (11.1%), and one rated it as good (2.2%). Three participants (6.7%) did not respond. Seventy-one percent reported manageability as excellent (32/45), nearly eighteen percent (8/45) as very good, and only three participants as good (6.7%). Two participants (2.2%) did not respond. Notably, all participants (100%) would recommend the program to family or friends (Table 2). Perceived Sustainability Regarding perceived sustainability, over ninety percent of the participants reported a desire to continue regular exercise even after the end of the research trial. Only four participants (4.9%) indicated that they did not want to continue (Table 2). Table 2 Experimental group participants´ adherence and satisfaction with the program. Variable Categories Experimental gr. (N=45) Intervention adherence 12 weeks 10-11 weeks 9 weeks and less 29 (64.4%) 13 (28.9%) 3 (6.7%) Adherence rate (72 exercise units) Mean (range) 99.9% (65-117%) Ratings of the program: clarity Excellent Very good Good Sufficient Poor Missing 39 (86.7%) 4 (8.9%) 2 (4.4%) meaningfulness Excellent Very good Good Sufficient Poor Missing 36 (80.0%) 5 (11.1%) 1 (2.2%) 3 (6.7%) manageability Excellent Very good Good Sufficient Poor Missing 32 (71.1%) 8 (17.8%) 3 (6.7%) 2 (4.4%) Recommendation to peers Yes No 45 (100%) 0 (0%) Expected sustainability post intervention Yes No 41 (90.1%) 4 (4.9%) Physical Functioning Outcomes As presented in Table 3, participants in the experimental group significantly improved in the single leg stance test by nearly 20 seconds, from a mean of 41.34 seconds to 59.20 seconds (p < .001). The observed improvement in the control group was minor and not statistically significant (p = .220). The experimental group also performed slightly better in the Timed Up-and-Go test, while the control group further declined; however, the differences were neither clinically nor statistically significant. The mean hand grip strength remained almost the same in both groups. Self-rated functional status improved in both groups, but the improvement was significant only in the experimental group (p < .000). However, the overall effect, when considering changes in both groups, was significant (p < 0.05). Table 3 (please, place here) Table 3 Pre-tests and post-test for main outcome variables and within-group change due to intervention, t-tests, effect size and Anova. Variable Experimental group (n = 45) T-test (p) ES Control group (n = 37) T-test T( p ) ES ANOVA F( p ) Pre-test mean (SD) Post-test mean (SD) Pre-test mean (SD) Post-tests mean (SD) Timed Up-and-go test 8.26 (2.28) 8.15 (1.85) -1.266 (.214) .05 7.89 (1.32) 8.12 (1.42) 0.355 (.724) .17 0.80 (.373) Single Leg Stance test 41.34 (54.63) 59.20 (54.46) -3.466 (.001) ** .33 48.63 (67.70) 55.70 (61.52) -1.248 (.220) .10 1.96 (.166) Hand grip 26.68 (7.59) 27.01 (7.33) -0.663 (.511) .06 25.44 (6.73) 26.58 (6.90) -2.337 (.025) * .17 1.26 (.265) Self-rated functional status 2.93 (0.84) 2.44 (0.81) 4.959 (.000) *** .59 2.86 (0.82) 2.76 (0.86) 0.726 (.473) .12 4.83 (.031) * Discussion The findings from this study confirm the feasibility and acceptability of the Permanento online education and exercise program designed to enhance functional capacity and promote an active lifestyle among older adults. The high retention and adherence rates indicate that the intervention is both practical and well received by this population. This study provides critical insights into how online exercise programs can be effectively implemented for community-dwelling older adults, addressing a significant gap in current public health strategies. One key strength of this study was the high adherence rate (99.9%) observed in the intervention group. This indicates the participants' motivation and the program's usability. The flexibility of exercise routines and the use of a digital platform likely contributed to this high adherence. These findings are consistent with previous research suggesting that technology-based interventions can significantly improve adherence to physical activity programs ( 22 , 23 , 26 , 33 ). The high acceptability of the Permanento program is another notable finding. Participants highly rated the program in terms of clarity, meaningfulness, and manageability. This suggests that the combination of educational content and practical exercise routines can effectively motivate older adults to engage in regular physical activity. The personalized and evidence-based nature of the program appears to resonate well with this demographic, aligning with research indicating that understanding the benefits and personal value of physical activity can enhance participation ( 28 ). This is supported by personal feedback from several participants, such as the comment from a 74-year-old woman: " The theoretical explanation of the principles and effects of regular exercise on 'core strengthening' gives me hope that my aging will be graceful, pleasant, and natural without pessimistic outlooks. I am delighted that I can actively prepare for this stage of life without fear of the future. " In terms of physical functioning, the intervention group showed significant improvements in single-leg stability. Improvements in agility were observed but not statistically significant, and grip strength remained unchanged. These mixed results were somewhat expected. The exercise program focused on strengthening the foundation of functional ability through principles applied in developmental kinesiology, which is unique and, to the best of our knowledge, has not been applied to exercise routines or empirically evaluated. These include the activation of the diaphragm through breathing, activation of the vestibular apparatus through head movements, and contralateral movements supporting core strength and stability. It is assumed that improvements in these aspects would first be observable in measures of stability, both static and dynamic, by improved core stability and proprioreception. This hypothesis was supported by our significant improvement in the single-leg stance test and clinical improvement in the Timed Up-and-Go test. The overall strength measured by grip strength might become observable later due to an expected increase in spontaneous physical activity. With regard to our conceptual framework, the most significant improvement observed lies in the subjective assessment of functional fitness. If an individual truly feels fitter, this subjective improvement is more impactful than objective parameters, which may not necessarily align with one's self-perception. For example, a significant improvement in dynamic balance, measured by a reduction in Timed Up-and-Go test performance from 8.6 seconds to 7.8 seconds, may not necessarily translate to an individual's perception of increased comfort and safety during more challenging daily activities such as stair climbing. However, when an individual perceives a change, it can make a substantial difference. This is precisely what our results indicate, much to our satisfaction. We anticipate that the observed improvements in functional fitness parameters will not be due solely to the Permanento program but also to increased spontaneous activity in daily life. Furthermore, we expect this change to be observed earlier among those who prefer more vigorous activities than among those who engage in more leisurely or social activities. This is entirely acceptable. Everyone has different goals, but we all need a solid foundation to support our preferred lifestyle. Ultimately, we all need to feel comfortable in our own bodies to live actively. Despite the positive outcomes, there are some limitations to consider. The study's reliance on self-reported measures for some outcomes could introduce bias. Future research should include detailed examinations to support perceived evaluations, such as standardized measures of quality of life or measures of life satisfaction. Additionally, longer follow-up periods to assess improvements in objective determinants of functional fitness and the sustainability of the observed benefits should be considered. Furthermore, while the intervention was highly acceptable to the study participants, more diverse populations should be examined to broadly generalize the findings. Conclusions In conclusion, the Permanento program has significant potential as a sustainable and effective intervention to positively impact functional capacity among older adults. This study provides a valuable framework for developing future online exercise programs targeting this demographic, thereby contributing to a more active lifestyle, healthier aging, and better quality of life. Abbreviations ANOVA Analysis of Variance ES Effect Size NCT National Clinical Trial SD Standardní odchylka SPSS Statistical Package for the Social Sciences WHO World Health Organization Declarations Funding: This research was funded by #NU22-09-00447: 2022–2025. Author Contribution All authors except for IH were involved in designing the study and the data collection process. MS analysed and interpreted the participants' outcome data. KM was a major contributor to the writing of the manuscript and serves as the corresponding author. AB and BN also contributed to the writing process. IH provided critical revisions and important intellectual content. All the authors have read and approved the final manuscript. Data Availability The datasets used and analysed during the current study are available from the corresponding author upon reasonable request. References WHO. World social report 2023: leaving no one behind in an ageing world. United Nations; 2023. Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to Prevent and Manage Frailty and Fragility Fractures. Curr Osteoporos Rep. 2023;21(2):205-15. Musich S, Wang SS, Hawkins K, Greame C. The Frequency and Health Benefits of Physical Activity for Older Adults. 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Anderson T, Neupert G. Pressing Reset, Original Strength Reloaded: A FontLife Publication, LLC; 2015. Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013;8(1):62-73. Kobesova A, Kolar P. Developmental kinesiology: three levels of motor control in the assessment and treatment of the motor system. J Bodyw Mov Ther. 2014;18(1):23-33. Fyfe JJ, Dalla Via J, Jansons P, Scott D, Daly RM. Feasibility and acceptability of a remotely delivered, home-based, pragmatic resistance 'exercise snacking' intervention in community-dwelling older adults: a pilot randomised controlled trial. BMC Geriatr. 2022;22(1):521. Daly RM, Gianoudis J, Hall T, Mundell NL, Maddison R. Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study. JMIR Mhealth Uhealth. 2021;9(1):e21094. Valenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to Technology-Based Exercise Programs in Older Adults: A Systematic Review. J Geriatr Phys Ther. 2018;41(1):49-61. Lim SER, Meredith, S.J., Agnew, S. Volunteer-led online group exercise for community-dwelling older people: a feasibility and acceptability study. BMC Geriatrics. 2023;23(461). Oba K, Kagiwada, Y., Kamada, M. . Evaluating the feasibility of a remote-based training program supported by information and communications technology in the older adults living at home. BMC Geriatrics. 2022;22(574). Říhova M, Jandová, T., Větrovský T., Machačová K., Kramperová V., Jaklová Dytrtová, J., Šteffl M., Holmerová, I. . Effectiveness of home-based video exercise programmes on physical fitness in older adults - systematic review and meta-analysis. Acta Univ Carol Kinanthropologica. 2023;59(2):93 - 112. Bates A, Furber, S., Sherrington, C. Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65 years and over: a pragmatic randomised controlled trial. BMC Geriatrics. 2022;22(366). Brand R, Cheval B. Theories to Explain Exercise Motivation and Physical Inactivity: Ways of Expanding Our Current Theoretical Perspective. Front Psychol. 2019;10:1147. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials, (2010). Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39(2):142-8. Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15. Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60. Chan KOW, Yuen, P.P., Fong, B.Y. Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall. BMC Geriatrics. 2023;23(845). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4502772","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317193671,"identity":"8e16ff53-a2cb-46bf-b56b-cf4bcc66ced8","order_by":0,"name":"Katerina Machacova","email":"data:image/png;base64,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","orcid":"","institution":"Charles University","correspondingAuthor":true,"prefix":"","firstName":"Katerina","middleName":"","lastName":"Machacova","suffix":""},{"id":317193672,"identity":"dcd99c73-3b74-4aea-81ed-b00ce1af41ae","order_by":1,"name":"Michal Steffl","email":"","orcid":"","institution":"Charles University","correspondingAuthor":false,"prefix":"","firstName":"Michal","middleName":"","lastName":"Steffl","suffix":""},{"id":317193673,"identity":"8740e0b2-4ddf-4d2f-aaf1-96e8c317e55d","order_by":2,"name":"Alzbeta Bartova","email":"","orcid":"","institution":"Charles University","correspondingAuthor":false,"prefix":"","firstName":"Alzbeta","middleName":"","lastName":"Bartova","suffix":""},{"id":317193674,"identity":"116f242f-d26f-408d-aaf9-cc7571de67f9","order_by":3,"name":"Blanka Novotná","email":"","orcid":"","institution":"Charles University","correspondingAuthor":false,"prefix":"","firstName":"Blanka","middleName":"","lastName":"Novotná","suffix":""},{"id":317193675,"identity":"8f18f978-8906-4853-b7c3-0138043759ae","order_by":4,"name":"Iva Holmerova","email":"","orcid":"","institution":"Charles University","correspondingAuthor":false,"prefix":"","firstName":"Iva","middleName":"","lastName":"Holmerova","suffix":""}],"badges":[],"createdAt":"2024-05-30 11:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4502772/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4502772/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60598663,"identity":"1f9c1347-22fa-479f-9134-c3dc05d1eb8a","added_by":"auto","created_at":"2024-07-18 15:55:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18795,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConsort flowdiagram\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4502772/v1/ffa6543ec6affc1b7d2fb30e.png"},{"id":62340921,"identity":"5c11b333-cb8a-4004-b67e-3bbb92218998","added_by":"auto","created_at":"2024-08-13 06:26:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":506836,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4502772/v1/497b2c42-637a-4431-b197-7e21e02d7547.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility and Acceptability of an Online Daily Exercise Program for Community-Dwelling Older Adults: A Randomized Controlled Trial","fulltext":[{"header":"Summary of Key Findings","content":"\u003cul\u003e\n \u003cli\u003eFeasibility and High Adherence: The study demonstrated high feasibility and adherence rates (99.9%) among participants, indicating that the online exercise program is practical and well received.\u003c/li\u003e\n \u003cli\u003eAcceptability: The Permanento program received high ratings for clarity, meaningfulness, and manageability, with 100% of participants willing to recommend the program to others.\u003c/li\u003e\n \u003cli\u003eImproved Balance and Functional Status: Participants in the intervention group showed significant improvements in single-leg stability and self-rated functional status, although improvements in agility were not statistically significant.\u003c/li\u003e\n \u003cli\u003ePotential for Long-term Adoption: Over 90% of participants expressed a desire to continue exercising\u0026nbsp;postintervention, indicating the program\u0026rsquo;s potential for long-term sustainability.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTrial Registration: The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894).\u0026nbsp;Funding:\u003c/p\u003e\n\u003cp\u003eThis research was funded by #NU22-09-00447: 2022-2025.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eDemographic changes are undeniable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The increasing proportion of older adults brings about challenges and necessitates actions at both the global and personal levels. Being physically active on a daily basis can prevent various negative consequences associated with aging, including a lower risk of cardiovascular disease, diabetes, frailty, and mental health issues, as well as reduced mortality (\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Conversely, insufficient physical activity is a leading risk factor for these issues (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Evidently, movement is a biological necessity essential for thriving in life (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, the population, including older adults, is moving less while living longer. The combination of decreased physical activity and increased life expectancy makes this issue rather urgent (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo date, strategies to reverse the trend of diminishing daily activity have been unsuccessful. Conclusions drawn from pooled analyses of population-based surveys suggest that the 2025 global physical activity target of a 10% reduction in insufficient physical activity will not be met (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The gap between the amount of physical activity our bodies need to perform and the amount they actually engage in is still growing. This should raise alarms, especially as we age, because prevalent inactivity can significantly affect the ability to perform daily activities independently in late life (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, the need to counteract the impacts of the modern lifestyle and move consciously and purposefully is undeniable. Public health prevention strategies should promote the importance of physical activity and encourage everyone to move more and permanently (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current array of exercise programs is vast and diverse, yet comprehensive preventive programs designed for daily use are either lacking or only short-term. Recently, attention has shifted from structured exercises, including training sessions that support individual components of functional fitness, such as strength, mobility, balance, and aerobic capacity, to alternative functional exercises aimed at more complex, lifestyle-integrated movements (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Although the majority of interventions have proven to be effective, they fail to be sustainable and thus do not fully address the challenges we face as a society. The need to find a solution that would encourage the entire population, including older adults, to be more active is up-to-date.\u003c/p\u003e \u003cp\u003eHowever, what constitutes the best exercise practice? Each individual has different preferences, capabilities, functional levels, or goals. There cannot be a single program that fits all. However, there is a universal condition: any individual must feel comfortable, strong, and safe when performing any type of physical activity, from self-care to leisure activities or sports. Therefore, we decided to design a preventive program that supports the very foundation of movement using developmental kinesiology (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Since early childhood developmental motor patterns can be used in rehabilitation and treatment of the locomotor system (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), it can be assumed that these same patterns can also be effective in prevention. The application of principals of developmental kinesiology to exercise practice among older adults is both unique and promising.\u003c/p\u003e \u003cp\u003eWhen designing the preventive program, we opted for a minimalist approach inspired by the concept of \u0026ldquo;exercise snacking,\u0026rdquo; applied daily and delivered online (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Familiar digital platforms provide an opportunity to deliver personalized, evidence-based exercise programs to anyone at any time (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Such exercise programs have proven to be acceptable (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and effective (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This shows potential, as technology-based exercise interventions may increase both participation and long-term adherence. Additionally, these important attributes may be bolstered by understanding the benefits of physical activity (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), valuing one's health, and perceiving positive responses to the activity (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn line with our intent to assist older adults in preserving their functional ability to move with strength, comfort, and safety and promoting an active lifestyle for as long as possible, we created a distinctive home education and exercise program named Permanento. Our aim was to trigger intrinsic motivation to be active (through education) and to offer an easy-to-follow, effective tool for minimalistic home exercise that would maintain the foundation of functional capacity necessary for the enjoyable performance of preferred activities or sports. It is hypothesized that enhanced functional capacity leads to increased engagement in other activities. The objective of this randomized controlled trial was to evaluate the feasibility and acceptability of this program and to empirically examine its impact on perceived and objective functional fitness among eighty-two community-dwelling older adults over 70 years of age.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e \u003cp\u003eThis study was a 12-week randomized controlled trial conducted among community-dwelling older adults. This study aimed to determine the feasibility and acceptability of an education-exercise program called Permanento and to evaluate its effect on determinants of physical functioning components. The study was conducted between February and May 2023 in Prague, Czech Republic. The exercise intervention was delivered online via a platform developed specifically for this study. All participants were briefed and instructed on how to access the videos and follow the exercise sessions. Pretest and posttest data were collected in person at the Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University. The research assistants who collected the data were blinded to the group assignments. Informal consent was granted by the Ethical Committee of the Faculty of Humanities, Charles University, and all participants provided written informed consent. The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894) on November 14th 2023.\u003c/p\u003e \u003cp\u003eParticipants and Recruitment\u003c/p\u003e \u003cp\u003eStatulator software (available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://statulator.com/about.html\u003c/span\u003e\u003cspan address=\"https://statulator.com/about.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to estimate the sample size. The effect size was set at 0.20, and the α error was set at 0.05. A statistical power of 0.95 could be achieved with 72 subjects. To account for expected withdrawals during the trial, a total of 98 community-dwelling volunteers aged between 70 and 82 years were recruited. Information about the opportunity to participate in the study was disseminated through organizations providing activities for older adults in Prague from September to December 2022 (Život 90, Senior Fitness, Elpida, Pr\u0026aacute;vě teď, Inbaze, and Universities of the Third Age). All participants met the eligibility criteria, which included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being 70 years or older, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) having online access and a device to play and follow exercise videos, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) living independently at home, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) not having any chronic or acute health conditions that would prevent participation in very simple exercises. Screening was performed over a phone call with one of the research assistants during the application process. A total of 104 older adults were screened, resulting in six exclusions due to low age (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) or lack of online access (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), as shown in Fig.\u0026nbsp;1 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). All eligible participants (N\u0026thinsp;=\u0026thinsp;98) were invited to participate in pretests; however, only 84 successfully completed the baseline test. Nine of the invited participants withdrew due to illness or a change of mind, and five did not appear without notice. The 84 tested participants were randomized into equal intervention and control groups. Group randomization was performed electronically using Microsoft Excel by an independent person not involved in the study. However, three participants did not respect the results of the randomization and relocated themselves from the control group to the intervention group. The intervention group (n\u0026thinsp;=\u0026thinsp;45) underwent the introductory and educational parts of the intervention and initiated the exercise plan. The control group (N\u0026thinsp;=\u0026thinsp;37) continued with their everyday activities as usual for 12 weeks and was instructed not to start any new activities. After the research trial, all participants in the control group followed the same program, including both the educational and exercise components, to ensure that they received the same procedures and benefits as the intervention group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEducation and Exercise Intervention\u003c/p\u003e \u003cp\u003eThe program consists of educational and exercise components to provide comprehensive information and trigger enthusiasm and intrinsic motivation to exercise. The educational section includes relevant topics necessary to understand the wider context of aging in the current world with the aim of (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) providing clear reasons for being physically active and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) offering simple guidelines for maintaining functional fitness through minimalistic daily exercise. The goal is to change the traditional \u0026ldquo;I should exercise\u0026rdquo; mindset to \u0026ldquo;I want to exercise\u0026rdquo;. For the purposes of the study, this educational component was delivered to the intervention group during a 3-hour workshop, but the same information was available on the online platform in the first 10 chapters. Each chapter includes text, audio, and introductory videos, allowing participants to refresh their memory at any time during or after the trial.\u003c/p\u003e \u003cp\u003eThe exercise component of the platform is divided into nine chapters, each containing one video routine ranging from 12 to 17 minutes. Each routine consists of a few welcoming words and explanations of the most important issues to be aware of during the exercise, such as correct positioning, various modifications of range of motion or intensity, and the importance of perceiving and listening to one's body during the exercise. Each exercise routine results in approximately 10 minutes of continuous physical activity. The program consists of nine simple exercise routines (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) that can be performed while sitting on a chair (#1, 2, 3), standing by a chair (#5, 6), or lying on a mat (#4) or bed (#7, 8, 9).\u003c/p\u003e \u003cp\u003eThe exercises are inspired by developmental kinesiology and follow completely natural principles that are simple but effective, especially when applied daily. The main principles include activation of the diaphragm through breathing, activation of the vestibular apparatus through head movements, and contralateral movements (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These principles are performed in a set of varying movements enriched by other gentle motions supporting proper posture and functional components necessary for the safe and confident performance of daily activities, such as strengthening phasic muscles, stretching postural muscles, and joint movements. All principles can be applied while sitting, standing, or lying down and are easy to perform, modify, and enjoy daily.\u003c/p\u003e \u003cp\u003eThe exercise plan was to exercise at least six days a week. Participants had flexibility in selecting a routine according to their current state of mind, but they had to follow certain rules to avoid performing the same routine the entire week. The weekly routine selection rules included performing only one bed exercise (#7, 8, 9) and at least three different routines from #1 to #6. The time of day for daily exercise was unrestricted, and participants were free to exercise more than the minimum. Participants maintained a diary to log their daily exercise routines, mood before and after exercising, and any additional comments.\u003c/p\u003e \u003cp\u003eAdverse Events\u003c/p\u003e \u003cp\u003eAn adverse event was defined as any event or occasion that prevented the participant from performing the day's exercise. Such events were expected given the length of the intervention and the time of year when minor health complications such as flu are common. Adverse events also included vacations or other commitments that prevented following the exercise plan, such as babysitting grandchildren. Successful completion of the program was considered when a participant completed at least 10 out of the 12 weeks of the intervention period.\u003c/p\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003cp\u003eAll assessments were performed at the Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic. Physiotherapy students served as research assistants and collected all the data before and after the trial. All research assistants were blinded.\u003c/p\u003e \u003cp\u003eActual and Perceived Physical Functioning:\u003c/p\u003e \u003cp\u003eThe multidimensional timed up-and-go (TUG) test was used to measure mobility skills, combining gait speed, balance, and overall functional capacity (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The single-leg stance test was used to assess static postural and balance control (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Grip strength was measured using a hand-grip dynamometer (Takei TKK A5401 Digital Hand-Grip Dynamometer). Standardized protocols were followed to test grip strength separately for the right and left hands, with the elbow extended to 90 degrees and the humerus positioned beside the body (Fess \u0026amp; Moran, 1981). The subjects were instructed to push the dynamometer for two to three seconds at their maximum effort for each trial. Each hand was tested in three consecutive trials, with short rests in between trials, and the strongest recording was noted for both hands. The cut-off points by sex were \u0026lt;\u0026thinsp;30 kg for men and \u0026lt;\u0026thinsp;20 kg for women (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Perceived physical functioning was assessed using a single item: \u0026ldquo;How is your functional status in general? Would you say your functional status is \u0026hellip;\u0026rdquo;, with response categories on a 5-point Likert scale.\u003c/p\u003e \u003cp\u003eAcceptability of the Intervention\u003c/p\u003e \u003cp\u003eAcceptability was assessed using a custom-designed questionnaire completed by each participant postintervention to evaluate their perception of the program. Participants were asked to rate the clarity, meaningfulness, and manageability of the program on a 5-point Likert scale (from 1 being the most negative to 5 being the most positive). Participants were also asked if they would recommend the program to family or friends. The questionnaire included open-ended questions to provide more detailed feedback regarding likes and dislikes during the intervention period.\u003c/p\u003e \u003cp\u003ePerceived and Actual Sustainability of Home Exercising\u003c/p\u003e \u003cp\u003eThe main mission of this program is to create a sustainable, long-term exercise routine that becomes a permanent and welcome part of older adults\u0026rsquo; daily lives. Expected sustainability was assessed at the end of the intervention with a simple question: \u0026ldquo;Do you plan to continue daily exercise according to the program?\u0026rdquo; followed by the open-ended question \u0026ldquo;Why?\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed using SPSS for Windows, Version 24 (Armonk, NY, United States: IBM Corp.). The descriptive statistics for continuous data are presented as the means and standard deviations, and those for categorical data are presented as counts and percentages. The data regarding adherence, acceptance, and sustainability were descriptive in nature and were presented as counts and percentages for the intervention group and where possible for the complete sample. Within-group changes were considered explanatory; thus, sample t tests or chi-square tests, depending on the data type, were calculated. The effect size (Cohen's d) for within-group changes pre- and postintervention was calculated as the mean posttest score minus the mean pretest score divided by the pretest standard deviation. Effect sizes were categorized as follows: \u0026lt;0.2 trivial, 0.2 to \u0026lt;\u0026thinsp;0.5 small, 0.5 to 0.8 moderate, and \u0026ge;\u0026thinsp;0.8 large (Cohen, 1988).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline characteristics\u003c/p\u003e\n\u003cp\u003eThe baseline\u0026nbsp;demographic characteristics of the participants are presented in Table 1 for the complete sample and separately for the two groups. There were no statistically significant differences between the control and experimental groups. The mean age at the time of data collection was approximately 74 years. Participants were primarily female (77.4%) and highly educated (53.7%). The health status, assessed by the number of chronic conditions, was very good considering the age of the\u0026nbsp;participants; only 12.2% reported three or more chronic conditions. Surprisingly, the same number of participants reported no medication usage at all. However, the number of medical visits was considerably high; almost one-fifth of the participants visited a medical specialist 8 or more times per year (mean of 5 visits, ranging from 1 to 20). The majority of the participants (93.3%) adhered to the exercise plan as recommended, following the program on a daily basis for 10 or more weeks out of the 12-week intervention. Only three participants exercised for nine weeks or less, but they still completed at least 65% of the exercise units and were thus not excluded from the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e \u003cem\u003eDemographic characteristic of the total of participants and according allocation to the groups.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003e\u003cstrong\u003eCategories (count, %) or continuous variable (mean, SD)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e(n= 82)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cstrong\u003eExperimental group \u0026nbsp;(n=45)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cstrong\u003eControl group (n=37)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e or F\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eAge (years)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e73.7 (3.43)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e73.0 (3.21)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e74.7 (3.49)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e1.263\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.264\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eGender\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003eFemale\u003cbr\u003eMale\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e65 (77.4%)\u003cbr\u003e19 (22.6%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e32 (71.1%)\u003cbr\u003e13 (28.9%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e31 (83.8%)\u003cbr\u003e6 (16.2%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e1.832\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.176\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eEducation\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003eBasic\u003cbr\u003eSecondary\u003cbr\u003eHigher\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e0 (0%)\u003cbr\u003e35 (42.7%)\u003cbr\u003e47 (53.7%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0 (0%)\u003cbr\u003e19 (42.2%)\u003cbr\u003e26 (57.8%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0 (0%)\u003cbr\u003e16 (43.2%)\u003cbr\u003e21 56.8%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.009\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.926\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eMarital status\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003eMarried\u003cbr\u003eWidowed\u003cbr\u003eSingle\u003cbr\u003eDivorces\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e40 (48.8%)\u003cbr\u003e21 (25.6%)\u003cbr\u003e2 (2.4%)\u003cbr\u003e19 (23.2%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e25 (55.6%)\u003cbr\u003e10 (22.2%)\u003cbr\u003e2 (4.4%)\u003cbr\u003e8 (17.8%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e15 (40.5%)\u003cbr\u003e11 (29.7%)\u003cbr\u003e0 (0%)\u003cbr\u003e11 (29.7%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e4.282\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.233\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eHealth status\u003cbr\u003e\u0026nbsp; \u0026nbsp;(No. of chronic\u003cbr\u003e\u0026nbsp; \u0026nbsp;conditions)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003e0\u003cbr\u003e1-2\u003cbr\u003e\u0026ge; 3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e24 (29.3%)\u003cbr\u003e48 (58.5%)\u003cbr\u003e10 (12.2%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e13 (28.9%)\u003cbr\u003e26 (57.8%)\u003cbr\u003e6 (13.3%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e11 (29.7%)\u003cbr\u003e22 (59.5%)\u003cbr\u003e4 (10.8%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.121\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.941\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eMedication\u003cbr\u003e\u0026nbsp; \u0026nbsp; (No. of pills)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003e0\u003cbr\u003e1-2\u003cbr\u003e\u0026ge; 3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e10 (12.2%)\u003cbr\u003e42 (51.2%)\u003cbr\u003e30 (36.6%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e5 (11.1%)\u003cbr\u003e22 (48.9%)\u003cbr\u003e18 (40.0%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e5 (13.5%)\u003cbr\u003e20 (54.1%)\u003cbr\u003e12 (32.4%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.520\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.771\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eMedical visits\u003cbr\u003e\u0026nbsp; \u0026nbsp;(No. per year)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003e\u0026le; 2\u003cbr\u003e3-7\u003cbr\u003e\u0026ge; 8\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003e22 (26.8%)\u003cbr\u003e45 (54.9%)\u003cbr\u003e15 (18.3%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e12 (26.7%)\u003cbr\u003e25 (55.6%)\u003cbr\u003e8 (17.8%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e10 (27.0%)\u003cbr\u003e20 (54.1%)\u003cbr\u003e7 (18.9%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.024\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e0.988\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003eAdherence to exercise plan \u0026ge; 11 weeks\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1191%;\"\u003eYes\u003cbr\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6309%;\"\u003eNA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e42 (93.3%)\u003cbr\u003e3 (6.7%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003eNA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e_\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e_\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFeasibility of the Online Exercise Intervention\u003c/p\u003e\n\u003cp\u003eAdherence\u003c/p\u003e\n\u003cp\u003eThe recommendation was to exercise at least 6 days a week according to the video routines for a minimum of 10 weeks, ensuring an 85% adherence rate. We expected some sick and vacation time and thus tolerated up to 2 weeks without exercise. Only three participants exercised for 9 or fewer weeks, but their adherence rate was over 65%, so they were included in the data analysis. Some participants were highly motivated and decided to exercise daily. The overall adherence to the exercise program for the intervention group was 99.9%, ranging from 65% to 117%, as 18 participants (40%) exercised more than the recommended 72 units (12 weeks/6 exercise sessions per week). The retention rate for the intervention group was 100%, while for the control group,\u0026nbsp;it was 95%, as 2 out of 39 participants did not\u0026nbsp;complete the\u0026nbsp;posttest. One participant withdrew due to health issues, and another\u0026nbsp;withdrew\u0026nbsp;due to long-term travel plans (Table 2).\u003c/p\u003e\n\u003cp\u003eAcceptability and Satisfaction\u003c/p\u003e\n\u003cp\u003eMore than eighty-six percent (39/45) of the participants in the experimental group evaluated the program as excellent, while the rest rated it as very good (4/45). Two participants (2.2%) did not respond. Eighty percent considered the program highly meaningful (36/45), five rated its meaningfulness as very good (11.1%), and one\u0026nbsp;rated it\u0026nbsp;as good (2.2%). Three participants (6.7%) did not respond. Seventy-one percent reported manageability as excellent (32/45), nearly eighteen percent (8/45) as very good, and only three participants as good (6.7%). Two participants (2.2%) did not respond. Notably, all participants (100%) would recommend the program to family or friends (Table 2).\u003c/p\u003e\n\u003cp\u003ePerceived Sustainability\u003c/p\u003e\n\u003cp\u003eRegarding perceived sustainability, over ninety percent of the participants reported a desire to continue regular\u0026nbsp;exercise\u0026nbsp;even after the end of the research trial. Only four participants (4.9%) indicated\u0026nbsp;that\u0026nbsp;they did not want to continue (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e \u003cem\u003eExperimental group participants\u0026acute; adherence and satisfaction with the program.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e\u003cstrong\u003eExperimental gr. (N=45)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003eIntervention adherence\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003e12 weeks\u003cbr\u003e10-11 weeks\u003cbr\u003e9 weeks and less\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e29 (64.4%)\u003cbr\u003e13 (28.9%)\u003cbr\u003e3 (6.7%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003eAdherence rate (72 exercise units)\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eMean (range)\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e99.9% (65-117%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003eRatings of the program:\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003eclarity\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eExcellent\u003cbr\u003eVery good\u003cbr\u003eGood\u003cbr\u003eSufficient\u003cbr\u003ePoor\u003cbr\u003e\u003cem\u003eMissing\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e39 (86.7%)\u003cbr\u003e4 (8.9%)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e2 (4.4%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003emeaningfulness\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eExcellent\u003cbr\u003eVery good\u003cbr\u003eGood\u003cbr\u003eSufficient\u003cbr\u003ePoor\u003cbr\u003e\u003cem\u003eMissing\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e36 (80.0%)\u003cbr\u003e5 (11.1%)\u003cbr\u003e1 (2.2%)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e3 (6.7%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003e\n \u003cul\u003e\n \u003cli\u003emanageability\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eExcellent\u003cbr\u003eVery good\u003cbr\u003eGood\u003cbr\u003eSufficient\u003cbr\u003ePoor\u003cbr\u003e\u003cem\u003eMissing\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e32 (71.1%)\u003cbr\u003e8 (17.8%)\u003cbr\u003e3 (6.7%)\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e2 (4.4%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003eRecommendation to peers\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eYes\u003cbr\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e45 (100%)\u003cbr\u003e0 (0%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.36065573770492%\" valign=\"top\"\u003eExpected sustainability post intervention\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.84426229508197%\" valign=\"top\"\u003eYes\u003cbr\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.795081967213115%\" valign=\"top\"\u003e41 (90.1%)\u003cbr\u003e4 (4.9%)\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePhysical Functioning Outcomes\u003c/p\u003e\n\u003cp\u003eAs presented in Table 3, participants in the experimental group significantly improved in the\u0026nbsp;single leg stance\u0026nbsp;test by nearly 20 seconds, from a mean of 41.34 seconds to 59.20 seconds (p \u0026lt; .001). The observed improvement in the control group was minor and not statistically significant (p = .220). The experimental group also performed slightly better in the Timed Up-and-Go test, while the control group further declined; however, the differences were neither clinically nor statistically significant.\u0026nbsp;The mean\u0026nbsp;hand grip strength remained almost the same in both groups. Self-rated functional status improved in both groups, but the improvement was significant only in the experimental group (p \u0026lt; .000). However, the overall effect, when considering changes in both groups, was significant (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 3 (please, place here)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e \u003cem\u003ePre-tests and post-test for main outcome variables and within-group change due to intervention, t-tests, effect size and Anova.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"820\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.14041514041514%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.07081807081807%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n = 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.698412698412698%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eT-test (p)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.738705738705739%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.437118437118436%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(n = 37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.797313797313798%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eT-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; T(\u003cem\u003ep\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.738705738705739%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.378510378510379%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eANOVA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eF(\u003cem\u003ep\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.25249169435216%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.249169435215947%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.249169435215947%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.249169435215947%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-tests\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.10353227771011%\"\u003e\n \u003cp\u003eTimed Up-and-go test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.891595615103533%\"\u003e\n \u003cp\u003e8.26 (2.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e8.15 (1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66747868453106%\"\u003e\n \u003cp\u003e-1.266 (.214)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e7.89 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e8.12 (1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763702801461632%\"\u003e\n \u003cp\u003e0.355 (.724)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.353227771010962%\"\u003e\n \u003cp\u003e0.80 (.373)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.10353227771011%\"\u003e\n \u003cp\u003eSingle Leg Stance test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.891595615103533%\"\u003e\n \u003cp\u003e41.34 (54.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e59.20 (54.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66747868453106%\"\u003e\n \u003cp\u003e-3.466 (.001) **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e48.63 (67.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e55.70 (61.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763702801461632%\"\u003e\n \u003cp\u003e-1.248 (.220)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.353227771010962%\"\u003e\n \u003cp\u003e1.96 (.166)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.10353227771011%\"\u003e\n \u003cp\u003eHand grip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.891595615103533%\"\u003e\n \u003cp\u003e26.68 (7.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e27.01 (7.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66747868453106%\"\u003e\n \u003cp\u003e-0.663 (.511)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e25.44 (6.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e26.58 (6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763702801461632%\"\u003e\n \u003cp\u003e-2.337 (.025)\u003c/p\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.353227771010962%\"\u003e\n \u003cp\u003e1.26 (.265)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.10353227771011%\"\u003e\n \u003cp\u003eSelf-rated functional status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.891595615103533%\"\u003e\n \u003cp\u003e2.93 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e2.44 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.66747868453106%\"\u003e\n \u003cp\u003e4.959 (.000) ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e2.86 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.257003654080389%\"\u003e\n \u003cp\u003e2.76 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.763702801461632%\"\u003e\n \u003cp\u003e0.726 (.473)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.724725943970768%\"\u003e\n \u003cp\u003e.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.353227771010962%\"\u003e\n \u003cp\u003e4.83 (.031)\u003c/p\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this study confirm the feasibility and acceptability of the Permanento online education and exercise program designed to enhance functional capacity and promote an active lifestyle among older adults. The high retention and adherence rates indicate that the intervention is both practical and well received by this population. This study provides critical insights into how online exercise programs can be effectively implemented for community-dwelling older adults, addressing a significant gap in current public health strategies.\u003c/p\u003e \u003cp\u003eOne key strength of this study was the high adherence rate (99.9%) observed in the intervention group. This indicates the participants' motivation and the program's usability. The flexibility of exercise routines and the use of a digital platform likely contributed to this high adherence. These findings are consistent with previous research suggesting that technology-based interventions can significantly improve adherence to physical activity programs (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe high acceptability of the Permanento program is another notable finding. Participants highly rated the program in terms of clarity, meaningfulness, and manageability. This suggests that the combination of educational content and practical exercise routines can effectively motivate older adults to engage in regular physical activity. The personalized and evidence-based nature of the program appears to resonate well with this demographic, aligning with research indicating that understanding the benefits and personal value of physical activity can enhance participation (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This is supported by personal feedback from several participants, such as the comment from a 74-year-old woman: \"\u003cem\u003eThe theoretical explanation of the principles and effects of regular exercise on 'core strengthening' gives me hope that my aging will be graceful, pleasant, and natural without pessimistic outlooks. I am delighted that I can actively prepare for this stage of life without fear of the future.\u003c/em\u003e\"\u003c/p\u003e \u003cp\u003eIn terms of physical functioning, the intervention group showed significant improvements in single-leg stability. Improvements in agility were observed but not statistically significant, and grip strength remained unchanged. These mixed results were somewhat expected. The exercise program focused on strengthening the foundation of functional ability through principles applied in developmental kinesiology, which is unique and, to the best of our knowledge, has not been applied to exercise routines or empirically evaluated. These include the activation of the diaphragm through breathing, activation of the vestibular apparatus through head movements, and contralateral movements supporting core strength and stability. It is assumed that improvements in these aspects would first be observable in measures of stability, both static and dynamic, by improved core stability and proprioreception. This hypothesis was supported by our significant improvement in the single-leg stance test and clinical improvement in the Timed Up-and-Go test. The overall strength measured by grip strength might become observable later due to an expected increase in spontaneous physical activity.\u003c/p\u003e \u003cp\u003eWith regard to our conceptual framework, the most significant improvement observed lies in the subjective assessment of functional fitness. If an individual truly feels fitter, this subjective improvement is more impactful than objective parameters, which may not necessarily align with one's self-perception. For example, a significant improvement in dynamic balance, measured by a reduction in Timed Up-and-Go test performance from 8.6 seconds to 7.8 seconds, may not necessarily translate to an individual's perception of increased comfort and safety during more challenging daily activities such as stair climbing. However, when an individual perceives a change, it can make a substantial difference. This is precisely what our results indicate, much to our satisfaction.\u003c/p\u003e \u003cp\u003eWe anticipate that the observed improvements in functional fitness parameters will not be due solely to the Permanento program but also to increased spontaneous activity in daily life. Furthermore, we expect this change to be observed earlier among those who prefer more vigorous activities than among those who engage in more leisurely or social activities. This is entirely acceptable. Everyone has different goals, but we all need a solid foundation to support our preferred lifestyle. Ultimately, we all need to feel comfortable in our own bodies to live actively.\u003c/p\u003e \u003cp\u003eDespite the positive outcomes, there are some limitations to consider. The study's reliance on self-reported measures for some outcomes could introduce bias. Future research should include detailed examinations to support perceived evaluations, such as standardized measures of quality of life or measures of life satisfaction. Additionally, longer follow-up periods to assess improvements in objective determinants of functional fitness and the sustainability of the observed benefits should be considered. Furthermore, while the intervention was highly acceptable to the study participants, more diverse populations should be examined to broadly generalize the findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the Permanento program has significant potential as a sustainable and effective intervention to positively impact functional capacity among older adults. This study provides a valuable framework for developing future online exercise programs targeting this demographic, thereby contributing to a more active lifestyle, healthier aging, and better quality of life.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eES\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Clinical Trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandardn\u0026iacute; odchylka\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research was funded by #NU22-09-00447: 2022\u0026ndash;2025.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors except for IH were involved in designing the study and the data collection process. MS analysed and interpreted the participants' outcome data. KM was a major contributor to the writing of the manuscript and serves as the corresponding author. AB and BN also contributed to the writing process. IH provided critical revisions and important intellectual content. All the authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. World social report 2023: leaving no one behind in an ageing world. United Nations; 2023.\u003c/li\u003e\n\u003cli\u003eDent E, Daly RM, Hoogendijk EO, Scott D. Exercise to Prevent and Manage Frailty and Fragility Fractures. Curr Osteoporos Rep. 2023;21(2):205-15.\u003c/li\u003e\n\u003cli\u003eMusich S, Wang SS, Hawkins K, Greame C. The Frequency and Health Benefits of Physical Activity for Older Adults. Popul Health Manag. 2017;20(3):199-207.\u003c/li\u003e\n\u003cli\u003eSherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, et al. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med. 2020;54(15):885-91.\u003c/li\u003e\n\u003cli\u003eWHO. Global action plan on physical activity 2018\u0026ndash;2030: more active people for a healthier world. Geneva: World Health Organization (WHO); 2018.\u003c/li\u003e\n\u003cli\u003eDong B, Yue, Y., Wang, Z. Association between physical activity, peak expiratory flow, and cognitive function in aging: a cross-sectional analysis. BMC Geriatr. 2024;24(460).\u003c/li\u003e\n\u003cli\u003eBueno-Antequera J, Mungu\u0026iacute;a-Izquierdo, D. Physical Inactivity, Sedentarism, and Low Fitness: A Worldwide Pandemic for Public Health. In: Rezaei N, editor. Integrated Science of Global Epidemics: Integrated Science, vol 14., Springer, Cham; 2023.\u003c/li\u003e\n\u003cli\u003eLee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-29.\u003c/li\u003e\n\u003cli\u003eMacera CA, Cavanaugh, A., Bellettiere, J. . State of the Art Review: Physical Activity and Older Adults. American Journal of Lifestyle Medicine. 2017;11(1):42-57.\u003c/li\u003e\n\u003cli\u003eStults-Kolehmainen MA. Humans have a basic physical and psychological need to move the body: Physical activity as a primary drive. Front Psychol. 2023;eCollection(Apr 11 2023).\u003c/li\u003e\n\u003cli\u003eWoessner MN, Tacey A, Levinger-Limor A, Parker AG, Levinger P, Levinger I. The Evolution of Technology and Physical Inactivity: The Good, the Bad, and the Way Forward. Front Public Health. 2021;9:655491.\u003c/li\u003e\n\u003cli\u003eGuthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077-e86.\u003c/li\u003e\n\u003cli\u003eYoshimura J, Tanimura C, Matsumoto H, Tokushima Y, Inoue K, Park D, et al. Relationship of Physical Activity to Self-Care Agency and Physical Condition Among Older Adults in a Rural Area. Yonago Acta Med. 2021;64(1):18-29.\u003c/li\u003e\n\u003cli\u003eOlanrewaju O, Kelly S, Cowan A, Brayne C, Lafortune L. Physical Activity in Community Dwelling Older People: A Systematic Review of Reviews of Interventions and Context. PLoS One. 2016;11(12):e0168614.\u003c/li\u003e\n\u003cli\u003eHolmerov\u0026aacute; I, Mach\u0026aacute;čov\u0026aacute;, K. Aktivn\u0026iacute; gerontologie aneb Jak st\u0026aacute;rnout dobře. Praha: Mlad\u0026aacute; fronta 2019.\u003c/li\u003e\n\u003cli\u003eDipietro L, Campbell WW, Buchner DM, Erickson KI, Powell KE, Bloodgood B, et al. Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review. Med Sci Sports Exerc. 2019;51(6):1303-13.\u003c/li\u003e\n\u003cli\u003eWeber M, Belala N, Clemson L, Boulton E, Hawley-Hague H, Becker C, et al. Feasibility and Effectiveness of Intervention Programmes Integrating Functional Exercise into Daily Life of Older Adults: A Systematic Review. Gerontology. 2018;64(2):172-87.\u003c/li\u003e\n\u003cli\u003eAnderson T, Neupert G. Pressing Reset, Original Strength Reloaded: A FontLife Publication, LLC; 2015.\u003c/li\u003e\n\u003cli\u003eFrank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization \u0026amp; sports rehabilitation. Int J Sports Phys Ther. 2013;8(1):62-73.\u003c/li\u003e\n\u003cli\u003eKobesova A, Kolar P. Developmental kinesiology: three levels of motor control in the assessment and treatment of the motor system. J Bodyw Mov Ther. 2014;18(1):23-33.\u003c/li\u003e\n\u003cli\u003eFyfe JJ, Dalla Via J, Jansons P, Scott D, Daly RM. Feasibility and acceptability of a remotely delivered, home-based, pragmatic resistance \u0026apos;exercise snacking\u0026apos; intervention in community-dwelling older adults: a pilot randomised controlled trial. BMC Geriatr. 2022;22(1):521.\u003c/li\u003e\n\u003cli\u003eDaly RM, Gianoudis J, Hall T, Mundell NL, Maddison R. Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study. JMIR Mhealth Uhealth. 2021;9(1):e21094.\u003c/li\u003e\n\u003cli\u003eValenzuela T, Okubo Y, Woodbury A, Lord SR, Delbaere K. Adherence to Technology-Based Exercise Programs in Older Adults: A Systematic Review. J Geriatr Phys Ther. 2018;41(1):49-61.\u003c/li\u003e\n\u003cli\u003eLim SER, Meredith, S.J., Agnew, S. Volunteer-led online group exercise for community-dwelling older people: a feasibility and acceptability study. BMC Geriatrics. 2023;23(461).\u003c/li\u003e\n\u003cli\u003eOba K, Kagiwada, Y., Kamada, M. . Evaluating the feasibility of a remote-based training program supported by information and communications technology in the older adults living at home. BMC Geriatrics. 2022;22(574).\u003c/li\u003e\n\u003cli\u003eŘ\u0026iacute;hova M, Jandov\u0026aacute;, T., Větrovsk\u0026yacute; T., Machačov\u0026aacute; K., Kramperov\u0026aacute; V., Jaklov\u0026aacute; Dytrtov\u0026aacute;, J., \u0026Scaron;teffl M., Holmerov\u0026aacute;, I. . Effectiveness of home-based video exercise programmes on physical fitness in older adults - systematic review and meta-analysis. Acta Univ Carol Kinanthropologica. 2023;59(2):93 - 112.\u003c/li\u003e\n\u003cli\u003eBates A, Furber, S., Sherrington, C. Effectiveness of workshops to teach a home-based exercise program (BEST at Home) for preventing falls in community-dwelling people aged 65\u0026thinsp;years and over: a pragmatic randomised controlled trial. BMC Geriatrics. 2022;22(366).\u003c/li\u003e\n\u003cli\u003eBrand R, Cheval B. Theories to Explain Exercise Motivation and Physical Inactivity: Ways of Expanding Our Current Theoretical Perspective. Front Psychol. 2019;10:1147.\u003c/li\u003e\n\u003cli\u003eCONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials, (2010).\u003c/li\u003e\n\u003cli\u003ePodsiadlo D, Richardson S. The timed \u0026quot;Up \u0026amp; Go\u0026quot;: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39(2):142-8.\u003c/li\u003e\n\u003cli\u003eSpringer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15.\u003c/li\u003e\n\u003cli\u003eLauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60.\u003c/li\u003e\n\u003cli\u003eChan KOW, Yuen, P.P., Fong, B.Y. Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall. BMC Geriatrics. 2023;23(845).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Community-dwelling older adults, Online programme, Education, Exercise, Feasibility, Acceptability, Exercise adherence","lastPublishedDoi":"10.21203/rs.3.rs-4502772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4502772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: We all know how important it is to stay physically active, especially in later life. However, the majority of the population, including older adults, remains sedentary and lacks regular physical activity. The aim of this study was to assess the feasibility and acceptability of a home-based online education and exercise program inspired by developmental kinesiology that was designed for daily use to support functional capacity and an active lifestyle.\u003c/p\u003e\n\u003cp\u003eMethods: Eighty-two community-dwelling older adults (mean ± SD age 73.7 ± 3.4, 77% female) were randomized into intervention (n = 45) and control (n = 37) groups. Participants in the intervention group followed a 12-week home-based exercise program of 15 minutes per day for at least 6 days a week. Adherence was assessed using a diary, and acceptability was assessed using a postintervention questionnaire. Functional status was examined by performance tests (Timed Up and Go Test, Single Leg Stance Test, and Hand Grip) and a single-item question (\"How would you rate your functional status from excellent to poor?\") at baseline and postintervention. The data were analysed in SPSS using descriptive statistics, t tests, chi-square tests, and ANOVA.\u003c/p\u003e\n\u003cp\u003eResults: The intervention was feasible and acceptable. The retention rate in the experimental group was 100%, and the adherence rate was 99.9%. The program was rated on a 5-point Likert scale as clear (87% considered the program excellent), meaningful (80%), or manageable (71%). All participants (100%) in the experimental group would recommend the program to peers, and 91% expressed a willingness to continue. Additionally, participants felt more fit postintervention (T = 4.96, p \u0026lt; .001; F = 4.83, p \u0026lt; .05) and demonstrated improved one-leg stability (T = -3.45, p = .001). The improvement in agility was not statistically significant but was slightly clinically significant (ES = .05), and grip strength was not affected by the intervention.\u003c/p\u003e\n\u003cp\u003eConclusions: We conclude that the designed program has great potential to become a welcome part of everyday life among older adults, providing many benefits for this population. It is evident that older generations can follow online exercise programs and improve their health habits in the long term.\u003c/p\u003e\n\u003cp\u003eTrial Registration: The trial was retrospectively registered at ClinicalTrials.gov (NCT06133894).\u003c/p\u003e\n\u003cp\u003eFunding: This research was funded by #NU22-09-00447: 2022-2025.\u003c/p\u003e","manuscriptTitle":"Feasibility and Acceptability of an Online Daily Exercise Program for Community-Dwelling Older Adults: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 15:55:09","doi":"10.21203/rs.3.rs-4502772/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccd12411-dbc8-44c2-b94a-6c6aaa63f5b2","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-13T06:18:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 15:55:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4502772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4502772","identity":"rs-4502772","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}