Comparative effectiveness of synchronous and asynchronous telehealth exercise programs on physical function in older adults: preliminary results

L. Marin,^1-3 P. Patanè,^2,3 M. Giuriato,² M. Vandoni,² B. M. V. Guerra,⁴ S. Sozzi,⁴ M. Schmid⁴ | ¹Laboratory for Rehabilitation and Orthopedic Surgery, Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; ²Laboratory of Adapted Motor Activity, Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Italy; ³Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Czech Republic; ⁴Bioengineering Laboratory, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy

Population aging is associated with a progressive decline in functional capacity, which increases the risk of falls, frailty, and loss of autonomy. Multicomponent physical activity has been shown to be an effective intervention, while telerehabilitation has emerged as a promising solution to overcome logistical barriers.^1-4 The present study aimed to evaluate the effectiveness of an adapted physical activity program delivered through two telehealth modalities, synchronous video call (VC) and asynchronous pre-recorded videos (VR), in improving physical performance, balance, and muscle strength in older adults. An experimental study was conducted between April and December 2025 involving seven older adults (mean age: 83 years) residing at Case ALER in Pavia (Italy). Participants were assigned to two groups: four individuals received the VC program, and three individuals received the VR program. In addition, three of the four participants in the VC group subsequently completed the VR program after a two-month washout period (control). Each training program lasted 12 weeks, consisting of two 45-minute sessions per week. Both training sessions followed an identical structure with warm-up, muscle strengthening, balance training, and cool-down phases, and were performed using minimal equipment (chair, wall, water bottles as additional loads). Functional assessments were conducted pre- and post-intervention (T0 and T1) and included the Six Minute Walk test (6MWT) and Timed Up and Go (TUG) test. The G-Walk wearable system (BTS Bioengineering, Italy) was used to acquire spatiotemporal data during the TUG and 6MWT. Technology acceptance was evaluated using the Technology Acceptance Model (TAM), and the enjoyment of physical activity was assessed using the Physical Activity Enjoyment Scale (PACES). Both questionnaires were administered at T1, corresponding to the end of each training program. The TUG-related data demonstrated improvements in both the VC and VR programs, with a greater magnitude of improvement observed in the VC condition. Data from the control indicated a lower capacity for improvement when compared with the group exposed to the VR modality. A similar pattern was also observed in the relative duration of the different TUG phases, expressed as a percentage of the total test duration. The 6MWT data demonstrated increases in both distance covered and average walking speed for both exercise programs, with a notably greater improvement observed in the VC modality compared to the VR modality. In contrast, the control showed no significant changes between pre- and post-training assessments under the VR condition. The TAM score was high for both the exercise programs (higher than 6 on a 0–7 scale). The PACES score at the conclusion of the VC program was higher than that observed at the end of the VR program (39.17±2.04 and 32.80±1.30, respectively), suggesting that participants derived greater enjoyment from the training delivered in a synchronous modality. Both VC and VR exercise programs were well tolerated and in institutionalized older adults, supporting the potential role of telehealth physical exercise programs in promoting functional capacity and autonomy. The VC modality demonstrated greater effectiveness than VR on functional outcomes, likely due to higher levels of supervision and interaction. Although some functional gains were retained after the washout period, further studies with larger samples are needed to confirm these preliminary findings and to better define the comparative effectiveness of different telehealth delivery modalities.

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Acknowledgment: this work was supported by Ministero della Salute, Piano di Sviluppo e Coesione 2014-2020, project number: T1-CN-03.