Outdoor exercise facility–based integrative mobile health intervention to support physical activity, mental well-being, and exercise self-efficacy among older adults with prefrailty and frailty in Hong Kong: pilot feasibility randomized controlled trial study

Background: Engaging in an adequate amount of physical activity (PA) serves as a protective factor against frailty. While previous PA interventions have been effective in improving physical functioning outcomes, they have not consistently succeeded in sustaining PA behavioral changes. Objective: The primary aim of this pilot randomized controlled trial (RCT) is to explore the feasibility and acceptability of an integrative mobile health (mHealth) intervention among community-dwelling older adults with prefrailty and frailty. The secondary aim was to investigate the potential effects of the intervention on sustaining PA levels and improving mental well-being and exercise self-efficacy in this population. Methods: A 2-armed pilot feasibility randomized controlled trial was conducted. A total of 38 inactive, community-dwelling older adults (aged>55 years) with prefrailty and frailty were randomized to either the intervention group (n=19), which received 4 weekly educational workshops at a university and a mobile app to support their use of outdoor exercise facilities in their neighborhood, or the control group (n=19), which received 4 weekly health education workshops with exercise experiential sessions tailored for older adults with frailty. To assess the acceptability of the intervention, individual semistructured interviews were conducted with, and a self-developed questionnaire was administered to, 14 participants from the intervention group. Results: The mean age of the participants was 71.8 (SD 9.34) years, and 24 out of 34 (71%) were female. As many as 34 participants out of 38 (89%) completed the study (18/19 in the control group and 16/19 in the intervention group). Workshop attendance rates were very high in both groups (intervention group, 63/68, 93%, and control group, 72/76, 95%). Self-reported adherence to the unsupervised outdoor practical sessions and engagement with the app was over 65% (36/51, 71%, and 35/51, 69%, in the intervention group. Two adverse events were reported in the intervention group, and none in the control group. As hypothesized, secondary outcome analyses showed that both groups increased their PA levels immediately after the intervention; however, only the intervention group maintained this increase at the 3-month follow-up. Additionally, favorable changes in mental well-being and exercise self-efficacy were observed in the intervention group. Feasibility and acceptability data also highlighted areas for improvement that should be addressed before a larger trial. Conclusions: This study provides initial proof-of-concept evidence for the integrative mHealth intervention. However, modifications are needed to enhance user adherence to both the mobile app and the outdoor practice component before proceeding to a larger trial.