Development and Feasibility of an eHealth Diabetes Prevention Program Adapted for Older Adults-Results from a Randomized Control Pilot Study

Abstract

Lifestyle programs that reduce health risks and support weight loss (WL) in older adults face adherence and attendance challenges due to reduced energy requirements, impaired mobility, lack of transportation, and low social support. Tailored lifestyle and weight management programs are needed to better support healthy aging for older adults. Here, we developed and piloted an age-adapted, remotely delivered modification of the Diabetes Prevention Program (DPP). The modification includes age-appropriate goals, visuals, and examples; flexible dietary composition; remote classroom and fitness-monitoring technology; and standardized online classroom materials employing pedagogical and behavior change theory. The modifications were designed to safeguard fidelity and to boost adherence, engagement, and knowledge integration, with the convenience of a fully remote WL program for diverse older adults. Six-month pilot data are presented from older adults (55-85 years, body mass index (BMI) 27-39.9 kg/m², N = 20) randomly allocated to an online DPP intervention with weight, diet, and activity monitored remotely, or into a waitlisted control. The intervention achieved 100% attendance and adherence to self-monitoring. The intervention group mean (±SD) body weight change was -9.5% (±4.1); 90% lost ≥ 5%. By contrast, the control group gained 2.4% (±1.8). Once thought incompatible with older adults, remote interventions are feasible for older adults and can support fidelity, adherence, engagement, and clinically significant WL. Standardized materials are provided for future implementation.

Keywords: diet; eHealth; fitness; intervention; lifestyle medicine; older adults; remote monitoring; weight loss.

Figure 1

Main strategies of the adaptation, as presented to participants.

Figure 2

Change in BMI for intervention and control groups. Note: Each line represents an individual participant in the pilot. Intervention participants (n = 10) completed 3 months of remotely delivered intervention, including self-monitoring tasks, healthy lifestyle sessions, and interventionist support communication. Control participants (n = 10) were instructed to maintain current lifestyle behaviors. Mean (SD) change in body weight in the intervention group after 3 months was −7.1% (3.0%), from a baseline mean (SD) BMI of 31.3 (2.63) to BMI 29.06 (2.80). All intervention participants lost weight during the period. During the same time period, the BMI change in controls was a mean increase of 0.9 kg/m² from 31.3 to 32.2, representing a 1.2% increase in mean body weight. Nine of the ten control group participants gained weight during the period.

Figure 3

Weight change compared to Stage of Change readiness for exercise and diet at 1 and 6 months. Note: Each bar represents an individual in the pilot. Information on the Stage of Change (SOC) is gathered throughout the intervention during in-session polling. In the Transtheoretical Model, the SOC is an indication of the level of change readiness for a given health behavior and is known to change over time, sometimes progressing towards increasing levels of action and sometimes backsliding towards non-adherence. As expected, greater percentages of weight loss correspond with progression towards action and maintenance for both diet and exercise behaviors.