title: Adherence to Technology-Based Exercise Programs in Older Adults: A Systematic Review.
abstract: OBJECTIVE
  Exercise participation and adherence in older people is often low. The integration of technology-based exercise programs may have a positive effect on adherence as they can overcome perceived barriers to exercise. Previous systematic reviews have shown preliminary evidence that technology-based exercise programs can improve physical functioning. However, there is currently no in-depth description and discussion of the potential this technology offers to improve exercise adherence in older people. This review examines the literature regarding older adults' acceptability and adherence to technology-based exercise interventions.
  
  
  METHODS
  A comprehensive systematic database search for randomized controlled trials, clinical controlled trials, and parallel group trials was performed, including MEDLINE, PsycINFO, EMBASE, CINAHL, EMB Reviews, and Cochrane Library, completed in May 2015. Trials reporting adherence to technology-based exercise programs aimed at improving physical function were included. Adherence was defined as the percentage of exercise sessions attended out of the total number of sessions prescribed.
  
  
  RESULTS
  Twenty-two studies were included. The mean cohort age range was 67 to 86 years. Studies were conducted in research facilities, aged care facilities, and people's homes. Ten studies compared outcomes between technology-based and traditional exercise programs. Adherence to both types of interventions was high (median 91.25% and 83.58%, respectively). Adherence was higher for technology-based interventions than traditional interventions independent of study site, level of supervision, and delivery mode. The majority of the studies used commercially available gaming technologies, and both types of exercise interventions were mostly supervised. A lack of detailed reporting of adherence and the pilot nature of most studies did not allow computation of a comprehensive adherence rate.
  
  
  CONCLUSIONS
  This systematic review provides evidence that technology offers a well-accepted method to provide older adults with engaging exercise opportunities, and adherence rates remain high in both supervised and unsupervised settings at least throughout the first 12 weeks of intervention. The higher adherence rates to technology-based interventions can be largely explained by the high reported levels of enjoyment when using these programs. However, the small sample sizes, short follow-up periods, inclusion of mostly healthy older people, and problems related to the methods used to report exercise adherence limit the generalizability of our findings.
  
  
  CONCLUSIONS
  This systematic review indicates that technology-based exercise interventions have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people. More research is required to investigate the feasibility, acceptability, and effectiveness of technology-based exercise programs undertaken by older people at home over extended trial periods.
authors.affiliation: Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.|Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Valenzuela
authors.affiliation: Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.|The Japan Society for the Promotion of Science, Tokyo, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Okubo
authors.affiliation: Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodbury
authors.affiliation: Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Neuroscience Research Australia (NeuRA), University of New South Wales, Sydney, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*