Development of a Web-based Program for Personalized Physical

Exercise for Older Adults

Frederico Baptista

, Bárbara Ursine

, Ana Isabel Martins

, Rosa Andias

, Joana Pais

Anabela G. Silva

and Nelson Pacheco Rocha

IEETA, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal

Centesis.UA@RISE, Health Sciences School, University of Aveiro, Aveiro, Portugal

Neuroinova, EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal

joanapais@neuroinova.com

Keywords: Older Adults, Web-based Application, Physical Activity, Physical Exercise.

Abstract: Information technologies support personalized strategies to promote the effectiveness of physical exercise

programs. The study reported by this paper developed a web-based program for personalised physical exercise

for community dwelling older adults. Considering the Medical Research Council framework for developing

and evaluating complex interventions, the paper reports the results of the development phase, which is the

first phase of this framework. The development phase included the identification of the existing evidence, the

identification of the developing theory, and the modelling of the intervention. The developed program and

respective web-based application integrate the inherent complexity of physical exercise programs and allow

the definition of personalized prescriptions considering a diverse range of factors (i.e., frequency, intensity,

time, type, volume, and progression) recommended by international guidelines.

1 BACKGROUND

Accidental falls and fall-related injuries are major

problems among older adults and put them at higher

risk of functional limitations, disabilities, and even

death (Kannus, Sievänen, Palvanen, Järvinen &

Parkkari, 2005). Specifically, in the European Union,

between 2010 and 2012, there were, approximately,

3,750,000 admissions to hospitals related to falls each

year (Turner, Kisser & Rogmans, 2015).

The risk of falls is related to the environment (e.g.,

architectural barriers, such as poor lighting or

slippery surfaces), behaviours (e.g., nutritional habits

or consumption of alcohol and tobacco), and

limitations of physical performance, such as poor

muscle strength and balance, or functional, cognitive,

and sensory impairment (Turner et al., 2015). Since

https://orcid.org/0000-0003-1842-6539

https://orcid.org/0000-0001-5308-8411

https://orcid.org/0000-0002-5220-0528

https://orcid.org/0000-0003-2419-5642

https://orcid.org/0000-0003-4663-8184

https://orcid.org/0000-0002-4386-5851

https://orcid.org/0000-0003-3801-7249

physical activity contributes to increase or maintain

physical performance, several guidelines (e.g.,

(Ferguson, 2014; Committee PAGA, 2018; US

Department of Health and Human Services, 2018;

World Health Organization, 2020; Izquierdo et al.,

2021)) establish recommendations for exercises that

increase endurance and flexibility, strengthen

muscles, and improve balance, aiming to prevent falls

and promote a healthy living (Vozzi et al., 2022).

The remote control offered by information

technologies, namely web-based or mobile

applications and ambient assisted living systems

(Queirós et al., 2015), constitute a potential facilitator

for the dissemination of physical exercise programs

(Vozzi et al., 2022).

Since the effectiveness of exercise programs at

distance for older adults requires further research, this

Baptista, F., Ursine, B., Martins, A., Andias, R., Pais, J., Silva, A. and Rocha, N.

Development of a Web-based Program for Personalized Physical Exercise for Older Adults.

DOI: 10.5220/0011982200003476

In Proceedings of the 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2023), pages 221-229

ISBN: 978-989-758-645-3; ISSN: 2184-4984

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

221

paper reports on the development of a web-based

program for personalized physical exercise for

community dwelling older adults. This development

was performed in the context of the project Built

Environments for an Active, Safe, and Healthy Life

(Ambientes Construídos para uma Vida Ativa, Segura

e Saudável - ACTIVAS).

2 METHODS

In 2000, the Medical Research Council (MRC)

introduced a framework to guide the development and

evaluation of complex interventions (Medical

Research Council, 2000), being complex

interventions defined as interventions with more than

one component (e.g., what practitioners and patients

should do).

The 2000 version of the MRC framework had

some limitations due to its similarity to those used to

guide the development of drugs. Consequently, a

revised version was published in 2008 (Craig et al.,

2008), which proposed four phases with no linear or

cyclic order:

 Development – systematization of the

theoretical understanding of the intervention,

the outcomes that are expected, and the specific

approaches to achieve these outcomes

considering the current scientific evidence.

 Feasibility and pilot – determination of

acceptability, compliance, delivery of the

intervention, recruitment, and retention, as well

as unexpected side effects not predicted during

the development phase.

 Evaluation – assessment of the effectiveness of

the intervention, namely by conducting

randomized controlled trials.

 Implementation – Dissemination of the

intervention and its results to be reliably

replicated in uncontrolled settings over the long

term.

This paper reports on the development phase of a

web-based program for personalized physical

exercise for community dwelling older adults.

According to the MRC framework, the development

phase was decomposed into three steps:

 Identifying the existing evidence – a literature

review was performed, which included existing

guidelines of recommended physical activity

(e.g., (Ferguson, 2014; Committee PAGA,

2018; US Department of Health and Human

Services, 2018; World Health Organization,

2020; Izquierdo et al., 2021)) and systematic

reviews related to the implementation of

physical activity and physical exercise

programs (e.g., (Sherrington et al., 2020; Di

Lorito et al., 2021; Rodrigues, Domingos,

Monteiro & Morouço, 2022)).

 Identifying the developing theory –

considering the results of the literature review,

a schematic model of the intervention was

prepared to systematize target behaviour,

intervention components, and long-term

outcomes.

 Modelling the intervention – the

responsibilities of the practitioner and the

actions of the participant were identified, as

well as the nature of the exercises and the

methods of organizing and delivering these

exercises. Moreover, practicalities and the

concrete structure of the intervention were

developed and refined, including the

information models of the physical exercise

program and exercises, interfaces of the

proposed web-based application, and a

preliminary exercise set.

Modelling the intervention might include studies

to progressively refine the design before embarking

on a full-scale evaluation (Craig et al., 2008).

Therefore, in the near future, practitioners and

potential participants will be involved in a focus

group and a usability study to assess respectively the

practitioner and participant instructions and the

adequacy of the proposed practitioner and participant

user interfaces to identify and surpass potential

drawbacks.

3 RESULTS

This section reports the results of the three steps of

the MRC development phase, as stated in the

Methods section.

3.1 Identifying the Existing Evidence

Although physical activity has been identified as a

protective factor against physical and cognitive

decline, cardiorespiratory, metabolic and immune

systems’ dysregulation, mental illness and falls

(Committee PAGA, 2018), a large percentage of

older adults have a sedentary behaviour defined as

spending more than 5.5h per day sitting at work or

driving, sitting at home while watching TV, reading,

eating, or sitting at a desk (Remón, Díaz-Benito,

Beatty & Lozano, 2020).

Physical activity is defined as any activity that

incorporates bodily movement produced by muscle

ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health

222

contraction and that requires an increase in energy

expenditure relative to the resting condition

(Caspersen, Powell & Christenson, 1985; Ferguson,

2014). In turn, physical exercise is defined as a

subtype of physical activity, which is planned,

structured, repetitive, and purposeful to preserve or

improve skill-related components of physical fitness

(Caspersen et al., 1985; Ferguson, 2014).

Physical exercise can be performed in several

settings, from clinical to home settings, supervised or

not, in an individual or group format (US Department

of Health and Human Services, 2018), being the most

important aspect, the motivation of the participant. In

this sense, physical exercise performed by a group has

been recommended as a facilitator of adherence by

older adults when compared to exercise performed

alone at home (Di Lorito et al., 2021).

To guarantee the various aspects to consider when

prescribing an exercise program, the American

College of Sports Medicine (ACSM) proposed the

Frequency, Intensity, Time, Type, Volume, and

Progression (FITT-VP) principles (Ferguson, 2014;

Bushman, 2018). Specifically, (i) frequency defines

how often are the physical exercises done each week

(Bushman, 2018), (ii) intensity defines how hard is

the physical exercise (e.g., very light, light, moderate

or vigorous) (Bushman, 2018), (iii) time represents

the duration of an exercise modality within a session,

as well as, the total duration of an physical exercise

program, (iv) type defines the modality of a physical

exercise, being an exercise modality a category that

encompasses exercises with a common primary goal

related to a specific health or skill component of

physical fitness (Caspersen et al., 1985), (v) volume

represents the total amount of physical exercise

(Bushman, 2018), and (vi) progression characterizes

how the physical exercise program is advanced

(Bushman, 2018).

Considering the type of exercise or modalities,

mobility exercises refer to an exercise set that

explores the maximum range of motion available in a

joint (Kisner & Colby, 2009). They aim to preserve

or improve the range of motion to allow a body

segment to have more freedom of movement to

perform functional tasks (Kisner & Colby, 2009).

These exercises may include movements to improve

the range of motion in a specific joint, as well as to

promote the participant’s ability to transfer from one

body position to another (e.g., lying to sitting or

sitting to standing).

In turn, resistance exercises require muscle

contraction against an external resistance or weight,

which can be the body itself (or just part of it) to

increase muscle mass and strength (American

College of Sports Medicine, 2009; Rodrigues et al.,

2022). There are different types of resistance

exercises including muscle strength (i.e., to improve

the muscle´s ability to exert force), endurance (i.e., to

improve the ability of muscles to exert external force

for many repetitions), and power (i.e., the ability to

exert muscle force at high speed) (Caspersen et al.,

1985; Ferguson, 2014; Rodrigues et al., 2022).

Moreover, balance exercises aim to assure the

ability to maintain the equilibrium, while stationary

(i.e., static balance) or moving (i.e., dynamic

balance), while flexibility exercises play an important

role in functional mobility, as they encompass

movements/postures to improve or maintain the

extensibility of soft tissues that cross or surround the

joints.

Finally, aerobic exercises (American College of

Sports Medicine, 2009; Ferguson, 2014) aim to

improve cardiovascular endurance, and should

incorporate exercises such as walking, running,

cycling, and dancing (Ferguson, 2014; US

Department of Health and Human Services, 2018) to

increase heart rate and optimize the venous return.

A recent systematic review comprising more than

one hundred studies and twenty-five thousand

participants showed that general physical activity

reduces the rate of falls by 23% when compared with

control and that this ratio increases up to 28% when

multiple modalities of exercise are included

(Sherrington et al., 2020).

Independently of the exercise modalities, warm-

up and cool-down exercises should be performed

before and after the conditioning phase, respectively,

allowing a gradual increase in heart and respiratory

rate and facilitating the return of the participant to

baseline activity, respectively (US Department of

Health and Human Services, 2018).

3.2 Identifying the Developing Theory

Figure 1 presents a schematic model of the

intervention supported by the web-based program for

personalized physical exercise for older adults. This

model highlights target behaviour, intervention

components, and long-term outcomes.

The intervention aims to promote the practice of

physical exercise and has four main components:

 Initial functional assessment – the intervention

begins with the initial functional assessment of

the participant performed by the practitioner,

which is essential to define a personalized

exercise program.

 Prescription – the exercise program is

materialized in a variable number of exercises

Development of a Web-based Program for Personalized Physical Exercise for Older Adults

223

that must be structured according to a specific

prescription protocol. This prescription is

supported by the practitioner interface of the

web-based application. In addition to the type

and number of exercises, the prescription also

comprises additional parameters related to

frequency, intensity, time or duration, volume,

and progression of the exercises.

 Implementation – the exercise program is

performed remotely by the participant with the

support of the web-based application. This

presents the exercises and respective

instructions and gathers the participant

feedback.

Figure 1: Schematic model of the physical exercise

intervention.

 Supervision – periodically, the practitioner

performs an assessment of the participant and

an analysis of the respective progression to

determine if it is necessary to adjust the initial

prescription.

Considering the long-term outcomes, the web-

based physical exercise program aims to promote

adherence to the practice of physical exercise by older

adults. This adherence not only promotes functional,

cognitive, musculoskeletal, and cardiovascular

benefits but also helps to prevent falls and fall-related

injuries (Fragala et al., 2019). This means that long-

term outcomes include functional, cognitive,

musculoskeletal, and cardiovascular benefits, as well

as falls and fall-related injuries prevention, which,

consequently, might reduce the use of healthcare

resources.

3.3 Modelling the Intervention

Based on the existing evidence and the identified

developing theory, information models for both the

physical exercise program and the individual

exercises that constitute it were defined. These

supported the development of the web-based

application, both in terms of the practitioner and the

participant interaction. Moreover, a preliminary

exercise set was created.

3.3.1 Modelling the Exercise Program

A physical exercise program is composed by a

variable number of exercises that must be structured

according to a specific prescription protocol, which,

as already mentioned, defines the frequency,

intensity, time, type, volume, and progression of the

exercises.

The program duration together with frequency

(i.e., the number of sessions per week) determines the

total number of sessions. In turn, the sessions are

composed of sets of exercises, although a period of

rest is recommended between two consecutive sets of

exercises.

Moreover, there are different types of exercises

(i.e., modalities). Independently of the respective

modality, each exercise might be repeated and

progressed as appropriate to each participant.

The progression of exercise might be

operationalized by manipulating diverse parameters,

such as speed, load, type of contraction (e.g., isotonic,

or isometric), type of resistance (e.g., body weight or

external resistance), base of support (e.g., feet

position) or a combination of these, considering the

specificities of the different exercise modalities and

the characteristics of the individuals. However,

having too many parameters to characterize each

physical exercise makes the prescribing process

difficult, time-consuming, and error prone. To

overcome this drawback, the proposed information

• To develop a web-based program for

personalized physical exercise.

• Practice of physical exercise.

• Initial functional assessment.

• Prescription of the physical exercise

program.

• Implementation of the physical exercise

program.

• Supervision of the implementation of the

physical exercise program.

• Adherence to the practice of physical

exercise.

• Functional, cognitive, musculoskeletal, and

cardiovascular benefits.

• Prevention of falls and fall-related injuries.

• Reduction in health care resources use.

ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health

224

exercise model defines that each exercise has

different difficulty levels, which abstracts the

configuration parameters. For instance, Table 1

illustrates the use of speed, surface incline, body

weight, additional weight, coordination element, and

feet position to distinguish difficulty levels of an

aerobic exercise (i.e., walking), a resistance exercise

(i.e., hip abductors strengthening), and a balance

exercise (i.e., calf raises).

Finally, each exercise difficulty level must have

instructions (i.e., both instructions to the practitioner

and participant).

Figures 2 and 3 formalize the information models

of both the program (Figure 2) and the physical

exercise (Figure 3).

Figure 2: Information model of the physical exercise

program.

The physical exercise program (Figure 2) has a

duration and a frequency, which are translated into

sessions 1 to i. Each session has 1 to j exercise sets,

and after each exercise set, there might be a rest

period.

In turn, each exercise (Figure 3) is associated with

one of the following modalities, according to its

characteristics: (i) mobility training; (ii) resistance

training; (iii) balance training; (iv) flexibility training;

and (v) aerobic training. Moreover, a particular

exercise might be repeated (i.e., 1 to k repetitions) and

has 1 to l difficulty levels.

Finally, for each difficulty level of each exercise,

instructions need to be prepared for both the

practitioner and participant, which contain textual,

graphical, and video information.

The practitioner’s instructions include:

 Joint name (only for exercises involving more

than one joint).

 Starting position (in the case of exercises

performed in a standing position, it should be

specified whether the exercise should be done

with or without hand support).

 Inclusion of progression parameters as

mentioned before, when applicable.

 Description of the movements with reference to

the joints involved (if necessary).

Figure 3: Information model of the physical exercise.

Table 2 presents an example of the instructions for

the practitioner of a mobility exercise (i.e., ankle

mobility) with four difficulty levels.

On the other hand, the instructions for the

participant must include the material that is required

to carry out the exercise (e.g., additional weight), a set

of safety instructions (e.g., 'place the chair against a

wall so that it doesn't move' or 'support both feet on

the floor shoulder-width apart, torso straight and look

straight ahead') and specific instructions for carrying

out the exercise.

Set of

Exercices k

Rest in

between

Set of

Exercices k

Rest in

between

Exercise set j

Rest between

exercise sets

Duration

Frequency

Session i

Exercise Modality

Mobility

Resistance

Balance

Level l

Repetition k

Instructions Practitioner

Participant

Flexibility

Aerobic

Development of a Web-based Program for Personalized Physical Exercise for Older Adults

225

Table 1: Examples of parameters that might be used to

distinguish the difficulty levels of walking, hip abductors

strengthening, and calf raises exercises.

Difficult

Level Parameters

Walkin

slowl

(

flat surface

)

Speed.

Walking at a speed of 5km/h (flat

surface

)

Walking at a moderate pace

carrying a light weight of no more

than 4.5 k

(

flat surface

)

Surface

inclination and

additional weight.

Walking at a moderate pace

carrying a light weight between

4.5 and 19 kg (inclined surface).

Hip abductors strengthening

Isotonic contraction, body weight,

with support and without

coordination element.

Resistance (body

weight)

Isotonic contraction, external

resistance, with support and

without coordination element.

Isotonic contraction, external

resistance, without support and

without coordination element.

Coordination

element.

Isotonic contraction, external

resistance, without support and

without coordination element.

Calf

aises

Feet hip-width apart, hands

support and without coordination

element.

Feet position.

Feet together, hands support and

without coordination element.

Table 2: Instructions for the practitioner of the ankle

mobility exercise.

Difficulty

Level

Instruction

1 Ankle plantar /dorsal flexion: sitting

osition.

2 Ankle circumduction: sitting position.

3 Ankle circumduction: standing position.

Supported hands. hip and knee flexion

from 45° to 90°.

4 Simultaneous hip, knee and ankle flexion:

standing position. Supported hands.

Simultaneous hip, knee, and ankle flexion,

followed by maximum extension of the

knee and tibiotarsal to the

round.

Concerning the specific instructions, these

include guidance regarding:

 Information about the initial position, namely

the alignment of the upper or lower limbs. In

the case of exercises performed in a standing

position with single leg support, specify

whether it should be done with or without hand

support.

 Movement guidelines (e.g., breath control to

facilitate the performance of certain exercises).

 In situations where the participant must always

return to the initial position before performing

the next repetition, this information must come

before the information about the number of

repetitions to be performed.

Table 3 presents the specific instructions for the

participant of the aforementioned ankle mobility

exercise.

Finally, it should be noted that the textual

instructions of Tables 2 and 3 are complemented with

figures and videos. The videos will be presented and

repeated while the participant is performing the

exercises.

3.3.2 Practitioner Console

The practitioner console allows the definition of

personalised prescriptions including the choice of the

intended modality, the exercises within each

modality, the level of difficulty of each one of them,

the number of repetitions to be performed for each

exercise, as well as the respective duration. This

structure provides the module responsible for the

participant interaction all the information that is

required to present the sequence of exercises and

respective repetitions according to the prescription

characteristics (i.e., frequency, intensity, time, type,

volume, and progression).

3.3.3 Participant Interaction

The participant interaction is divided into three main

components:

 Session preparation – the application

determines if there is a prescription containing

at least one open session. If this is not the case,

the participant is informed that there are no

exercises available. Otherwise, the application

displays an introductory screen with

information about the next exercise to be

performed.

 Session realization – the web-based application

supports the participant during the realization

of the physical exercise. While there is a

session with exercises to be performed and the

participant wishes to continue, the application

will repeat the following actions: (i) determines

the next exercise and presents the respective

instruction; (ii) after the indication that the

participant wants to start, repeats the video with

the exercise instructions the prespecified

number of repetitions; (iii) waits for the

indication that the participant has finished the

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226

exercise; and (iv) if there is an indication for a

period of rest after the completion of the

exercise, transmits this indication to the

participant.

 Session closure – the session ends when there

are no more exercises to be performed or the

participant does not wish to continue. When

this happens, the application gathers the

participant feedback (e.g., the Borg Rating of

Perceived Exertion Scale).

Table 3: Specific instructions for the participant to carry out

the ankle mobility exercise.

Difficulty

Level

Instruction

1 Sitting: straighten your right knee. In this

position, move your toes up and down as

far as you can. After completing the set

number of repetitions, return to the

starting position and repeat the movement

to the left side.

2 Sitting: straighten your right knee. In this

position, make circles with the tip of your

foot (as big as you can). After completing

the set number of repetitions, return to the

starting position and repeat the movement

to the left side.

3 Standing: support yourself on a stable

surface (e.g., a wall). Raise the leg with the

knee straight to about 45 degrees. In this

position, make circles with the tip of your

foot (as big as you can). After completing

the set number of repetitions, return to the

starting position and repeat the movement

to the left side.

4 Standing: support yourself on a stable

surface (e.g., a wall). Raise the leg with the

knee straight to about 45 degrees. In this

position, make circles with the tip of your

foot (as big as you can). After completing

the set number of repetitions, return to the

starting position and repeat the movement

to the left side. Standing: Support yourself

on a stable surface (e.g., a wall). Raise

your right knee. In this position, pull the

ball of the foot up as far as you can. Then

lower the leg by straightening the knee and

bringing the toe down as far as you can.

After completing the set number of

repetitions, return to the starting position

and repeat the movement to the left side.

3.3.4 Preliminary Exercise Program

To assess the feasibility of the web-based program for

personalized physical exercise for community

dwelling older adults a set of 35 exercises was

prepared, each one with six difficulty levels. This set

includes mobility, resistance, balance, flexibility, and

aerobic exercises:

 Mobility exercises – head and neck mobility

(sitting and standing), shoulder and arm

mobility (sitting and standing), trunk and spine

mobility, hip and knee mobility, or ankle

mobility.

 Resistance exercises – hip abduction, hip

extension, sit-to-stand, squat, hip flexion, knee

extension, knee flexion, elbow flexion, lifting a

weight (sitting and standing), arm spread

(sitting and standing), squeezing a ball (sitting

and standing), pulling towel (sitting and

standing).

 Balance exercises – Straight-line walking, heel

raises, or heel-walking are examples of static

balance exercises, while maintaining balance in

single-leg or two-leg positions are examples of

dynamic exercises.

 Flexibility exercises – trunk and arm stretch,

pectoral stretch, quad stretch, hamstring

stretch, calf stretch, or wrist stretch.

 Aerobic exercises – dance and aerobic step.

All the exercises considered have been applied in

different exercise programs for older adults, namely

face-to-face exercise programs performed in clinical

settings. However, since these exercises are intended

to be carried out remotely, a critical aspect to consider

is the suitability of the instructions provided.

Therefore, to assess the adequacy of the instructions

prepared for the different exercises of a preliminary

exercise program, a focus group was recently

approved by an ethics committee, involving potential

practitioners and participants to consolidate the

instructions provided by the web-based application.

4 DISCUSSION AND

CONCLUSION

There are many international guidelines on exercise

prescription for older adults (American College of

Sports Medicine, 2009; Ferguson, 2014; US

Department of Health and Human Services, 2018;

World Health Organization, 2020), which agree on

several recommendations, including the delivery

modes and the need to include different exercise

modalities and to establish a rate of progression.

However, they differ in terms of frequency, duration,

intensity, and the parameters to configure the

progression rates. This means that the prescription of

a physical exercise program must be flexible.

Development of a Web-based Program for Personalized Physical Exercise for Older Adults

227

The information models for both the program

(Figure 2) and the physical exercise (Figure 3) were

defined to integrate the inherent complexity of a

physical exercise program and to guarantee the

flexibility of the prescriptions by allowing their

personalization.

An aspect that deserved special attention was the

progression of the exercise program. The rate of

progression might be established by manipulating

diverse factors such as exercise duration, frequency,

and intensity, and by adding different elements

related to motor and cognitive function or integrating

multiple health- and skill-related components of

physical fitness simultaneously in the same exercise.

The literature is not clear about which progression

parameters should be used for each exercise modality,

but some parameters might be considered to assist the

prescription according to the plausibility of each

modality. For general mobility exercises, an example

of how the progression factors can be used is

performing the exercises in single or multiple

anatomical planes of movement, as well as choosing

to perform exercises involving one or more joints

(single-joint versus poly-joint movement) (Kisner &

Colby, 2009). Regarding resistance training, some

progression factors that can be explored are different

types of muscle contraction within the same exercise

(isotonic versus isometric versus isotonic/isometric

combination), using body weight or an external

resistance as a load, unstable surfaces, and the

velocity at which the movement is performed, and the

inclusion of a coordination element (Fragala et al.,

2019). Progression factors can also be included in

balance exercises, integrating the different systems

involved in the control of body balance, namely the

width of the base of support, external support, support

surface stability, sensory input, dynamic movements

that perturb the centre of gravity, coordinating

element, among others (Akerman, Gonçalves &

Perracini, 2011). In terms of flexibility exercises,

different body positions to stretch the same muscle

group can be used. When it comes to aerobic training,

there are a wide variety of progression factors that can

be used, depending on the type of cardiovascular

training chosen (Ferguson, 2014).

In the present study, the diversity of progression

factors was abstracted by difficulty levels, which

resulted from the instantiation of diverse parameters

such as speed, load, type of contraction, type of

resistance, type of support or coordination.

In terms of the instructions for a specific exercise,

each difficulty level must present instructions for the

practitioner and participant. The practitioner

instructions include, for instance, information related

to joint name, the starting position, the inclusion of

progression parameters and a description of the

movements with reference to the joints involved. In

turn, the instructions for the participant include the

identification of the material necessary to carry out

the exercise, safety instructions and specific

instructions related to the initial position, movement

guidelines, suggestion of specific positions or

alternative movements.

Finally, concerning the practitioner and

participant interaction, two different user interfaces

were defined (i.e., the prescription console for the

practitioner, and the participant interface).

From the implementation standpoint, the

proposed models (i.e., physical exercise program and

physical exercise information models, difficulty

levels, instructions, and practitioner and participant

interactions) were adequate and led to a coherent

development of the web-based application with a

preliminary set of 30 different exercises. These

exercises can be aggregated to constitute coherent

individual sessions, which in turn form a physical

exercise program adaptable to individual needs and

characteristics.

In what concerns the experience of the application

of the MCR framework to develop the web-based

physical exercise program and respective

components and models, it is possible to conclude

that the first phase of this framework (i.e., the

development phase) provided efficient guidance on

the methodological and practical decision-making.

To complete the development phase of the MCR

framework, two additional studies are underway: (i)

content validation of the practitioner and participant

instructions, by conducting a focus group; and (ii) a

usability study to assess the practitioner and

participant user interaction, by conducting a heuristic

evaluation involving experts, and a user-centred

evaluation involving practitioners and potential

participants.

Future work also includes the remaining three

phases of the MCR framework, that is, feasibility and

piloting (i.e., assessment of acceptability,

compliance, and retention), evaluation (i.e.,

assessment of the effectiveness and cost-

effectiveness, and understanding the changes

introduced by the new processes), and

implementation (i.e., dissemination, surveillance and

long-term follow up).

ICT4AWE 2023 - 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health

228

AKNOWLEDGEMENTS

This work was supported by Programa Operacional

Competitividade e Internacionalização (COMPETE

2020), Portugal 2020 and Lisboa 2020 of the Fundo

Europeu de Desenvolvimento Regional (FEDER) /

European Regional Development Fund (ERDF),

under project ACTIVAS - Ambientes Construídos

para uma Vida Ativa, Segura e Saudável, POCI-01-

0247-FEDER-046101.

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