title: Lessons learned: feasibility and acceptability of a telehealth-delivered exercise intervention for rural-dwelling individuals with dementia and their caregivers.
abstract: BACKGROUND
  Until dementias can be prevented or cured, interventions that maintain or maximize cognitive and functional abilities will remain critical healthcare and research priorities. Best practice guidelines suggest that individualized exercise programs may improve fitness, cognition, and function for people with mild to moderate dementia; however, few high quality exercise intervention trials exist for this population. Increasingly, telehealth is being used to improve the delivery and availability of healthcare services for individuals living in rural areas, including exercise. This article describes the feasibility of a telehealth-delivered exercise intervention for rural, community-dwelling individuals diagnosed with dementia and their caregivers.
  
  
  METHODS
  A mixed-methods two-phase exploratory approach was used. In phase 1, Rural and Remote Memory Clinic (RRMC; Saskatoon, Saskatchewan, Canada) patients and caregivers were surveyed about current exercise levels, perceptions about exercise, exercise preferences, and perceived barriers to exercise; community resources, acceptability of telehealth exercise interventions, and physical activity and exercise attitudes (Older Persons Attitudes Toward Physical Activity and Exercise Questionnaire). Data were analyzed using descriptive statistics and factors associated with willingness to participate in a telehealth exercise intervention were explored using hierarchical linear regression. In phase 2, acceptability, practicality, and implementation were examined. Two RRMC patient-caregiver dyads completed a 4-week exercise program delivered via telehealth. Observed engagement in the telehealth-based exercise intervention, using a revised version of the Menorah Park Engagement Scale (by Hearthstone Alzheimer Care), and attendance were monitored. Patient-caregiver dyads were interviewed at the end of the intervention phase and completed a telehealth and intervention satisfaction questionnaire. Interviews were thematically analyzed and questionnaire data were analyzed descriptively.
  
  
  RESULTS
  Phase 1: Survey response rate was 50% (n=77). Patients (n=42) and caregivers (n=35) were equally likely to express interest in participating in the telehealth-based intervention. Willingness to participate in group exercise was the only significant predictor of willingness to participate in a telehealth-based intervention, accounting for 24.4% of the variance (F-statistic=16.14, p<0.001). Phase 2: Attendance rates were high for the telehealth-delivered exercise sessions. Engagement scale data indicated that the caregivers helped the patient participants during the intervention and that, overall, all participants were engaged in the target activity during the sessions. Ease of getting to the telehealth department, how well privacy was respected, ability to focus without distraction due to telehealth, ability to engage with group, and ability to engage with facilitator over telehealth were rated highly, as was the overall intervention experience. Telehealth voice and visual quality, ease of room set-up and conduciveness of the room to exercise were rated as good. Thematic analysis found that both dyads liked participating in the intervention together as a couple, and that participating in an exercise intervention with persons who were in a similar situations was deemed beneficial.
  
  
  CONCLUSIONS
  Study results identified that although there are barriers to overcome, the development and evaluation of telehealth-delivered exercise interventions is a timely and important research activity that has the potential to facilitate improved healthcare services for individuals with dementia and their caregivers.
authors.affiliation: School of Rehabilitation, ScienceMcMaster University, Hamilton, Ontario, Canada. vdalbel@mcmaster.ca.
authors.forename: Vanina P M
authors.initials: VP
authors.lastname: Dal Bello-Haas
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. megan.oconnell@usask.ca.
authors.forename: Megan E
authors.initials: ME
authors.lastname: O'Connell
authors.affiliation: Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. debra.morgan@usask.ca.
authors.forename: Debra G
authors.initials: DG
authors.lastname: Morgan
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. margaret.crossley@usask.ca.
authors.forename: Margaret
authors.initials: M
authors.lastname: Crossley
mesh_terms: D000544:Alzheimer Disease / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000628:therapy*; D015444:Exercise; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012424:Rural Population; D012525:Saskatchewan; D017216:Telemedicine / Q000458:organization & administration*