Barriers and facilitators of tele-exercise among older people at risk of falls: a qualitative study within a randomised controlled trial

Background: Regular physical activity is essential for older people to maintain muscle mass and strength, thereby reducing the risks of sarcopenia and accidental falls. However, the COVID-19 pandemic has limited outdoor exercise opportunities. This qualitative study examined barriers and facilitators of tele-exercise among older people at risk of falls. Methods: A qualitative study within a randomised controlled trial was conducted from December 2022 to April 2023. Community-living older people aged ≥65 years who were at risk of falls were recruited from three community centres in Hong Kong. Participants engaged in remote exercise training (based on the Otago Exercise Programme) 3 days per week for 3 months. Semi-structured individual interviews with open-ended questions were conducted post-intervention. Interviews were audio-recorded, transcribed, and analysed based on the Theoretical Domains Framework. Results: This study included 25 participants with a mean age of 78.28 (range, 65-91) years; 80% were women; 56% completed primary education or below. Barriers to teleexercise included background noise, hearing difficulties, fear of new technology, and small screen size. Facilitators of tele-exercise included the absence of travel hassles, clear instructions from the instructor, easy technical operation, and the simplicity of movements. The home environment acted as both a facilitator and barrier to teleexercise. Conclusion: This study provided insights into the tele-exercise experiences of older people at risk of falls. Despite the barriers, participants reported enjoying the tele-exercise training programme. Addressing specific challenges is crucial for older people participating in teleexercise. Further research should focus on optimising teleexercise programmes to promote regular physical activity and enhance well-being among older people at risk of falls. Identification of barriers and facilitators of older people's adherence to tele-exercise will be conducted in future.