Digitally Delivered, Group-Based Exercise Interventions for Older Adults: Scoping Review

Falls and fractures are the leading cause of unintentional injury among older adults, resulting in increased mortality and morbidity, as well as reduced physical function and quality of life. In-person exercise programs aimed at improving strength, balance, and postural control have demonstrated benefits for physical function, quality of life, and fall risk reduction among older adults. Technology-driven approaches can further enhance the accessibility of exercise programs. In particular, digitally delivered programs offer the opportunity to balance risks and benefits while promoting engagement and potentially improving physical function.

The overall aim of this review was to summarize the growing body of research on the efficacy, usability, and safety of these programs in older adults.

MEDLINE via PubMed, the Cochrane Controlled Register of Trials (CENTRAL), and Embase databases were searched for this review. The initial search was conducted in November 2022 and updated in July 2024. Randomized controlled trials, nonrandomized trials, and single-arm pilot studies of at least 6 weeks' duration reporting digitally delivered exercise for presumptively healthy older adults, taught in real-time (not prerecorded) by a qualified instructor, were included. Interventions targeting specific clinical subpopulations (eg, cardiac rehabilitation, Parkinson disease, chronic obstructive pulmonary disease) were excluded, although common age-related conditions such as hypertension, diabetes, and osteoporosis were included. The review was preregistered via INPLASY (registration number 3773).

A total of 4242 studies were screened by title and abstract, with 76 progressing to full-text review. Of these, 23 (30%) met all inclusion criteria, comprising 6 pilot single-arm studies, 5 nonrandomized trials, and 12 randomized trials. Interventions ranged from 6 to 24 weeks, with most lasting 8-12 weeks, and class participation typically occurred 2-3 days per week. Class sizes ranged from as few as 4 to more than 30 participants. Instructor experience varied and included licensed professionals, such as physical therapists, kinesiologists, and certified trainers, as well as laypeople specifically trained for the intervention. A total of 18 out of 23 (78%) studies reported physical outcomes, including balance, strength, and functional measures. Fourteen of these studies reported clinically meaningful improvements following the intervention, most commonly in strength and balance, measured by the 30-second chair stand test and the timed up and go; 20 studies (87%) reported 1 or more observations regarding safety or program usability. Among the studies that provided data on adverse events, most were conducted without injuries or reported only minor injuries. More than 60% of the authors (15/23, 65%) noted in their conclusion statements that participant acceptance of the digital delivery format was high.

Overall, these findings demonstrate partial effectiveness in improving physical function related to fall prevention among older adults. Additionally, high attendance, participant enjoyment, and safety highlight the utility of digitally delivered exercise programs for older adults taught in real time.

International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202280097; https://inplasy.com/inplasy-2022-8-0097/.