Applications to prescribe exercise in frail older people: review of the available tools in the market

Introduction: Several remote interventions such as applications (APPs), have been used to continue promoting healthy aging and preventing disability during the COVID-19 pandemic. The growing trend of APPs in health is exponential and may facilitate implementation, evaluation and scaling up of exercise prescription interventions. Numerous tools are available, but little is known regarding their usability, validatity, and recommendation, especially for frail older adults.

Methods: In-house, we developed an application and conducted a search in Apple App Store and Google Play Store using topic-related keywords. This tool also facilitated the extraction of basic app-information of the search results. We included applications available to an English-speaking market. Therefore, searches were done in the following country-specific app stores: Australia, Canada, Ireland, South Africa, the United Kingdom, and the United States. The resulting APPs were filtered using various inclusion and exclusion criteria. The resultant applications underwent a more in-depth characterization and searches for scientific publications on each APP website and PubMed.

Results: From an initial search result of 2846 applications, 459 met the initial inclusion criteria. After a more in-depth review of their features, 39 apps remained for possible application in older frail patients. After testing them, 22 apps were excluded due to unavailability, lack of elderly/frailty focus, a need for payment or complex navigation. Seventeen APPs fit the inclusion and exclusion criteria and were deemed appropriate after peer review. Of these, only 1 app, Vivifrail, had any type of publication/published evidence to back up feasibility, applicability, etc.

Conclusion: APPs can be valuable tools in prescribing exercise for frail older adults living in the community. However, few apps seem useful on a large scale, and there is limited evidence to support their effectiveness. It is important to invest in adapting Information and Communication Technologies to this population group.

Applicability: It is necessary to maintain the levels of physical activity in older adults. Using adapted and validated applications, we could promote healthy aging more widely. This work can orient professionals and institutions, from health and social care or the third sector to better select APPs for this aim. Another complementary aspect to be investigated in further studies is the reduction of the digital divide for older adults.