A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VOLUME 4, 2016 <s> Background: Reaction time, coordination, and cognition performance typically diminish in older adults, which may lead to gait impairments, falls, and injuries. Regular strength–balance exercises are highly recommended to reduce this problem and to improve health, well-being, and independence in old age. However, many older people face a lack of motivation in addition to other strong barriers to exercise. We developed ActiveLifestyle, an information technology (IT)-based system for active and healthy aging aiming at improving balance and strength. ActiveLifestyle is a training app that runs on a tablet and assists, monitors, and motivates older people to follow personalized training plans autonomously at home. Objective: The objectives were to (1) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people, (2) assess the impact of ActiveLifestyle on physical activity behavior change, and (3) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed. Methods: A total of 44 older adults followed personalized, 12-week strength and balance training plans. All participants performed the exercises autonomously at home. Questionnaires were used to assess the technological familiarity and stage of behavior change, as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle. Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study. Pretests and posttests were performed to evaluate gait speed of the participants before and after the study. Results: Participants were 75 years (SD 6), predominantly female (64%), held a trade or professional diploma (54%), and their past profession was in a sitting position (43%). Of the 44 participants who enrolled, 33 (75%) completed the study. The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength–balance exercises (median 6 on a 7-point Likert scale). Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan, as well as to change their behavior permanently toward a more physically active lifestyle. The exercises were effective to improve preferred and fast gait speed. Conclusions: ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength–balance exercises over 12 weeks and had low dropout rates. The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention. The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time. [J Med Internet Res 2013;15(8):e159] <s> BIB001 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VOLUME 4, 2016 <s> Objectives ::: The purpose of this study was to examine the function, health status, and efficacy effects of a combined exercise program using an iPad among older women in Korea, a tech-savvy country. <s> BIB002 </s> A Survey of Tablet Applications for Promoting Successful Aging in Older Adults <s> VOLUME 4, 2016 <s> The purpose of this pilot study was to test a mobile app that combines exercise, health education, and bingo (Bingocize®) to improve functional performance, health knowledge, and adherence. Senior volunteers were assigned to use the app on tablets twice a week for 10 weeks or a use the app to play only modified bingo. Pre/post functional performance and health education knowledge were compared using Mixed ANOVA (p<.05). Health knowledge ( λ=6.06, F (1,10)=6.50, p=.029, =.394), Short Physical Performance Battery ( λ=.584, F(1, 10) =6.41, p=.032, =.416) , and gait velocity (λ=6.10, F (1,10)=6.40, improved in the experimental group only. Adherence was equivalent in both groups. Bingocize®and ef fective way to teach older adults health information, while improving functional performance. <s> BIB003
Further evaluation of ActiveLifestyle has been performed with 44 older adults BIB001 . This was the first study assessing the effectiveness of a tablet-based health intervention for older adults. Three treatment groups were compared: (a.) an individual group receiving the individual version (only individual motivational strategies); (b.) a social group using the social version (both individual and group motivational strategies); and (c.) a control group that performed exercises using printed instructions with no motivational strategies. 33 older adults completed the study, with the highest attrition rate in the control group. The study found statistically significant differences in adherence to the training plans (ratio of completed workout sessions by each participant divided by the total number of possible training sessions) between the social and control groups, and between individual and control groups. However, there was no significant difference in this adherence between the social and the individual groups. There was an overall increase in gait speed for all the participants at the conclusion of the study, though there was no significant difference between the three groups. The self-motivational strategies worked best for the individual group while the social motivation suited the social group, although the majority of the participants in the individual group felt that it would be more motivated to use the social version. There was only a significant change in the behavior score among the social group. Thus, based on the results of the study, it can be concluded that a combination of physical exercise and IT enabled motivational strategies can be effective. In another tablet-based application, Embodied Conversational Agent (ECA) was used to motivate older adults to walk  . ECA is an animated character that simulates faceto-face conversations using voice, hand gesture, gaze cues, and other nonverbal behavior. A study with 263 older adults was conducted to test the effectiveness of this application. The intervention group received a tablet computer with the ECA application installed for first two months of the study, a pedometer for recording the walking steps, and a data cable for connecting the pedometer with the tablet. The control group only received a pedometer. Interviews were conducted at the end of 2 months and 12 months of the study. The average steps recorded by the intervention group were greater than that by the control group for both evaluation time points, even though there was a decrease in average steps recorded from 2 months to 12 months. However, the decrease in average count (in both groups) specifically occurred among participants with inadequate health literacy. An increase was observed for participants with high literacy. The participants in the intervention group were satisfied with ECA. An eight week study by Korean researchers has demonstrated the effectiveness of an iPad based exercise program in improving cognitive status, and exercise self-efficacy among the intervention group BIB002 . Sixteen participants in the intervention participated weekly in a 30-minute group exercise training class in a senior living. They performed one exercise at least 3 times a week watching training videos on an iPad. Ten participants in the control group were part of a once-a-week group-based yoga program at the senior center. Crandall et al. developed a tablet-based application called Bingocize, a combination of Bingo and exercise, developed to promote exercise and health education simultaneously. A number selected in this application corresponded to a health question or an exercise to be performed by the participants BIB003 . A study with 8 participants in the experimental group and 7 participants in the control group was conducted for 10 weeks to test the effectiveness of the application. The study found a significant difference in functional performance and gait velocity between the two groups. However, no difference was observed in arm curl movement. However, the study proved the effectiveness of a multi-modal application (combining health education and exercise) but the findings cannot be generalized due to the small sample size.