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. 2022 Feb 23;36(3):359-367.
doi: 10.1080/02699052.2022.2059817. Epub 2022 Apr 4.

Usability of a two-way personalized mobile trainer system in a community-based exercise program for adults with chronic traumatic brain injury

Kan Ding  1 , Shannon B Juengst  2   3 , Stephanie Neaves  2 , Ahmad Turki  4 , Chaowei Wang  5 , Mu Huang  3 , Tri Pham  6 , Khosrow Behbehani  4 , Ming Li  5 , Linda Hynan  7 , Simon Driver  8 , Rong Zhang  1   9 , Kathleen R Bell  2
Affiliations

Usability of a two-way personalized mobile trainer system in a community-based exercise program for adults with chronic traumatic brain injury

Kan Ding et al. Brain Inj. .

Abstract

Objective: To examine the usability of an Apple Watch-based, two-way Personalized Mobile Trainer (PMT) in community-based exercise programs for individuals with chronic traumatic brain injury (cTBI).

Methods: This is a prospective pilot study. Twenty participants with cTBI aged 46-73 were enrolled in a 3-month individualized exercise program. After one in-person training session on PMT and exercise program, participants were prescribed either aerobic exercise training (AET) or stretching and toning (SAT) performed at home. The PMT was used to remotely deliver updated exercise prescription, track exercise progress, and communicate with the participants. The primary outcome was compliance with the exercise programs.

Results: All the participants completed the assigned exercise program with an average compliance of 76%. Nineteen (95%) participants were able to use the PMT properly during exercise sessions. After 3 months of training, the AET trended toward maintaining exercise endurance when compared with the SAT group (0.3% vs -4%, p = 0.14) with a medium effect size of 0.43.

Conclusion: Using the PMT system to support and track exercise in community-based exercise programs is feasible. The PMT may promote compliance with the training program but testing its effectiveness with larger trials is warranted.

Keywords: Mobile health (mHealth); exercise; traumatic brain injury.

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Figures

Figure 1.
Figure 1.. Personal Mobile Trainer (PMT) system
Personalized Mobile Trainer (PMT) system consists of three components: 1) TBICare App installed on the participant’s iPhone and Apple Watch and 2) Provider Portal on HIPAA-Compliant Amazon Web Service (AWS), and 3) TBICare Chat which is a HIPAA-protected chat app on the participant’s iPhone. A. The personalized exercise prescription is entered through Provider Portal and delivered to TBICare App on the iPhone. B. The participant initiates the workout session on the Apple Watch. C. After each workout session, the participant is asked to complete Borg Rating of Perceived Exertion scale and an emotional response survey in the TBICare app on the iPhone. D. The physiological data during the workout session and the post-workout surveys are uploaded to the cloud. E. The care team reviews the patient’s exercise data weekly through Provider Portal. F. Feedback is provided to the participant through TBICare Chat and notification function. The participant can also communicate with the care team via TBICare Chat.
Figure 2.
Figure 2.. Study flowchart
AET: aerobic exercise training; SAT: stretching and toning.
Figure 3.
Figure 3.. Exercise Endurance Outcome
The group difference between AET and SAT groups in exercise endurance was noted at baseline and after intervention. However, there was no significant improvements of exercise endurance in either group after 3-month intervention. 6MWD: 6-minute walk distance; AET: aerobic exercise training; SAT: stretching and toning.
Figure 4.
Figure 4.. Compliance in the exercise program
Weekly compliance was calculated as the sum of all minutes of exercise during the week from completed exercise session divided by the total minutes prescribed that week. A completed session was defined as one that lasted longer than 10 minutes and in which the intensity target was achieved. The average weekly compliance rate was presented. AET: Aerobic exercise training; SAT: Stretching and toning; ns: non-significant defined as p> 0.05. Dashed line is the target compliance of 80%.
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