Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study.
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BACKGROUND Community dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments OBJECTIVE We aimed to evaluate whether a wearable device and mobile based intermittent coaching or self management could increase physical activity and health outcomes of small groups of older adults in rural areas METHODS To address the above evaluation goal we carried out the Smart Walk program a health care model wherein a wearable device is used to promote self exercise particularly among community dwelling older adults managed by a community health center We randomly selected older adults who had enrolled in a population based prospective cohort study of aging the Aging Study of Pyeongchang Rural Area The Smart Walk program was a 13 month program conducted from March 2017 to March 2018 and included 6 months of coaching 1 month of rest and 6 months of self management We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre and postanalyses of the Smart Walk program We also performed intergroup analysis according to adherence of wearable devices RESULTS We recruited 22 participants 11 robust and 11 prefrail older adults The two groups were similar in most of the variables except for age frailty index and Short Physical Performance Battery score associated with frailty criteria After a 6 month coaching program the prefrail group showed significant improvement in usual gait speed mean 0 73 SD 0 11 vs mean 0 96 SD 0 27 P 02 International Physical Activity Questionnaire scores in kcal mean 2790 36 SD 2224 62 vs mean 7589 72 SD 4452 52 P 01 and European Quality of Life 5 Dimensions score mean 0 84 SD 0 07 vs mean 0 90 SD 0 07 P 02 although no significant improvement was found in the robust group The average total step count was significantly different and was approximately four times higher in the coaching period than in the self management period 5 584 295 83 vs 1 289 084 66 PUnder 001 We found that participants in the long self group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0 65 SD 1 317 and mean 0 097 SD 0 513 respectively compared with the other groups CONCLUSIONS Our Smart Walk program improved physical fitness anthropometric measurements and geriatric assessment categories in a small group of older adults in rural areas with limited resources for monitoring Further validation through various rural public health centers and in a large number of rural older adults is required