Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial

Interventions in ambulatory healthcare settings to reduce social isolation among adults aged 18-64: a systematic review

BACKGROUND

Social isolation is associated with increased all-cause and premature mortality, poor chronic disease management, and mental health concerns. Limited research exists on interventions addressing social isolation among individuals under 65 despite its increasing prevalence among young and middle-aged adults.

AIM

To identify interventions from the extant literature that address social isolation and loneliness in ambulatory healthcare settings in adults aged 18-64 and to identify elements of successful studies for future intervention design.

DESIGN & SETTING

Systematic review of interventions targeting social isolation in community-dwelling adults aged 18-64 within ambulatory healthcare settings.

METHOD

A search strategy was developed to identify relevant articles in the following databases: Ovid MEDLINE, Embase, EBM Reviews, Scopus, CINAHL, and PsychInfo. Data were extracted on study design and setting, intervention type, outcome related to social isolation/loneliness, and scale of measure used.

RESULTS

25 078 citations were identified and underwent title and abstract screening. 75 articles met our inclusion criteria and were synthesised, including an assessment of bias. Effective interventions were delivered in community health settings, incorporated a group component, and used digital technologies. They also addressed the association between mental health and social isolation using cognitive-behavioural therapy (CBT) approaches and enhanced self-management and coping strategies for chronic conditions through psycho-educational interventions.

CONCLUSION

Future research should prioritise adults living in low-income and middle-income countries, racialised individuals, as well as those with fewer educational opportunities. There is also a need to advance research in primary care settings, where longitudinal patient-provider relationships would facilitate the success of interventions.

Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

BACKGROUND

There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.

METHODS

In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale).

RESULTS

Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group.

CONCLUSION

The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

Implementation of community physiotherapy in primary care: one-year results of an on-call physiotherapy service

BACKGROUND

Primary health care systems have a key role in meeting health needs of community, including function. The aim of this paper is to describe the population involved in the Community Physiotherapist project and their health outcomes over a one-year period.

METHODS

The Community Physiotherapist is an on-call service which requires a request by general practitioners or medical specialists. Reason for prescription, waiting time for service delivery, diagnostic categories, provided intervention, number of interventions and outcomes were recorded for everyone included in the project. Possible differences in characteristics between individuals referred by medical specialists and general practitioners were also investigated.

RESULTS

From January to December 2022, 409 individuals were referred to the Community Physiotherapist pathway. Functional goals were achieved in 79.5% of interventions, without reported adverse events. In most cases physiotherapists provided counselling or caregiver training and 3.3% of individuals needed a full rehabilitation program. The groups of individuals referred by the two types of prescribers showed no significant differences, apart, as expected, from their median age.

CONCLUSIONS

The introduction of the Community Physiotherapist model within the primary care setting allows to provide appropriate, effective and safe interventions. Sharing the project among all the health professionals helped to support its appropriateness and effectiveness. Results also indicate that a new organizational model, such as the Community Physiotherapist, will take a long time to be implemented.

Protocol for a remote home-based upper extremity self-training program for community-dwelling individuals after stroke

Background

Half of all stroke survivors experience hemiparesis on the contralateral side, resulting in chronic upper extremity (UE) impairment. Remote rehabilitation is a promising approach to optimize the gains made in the clinic to maximize function and promote UE use at home. This paper describes the study protocol for a remote home-based UE self-training program.

Design

This was a feasibility study that used a convergent mixed methods approach.

Methods

We collected data on 15 community-dwelling individuals with UE hemiparesis after stroke. The study used motivational interviewing (MI) and ecological momentary assessments (EMA) to maximize engagement in a 4-week personalized UE self-training program. The study consisted of three phases: 1) training in MI for the interventionists 2) creating customized treatment plans using shared decision making, and 3) four weeks of UE self-training.

Measures and analysis

To evaluate feasibility, we will summarize recruitment and retention rates, intervention delivery, acceptance, adherence, and safety. Quantitative UE outcomes will measure change in UE status after the intervention (Fugl-Meyer Assessment, Motor Activity Log, Canadian Occupational Performance Measure, and bilateral magnitude ratio). Qualitative data (1:1 semi-structured interviews) will capture participants' perceptions and experience with the intervention. Quantitative and qualitative data will be integrated to gain a deeper understanding of the facilitators and barriers for engagement and adherence to UE self-training.

Conclusion

The results of this study will advance the scientific knowledge for use of MI and EMA as methods for enhancing adherence and engagement in UE self-training in stroke rehabilitation. The ultimate impact of this research will be to improve UE recovery for individuals with stroke transitioning back into community.

Clinical trials registration

NCT05032638.

Impact of Perceived Safety and Barriers on Physical Activity Levels in Community-Dwelling Older Adults During the COVID-19 Pandemic in Singapore: A Cross-Sectional Mixed Methods Study

This descriptive cross-sectional mixed methods study conducted in Singapore aimed to describe community-dwelling older adults' differences in physical activity (PA) based on perceived safety to exercise, barriers to PA, and preferred modes of PA during a pandemic. Out of 268 older adults, 25.4% felt unsafe to exercise during the pandemic. More participants who felt unsafe were aged 75 years and older (72.1% vs. 57.0%, p = .028) and lacked formal education (54.4% vs. 37.0%, p = .040). Barriers included difficulties exercising with masks, family concerns, and exercise center closures. Those who felt unsafe were significantly more likely to exercise at home and had significantly shorter duration of exercise and walks per week (2.72 vs. 4.50 hr, p = .002). Perceived barriers and exercise preferences should be considered when developing programs to improve older adults' PA during pandemics.

Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis

Importance

Loneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality.

Objective

To evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation.

Data Sources

OVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020.

Study Selection

Peer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included.

Data Extraction and Synthesis

Two independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022.

Main Outcomes and Measures

Quantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences.

Results

Seventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants' ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (-1.86; 95% CI, -3.14 to -0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (-1.40; 95% CI, -2.37 to -0.44; I2 = 70%).

Conclusions and Relevance

In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size's magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.

The impact of loneliness and social isolation on health state utility values: a systematic literature review

Background

Loneliness and social isolation are recognised as social problems and denote a significant health burden. The aim of this study was to conduct a systematic literature review to explore the health state utility values (HSUVs) associated with loneliness and/or social isolation.

Method

Peer-reviewed journals published in English language that reported both HSUVs along with loneliness and/or social isolation scores were identified through five databases. No restrictions were made relating to the population, study design or utility estimation method used.

Results

In total, 19 papers were included; 12 included a measure of loneliness, four studies included a measure of social isolation and three studies considered both loneliness and social isolation. All studies focused on individuals with pre-existing health conditions—where the EQ-5D-3L instrument was most frequently used to assess HSUVs. HSUVs ranged from 0.5 to 0.95 in those who reported not being lonely, 0.42 to 0.97 in those who experienced some level of loneliness, 0.3 to 0.87 in those who were socially isolated and 0.63 to 0.94 in those who were not socially isolated.

Conclusion

There was significant variation in HSUVs complicated by the presence of co-morbidities, population heterogeneity, variations in methods used to derive utility scores and differences in the measurement of loneliness and/or social isolation. Nevertheless, the lower HSUVs observed should be considered to significantly impact quality of life, though we also note the need for further research to explore the unique impact of loneliness and social isolation on HSUVs that can be used in the future economic evaluations.

Delivery of Home-Based Exercise Interventions in Older Adults Facilitated by Amazon Alexa: A 12-week Feasibility Trial

OBJECTIVES

To evaluate the feasibility of using voice-controlled intelligent personal assistants (VIPAs) to remotely deliver and monitor an individually-tailored, home-based exercise program to older adults living independently and alone.

DESIGN

12-week, prospective single-arm feasibility study.

SETTING

Community residences.

PARTICIPANTS

15 adults aged 60 to 89 years living alone.

INTERVENTION

All participants were prescribed home-based muscle strengthening, weight-bearing impact and balance exercises, increasing from two to four 10-minute sessions per day over 12 weeks. Sessions were delivered using VIPAs (Amazon Alexa Echo Show 5; "Alexa") and a novel software program ("Buddy Link"). The program was individualized by an exercise physiologist based on participant voice responses to Alexa questions.

MEASUREMENTS

Study outcomes were feasibility (rate of retention, adherence, and adverse events), usability (System Usability Scale) and changes to quality of life (European Quality of Life Scale), and lower-extremity function (30 second sit-to-stand test).

RESULTS

All 15 participants (mean age, 70.3 years) completed the study (retention 100%). Mean adherence to the exercise program was 115% (i.e., collectively all participants were prescribed 8640 exercises but completed 9944 exercises) with no adverse events reported to be related to the intervention and usability scored as above average (75/100). Other outcomes did not significantly change across the 12-week follow-up (all P>0.05).

CONCLUSIONS

In this feasibility study of community-dwelling older adults living alone, a home-based exercise program delivered and monitored remotely by an exercise physiologist using VIPAs was safe and feasible.

Analysis of Compliance with Time under Tension and Force during Strengthening Exercises with Elastic Bands

Quantifying training variables of a physical exercise modality is essential for an appropriate dosage. In training with elastic bands, time under tension (TUT) and force represent the duration and intensity of this force-training modality. The aims of this study were to evaluate the degree of compliance to TUT prescription for three different scenarios of two exercises and the comparison of the force values obtained versus the estimate values. A total of 29 healthy volunteers were evaluated in a clinical environment under controlled conditions in 3 different scenarios (different velocities or ROMs) of both shoulder abduction and knee extension in 2 sets of 10 repetitions per scenario within a single session. Concentric and isometric phases showed a higher degree of compliance for their TUTs than the eccentric phase TUTs for all scenarios of both exercises, whereas the degree of compliance was higher for the total TUT than for the phases’ TUTs. Additionally, the eccentric phase showed a general tendency to develop for longer time periods than prescribed, whilst the fast scenario showed a higher degree of compliance for isometric phase TUTs and total TUTs than the extant two scenarios in both exercises. On the other hand, the force of the elastic bands tends to be overestimated according to the estimates of the manufacturers. These findings, both those related to the degree of compliance with TUTs and the force analysis, can be used by physiotherapists and other exercise professionals as a reference to achieve a good dosage of routine exercises with elastic bands.

Patient Satisfaction Using a Home-Based Rehabilitation Protocol for the Non-Surgical Treatment of Proximal Humeral Fractures: A Prospective Longitudinal Cohort Study

Supervised, center-based, daily physiotherapy presents limitations: transport, need for an accompanying person, or risk of infection. Home-based rehabilitation protocols (HBRP) can be effective alternatives. We use a HBRP for the non-surgically treated proximal humeral fractures (PHF) in older patients.

Telehealth sounds a bit challenging, but it has potential: participant and physiotherapist experiences of gym-based exercise intervention for Achilles tendinopathy monitored via telehealth

BACKGROUND

Although telehealth is becoming more popular for delivery of care for individuals with musculoskeletal pain, to our knowledge telehealth has not been used to manage Achilles tendinopathy. This research aimed to explore the experience of participants and physiotherapists with gym-based exercise interventions for Achilles tendinopathy monitored via videoconference.

METHODS

A qualitative, interpretive description design was performed using semi-structured interviews (8 participants) and a focus group (7 physiotherapists). Participants and physiotherapists were interviewed about their experiences of the use of telehealth during a gym-based exercise intervention incorporating different calf load parameters for Achilles tendinopathy. We employed an inductive thematic analysis approach to analyse the data.

RESULTS

Three themes identified from both participants and physiotherapists included i) acceptability of telehealth; ii) enablers to adherence with telehealth; and iii) barriers to adherence with telehealth. Two extra themes arose from participants regarding adherence with gym-based exercise, including enablers to adherence with the exercise intervention, and barriers to adherence with the exercise intervention. Both participants and physiotherapists expressed overall satisfaction and acceptability of telehealth monitoring of gym-based exercise.

CONCLUSION

Gym-based exercise intervention for Achilles tendinopathy involving weekly telehealth monitoring was acceptable to both participants and physiotherapists. Potential enablers and barriers were identified that may improve adherence to this type of intervention.

Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations

OBJECTIVE

Investigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities.

DESIGN

Systematic review of randomised controlled trials.

DATA SOURCES

Searches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO.

ELIGIBILITY CRITERIA

Trials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence.

RESULTS

Forty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: -0.4 to 0.1), physical function (95% CI: -0.2 to 0.2) and quality of life (95% CI: -0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: -0.1 to 0.5) and quality of life (95% CI: -0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term.

CONCLUSIONS

Exercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.

Acceptability and Feasibility of an Isometric Resistance Exercise Program for Abdominal Cancer Surgery: An Embedded Qualitative Study

Although it is recognized in the early stages of cancer recovery that changes in lifestyle including increases in physical activity improves physical function, there are no clear findings whether low versus moderate intensity activity or home or gym exercise offer optimal benefit. Isometric-resistance exercises can be carried out with very little equipment and space and can be performed while patients are bed-bound in hospital or at home. This embedded qualitative study, based in an English hospital trust providing specialist cancer care, was undertaken as a component of a feasibility trial to evaluate the acceptability and feasibility of an isometric-resistance exercise program and explore the suitability of functional assessments by drawing from the experiences of abdominal cancer patients following surgery. Telephone interviews were undertaken with 7 participants in the intervention group, and 8 interviews with the usual care group (n = 15). The gender composition consisted of 11 females and 4 males. Participants’ ages ranged from 27 to 84 (M = 60.07, SD = 15.40). Interviews were conducted between August 2017 and May 2018, with audio files digitally recorded and data coded using thematic framework analysis. Our results show that blinding to intervention or usual care was a challenge, participants felt the intervention was safe and suitable aided by the assistance of a research nurse, yet, found the self-completion questionnaire tools hard to complete. Our study provides an insight of trial processes, participants’ adherence and completion of exercise interventions, and informs the design and conduct of larger RCTs based on the experiences of abdominal cancer surgery patients.

Practical Recommendations for Maintaining Active Lifestyle during the COVID-19 Pandemic: A Systematic Literature Review

Diminished volumes of habitual physical activity and increased sedentary levels have been observed as a result of COVID-19 home-confinement. Consequences of inactivity, including a higher mortality rate and poorer general health and fitness, have been reported. This systematic review aimed to provide practical recommendations for maintaining active lifestyles during pandemics. In May 2020, two electronic databases (PubMed; Web of Science) were used to search for relevant studies. A total of 1206 records were screened by two researchers. Thirty-one relevant studies were included in this systematic review, in which the methodological quality was assessed. With regard to six studies, which explicitly dealt with physical activity during COVID-19, the evidence level is classified by three articles to level II, and in the other three to level VI. Regarding the physical activity recommendations in these papers, three of them were classified to a medium, and the same number to a weak evidence base. Of the 25 papers which refer to other pandemics and/or isolation situations, one was classified to evidence level I, four were ranged to level II, three to level III, one to level V, and the others to level VI. This systematic review revealed that reduced physical activity levels are of serious concern during home confinement in pandemic times. The recommendations provided by many international organizations to maintain active lifestyles during these times mainly target the general population, with less consideration for vulnerable populations (e.g., older adults, people with health issues). Therefore, personalized and supervised physical activity programs are urgently needed, with the option to group-play physical activity programs (e.g., exergames). These can be assisted, delivered, and disseminated worldwide through information and communication technology solutions. If it is permitted and safe, being active outside in daylight is advised, with an effort level of mild to moderate using the rating of perceived exertion scale. Relaxation techniques should be integrated into the daily routine to reduce stress levels. On the evidence base and levels of the included articles in this review, the results need to be interpreted with caution. Given that policies are different across regions and countries, further research is needed to categorize recommendations according to different social-distancing scenarios.

Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial

Type 2 diabetes mellitus (T2DM) is significantly associated with osteoarthritis (OA). This study investigated the effects of two resistance exercise approaches on glycated hemoglobin (HbA1c) level and function performance. Enrolled were 70 older patients with both T2DM and knee OA. The dynamic group performed resistance exercises with an elastic resistance band. The isometric group underwent isometric contraction exercises. After the 12-week intervention, a significant within-group improvement (all p < 0.001) was observed for the chair stand test (CST; 10.8%, vs. 7.1%), timed up and go (TUG) test (12.6% vs. 7.6%), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function subscale (62.3% vs. 36.1%), and overall WOMAC (54.5% vs. 34.5%) in the dynamic and isometric group, respectively. In addition, in terms of between-group differences, the dynamic group had significant improvements in CST (p = 0.011), TUG (p < 0.001), WOMAC physical function subscale (p = 0.033), and overall WOMAC (p = 0.036) scores compared with the isometric group. However, no significant change in HbA1c was observed in either group. In conclusion, the dynamic resistance exercise significantly improved muscle strength, dynamic balance, and physical function in this comorbid population; however, there was no notable difference in change in HbA1c among different resistance exercises.

Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol

BACKGROUND

It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers.

METHODS

This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up.

DISCUSSION

Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice.

TRIAL REGISTRATION

This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621.

Barriers and enablers to ongoing exercise for people with chronic health conditions: Participants' perspectives following a randomized controlled trial of two interventions

BACKGROUND

At present there is no clear evidence to support any one particular intervention for engaging adults with chronic health issues in ongoing exercise. An understanding of consumer perceptions and preferences is important, because low rates of exercise adherence are likely to limit any benefits obtained.

OBJECTIVE

To identify and compare participants' perceptions about their own motivation, capacity and opportunity to adhere to an allocated exercise program during either a gym-based or a home-based exercise program with telephone follow-up.

METHOD/DESIGN

This qualitative study used convenience sampling to recruit participants (adults with chronic health issues) immediately after a randomised controlled trial comparing gym-and home-based exercise programs conducted for 12 months. Ten people, five from each intervention group, attended face-to- face semi-structured interviews at a local Community Health Service. Thematic analysis methods were used to analyse the dataset.

RESULTS

Improved social interaction in the gym-based program was seen to contribute to adherence, however home-based programs were perceived as more convenient and easily integrated into daily routines. Individualized exercise prescription by a health professional with regular follow up (in person or by telephone) promoted an active practitioner-participant relationship. Health coaching combined with exercise was perceived to improve self-efficacy and assisted with the removal of intrinsic and extrinsic exercise barriers.

CONCLUSION

This research presented many common and different themes in participant's motivation, capacity and opportunity in sustained adherence to a gym or home-based exercise program. However, this study found no superior intervention or individual preference to improve ongoing exercise adherence.

Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial

QUESTION

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

DESIGN

A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon.

PARTICIPANTS

People with chronic health conditions who had completed a 6-week exercise program at a community health service.

INTERVENTIONS

One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks.

OUTCOME MEASURES

Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L).

RESULTS

Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach.

CONCLUSION

The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently.

REGISTRATION

ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54].