Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study

Author(s): Katzman, Wendy B; Gladin, Amy; Lane, Nancy E; Wong, Shirley; Liu, Felix; Jin, Chengshi; Fukuoka, Yoshimi | Abstract: Background:Hyperkyphosis is common among older adults, and is associated with multiple adverse health outcomes. A kyphosis-specific exercise and posture training program improves hyperkyphosis, but in-person programs are expensive to implement and maintain over longer-periods of time. It is unknown if a technology-based posture training program disseminated through a smartphone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective:The primary purpose of this study was to assess the feasibility of subject recruitment, short-term retention and adherence, and the acceptability of a technology-based exercise and postural training program disseminated as video clip links and text messaging prompts via a smartphone. The secondary purpose was to explore the potential efficacy of this program on kyphosis, physical function and health-related quality of life in older adults with hyperkyphosis. Methods:This was a 6-week pre-post design pilot trial. We recruited community-dwelling adults ≥65 years with hyperkyphosis ≥40 (±5) degrees and access to a smartphone. The intervention had two parts: 1) exercise and posture training via video clips sent to participants daily via text messaging which included 6 weekly video clip links to be viewed on the participant's smartphone and 2) text messaging prompts to practice good posture. We determined subject recruitment, adherence, retention and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput to wall (OTW), Short Physical Performance Battery (SPPB), Scoliosis Research Society SRS-30, Center for Epidemiological Studies Depression (CESD) and Physical Activity Scale for the Elderly (PASE). Results:64 potential participants were recruited, 17 participants were enrolled and 12 completed post-intervention testing at 6-weeks. Average age was 71.6 (SD=4.9) years and 50% were female. Median adherence to daily video viewing was 100%, (range 14 to 100) and to practicing good posture 3 times or more per day was 71%, (range 0 to 100). Qualitative evaluation of acceptability of the intervention revealed the smartphone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8 (95% CI: 12, 5) degrees (pl0.001), OTW decreased 1.9 (95% CI: 3.3, 0.7) cm (p=0.007), and physical activity measured by PASE increased 29 (95% CI: 3, 54) points (p=0.03). The health-related quality of life SRS-30 score increased 0.11 (SD=0.19) points, but it was not statistically significant, p=0.09. Conclusions:Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable in a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis that may be more easily disseminated than in-person training.