The feasibility and acceptability of remote positive movement: a remotely delivered adapted mind-body physical activity intervention for older people

Abstract

Background: People are living for longer, and with ageing comes changes in physical, psychological, and social functioning. Due to a decline in overall functioning, there is a need for adapted physical activity interventions. Furthermore, access to such interventions might become challenging with reduced abilities therefore, remotely delivered interventions might provide an avenue for people to remain active. This thesis aims to test the feasibility and acceptability of Remote Positive movement using mixed methods. Methods: The Medical Research Council (MRC) and Person Based Approach (PBA) research frameworks were employed resulting in a mixed methods study. A systematic review and meta-analysis were conducted to investigate the effectiveness of adapted mind-body physical activity interventions for older people. Qualitative semi-structured interviews were conducted pre-intervention to explore perceptions and experiences of older people on physical activity and the use of digital technologies, as well as post intervention to identify benefits and challenges to participating in remote Positive Movement. A quantitative approach was utilised to test the feasibility and acceptability of the intervention, looking at recruitment, study procedures, data collection materials, retention, attendance, and initial impact. The experimental design was conducted in two phases (two sessions/week over eight weeks and one session/week over 20 weeks). Findings: The systematic review and meta-analysis indicated that adapted mind-body interventions for older people could result in small to moderate effects on some components of physical function, quality of life and wellbeing. No remotely delivered interventions were identified in the review, presenting a knowledge gap within the literature. The qualitative findings showed that the target population were willing to participate in the remotely delivered intervention in the context of COVID-19 and absence of face-to-face alternatives. In addition, recruitment, data collection and intervention delivery via Zoom was conducted successfully and deemed a feasible mode of delivery. The retention and attendance rates were reported to be within acceptable ranges, however there were mixed views on whether participants preferred face to face or remote interventions. The quantitative findings reported that remote Positive Movement shows some promise in improving quality-of-life and overall physical function in older people. Conclusions: Older people were willing to engage in remote interventions and some found it beneficial and convenient, whilst others still preferred face to face interventions. A gender bias and addressing digital literacy and access were concerns identified for future research to address. This PhD encourages a culture of developing hybrid interventions that offer the choice of face-to-face or remotely delivered interventions to encourage uptake of physical activity from older adults. The findings reported in this thesis highlight the importance of developing and implementing tailored interventions that aim to cater to the different population needs and the role of joined up working within communities to facilitate this. Additionally, recommendations for future research have been made. In conclusion, remote delivery of the intervention was deemed feasible, a larger study is needed to evaluate its effectiveness. Contribution to knowledge: This thesis includes a systematic review that was to the authors knowledge, the first to look at the effectiveness of adapted mind-body physical activity interventions for older people. No digital interventions were included in the review highlighting a knowledge gap. The delivery of physical activity interventions over Zoom or other video conferencing platforms became popular during the COVID-19 pandemic, however there is limited literature on the feasibility of conducting instructor-led, interactive live-stream adapted mind-body interventions for community dwelling older people. This thesis aims to add to this evidence base.