When COVID-19 forced millions of Australia into lockdown, a national team of physiotherapists, concerned about the impact this would have on the health and wellbeing of older people, initiated and fast tracked the development and launch of a website that offers guidance on how older people can stay active while in isolation.

Called Safe Exercise at Home, the APA-endorsed website is the collaborative effort of nine physiotherapy clinicians and researchers who have an interest in the areas of aged care, falls prevention, exercise and rehabilitation, and a research officer with website expertise.

It features simple and functional exercises and gives ideas of safe ways older people and those with mobility limitations can maintain or increase activity levels at home.

Exercise information is provided at three levels of function and fitness, with Level 1 being the easiest. There are also tips to stay motivated; guidelines on strength, fitness and balance exercise, as well as health problems; and additional resources for older people and health professionals. Additional written content and instructional videos provide information on various health problems, such as falls, osteoporosis, arthritis and heart disease, for which exercise can be beneficial.

The Australian team involved in the website development since inception have affiliations with 10 universities, institutes and health services including University of Sydney, University of Melbourne, Monash University, Curtin University, University of South Australia, University of Queensland, University of Tasmania, the National Ageing Research Institute, Sydney Local Health District, and Western Health and Peninsula Health in Victoria.

Associate Professor Frances Batchelor, APAM, from the National Ageing Research Institute, says the website is not intended to replace individual health professional care, but rather complement physiotherapy advice and guidance, particularly when stay-at-home restrictions are in place.

‘It fills a gap in accessing exercise opportunities when people are in isolation. When people are less active they risk losing functional abilities and will be at an increased risk of falls. Isolating at home doesn’t mean you need to be less mobile,’ says Frances, who has more than 30 years of clinical experience in rehabilitation, aged care and neurology.

‘If people were physically active before the restrictions of COVID-19, it’s important to try and replicate the amount and types of these activities in ways consistent with the limitations in place. If anyone was not physically active before the COVID-19 outbreak, it can be a good time to start an exercise program. Obviously, the website is not to replace going to the physiotherapist, but rather it is an added tool for people to work with.’

For some members of the project team, the need to develop the website resonated personally.

‘A couple of us were seeing our own ageing parents stop going to exercise classes when they desperately need it,’ says Professor Keith Hill, APAM, director of Monash University’s Rehabilitation, Ageing and Independent Living (RAIL) Research Centre.

‘In my case, my mum had an at-home exercise program that she had used previously, but had not resumed it after her group exercise classes had stopped. This seemed a fairly common scenario so it was a bit of a trigger for us to try and make sure that people were thinking about the need to stay active; and to also give those who hadn’t been exercising an opportunity to start, because it’s never too late to start moving.’

For ease of use, each of the three activity levels has a multimodal exercise approach and adheres to the Australian guidelines that recommend all older people and those with mobility problems be active every day, doing a range of physical activities that promote fitness, strength, balance and flexibility.

Users who are not sure which level best suits them are advised to start at the easiest, Level 1, and graduate to Level 3 over time.

‘This approach gives an option for people to start at the level of where they’re at physically,’ Frances says. ‘Level 1 would be aimed at someone who may be a little bit more on the frail side and might have some difficulties walking and be confined to their house. Level 2 is for people who are mobile, yet may need help with activities of daily living, and Level 3 is for people who are active and independent and might be going for regular walks outside of the house.

‘While we’re pitching at those three levels, the information is also optimising safety for everyone.’

Since Safe Exercise At Home went live in early May, visitor numbers to the site have increased steadily. At the end of June, more than 20,000 users and 27,000 sessions had been recorded, with about 20 per cent located outside of Australia. While still early days, it’s a positive result, Keith says.

‘As we monitor the analytics, we are seeing engagement with the information, which shows there is a demand for real-time accessible information on physical activity and exercise for older people not just here in Australia but in other countries. It’s good news on many levels, particularly for people accessing the site.’

Website design adheres to older users accessibility guidelines, such as presenting text in a larger-than-normal font size, prominence of spacing, using different colours to aid navigation and simplicity in design and content presentation. Physiotherapists developed and reviewed all content, including videos, and case studies that feature actual older people’s stories about their own experiences.

Yet, it’s not just the target audience that is engaged with the website. National and international allied health and medical professionals are actively sharing the website domain through their industry marketing channels, including face-to-face recommendations with patients. Analytics report direct visits (11,387) as the primary source of acquisition, followed by referral from another site (4884) and social media channels (2728).

‘It’s good to see the reach and growth recorded in our analytics,’ says Keith, a physiotherapist and senior researcher with 40 years clinical experience in rehabilitation and aged care. ‘Each week when we meet we are seeing a rise in users and this shows that the expertise here in Australia is respected widely and health professionals are willing to promote it and tell their patients about it, too.’

Anecdotal evidence provided through the project team’s active network of clinicians report an increased uptake in exercise from male clients, who are actively using the site, says Dr Stephanie Fu, an APA Specialist Gerontological Physiotherapist (as awarded by the Australian College of Physiotherapists in 2013), from Mater Health Services Brisbane and University of Queensland.

‘The feedback I’ve been getting from patients and other health professionals is that the videos are real, and by that I mean the people demonstrating the exercises are everyday Australians that older people can identify with—it’s them,’ says Stephanie, who is also the principal practitioner and director of Ageing Balance in Brisbane.

‘Presenting the information in the way that we have helps the patient feel empowered, because that’s something that they can access themselves in their own time. And there is some anecdotal evidence that suggests men, who otherwise may not have engaged in exercise or attended classes before COVID-19, are now active users of the site. Getting this information from our networks is an important part of this project, and I think that because the project resonates with so many people, I have found it to be one of the easiest collaborations that I have participated in.’

Adds Keith: ‘The project and the site is run on a shoestring budget, yet everyone involved could see the importance of it to helping important members of our community and even the physiotherapy profession. We all wanted to get it up and running as quickly as possible. It’s a marvellous effort on everyone’s part and it’s fantastic for it to have the endorsement of various international advisors and the APA.’

Future plans for the project team include ongoing content development and promotion of the site to increase awareness and use.

‘It’s a not a set-and-forget site, so we will be continuing to analyse the data to see what content is resonating and what we can improve on. This is a website that a large number of professionals feel very passionate about, and for physiotherapists it is a valuable tool to present content in easy-to-consume formats for our older and less-mobile population.’

>> Visit here for more information and resources. 

The website development team is Associate Professor Cathy Said, Professor Keith Hill, Professor Cathie Sherrington, Rik Dawson (an APA Director), Associate Professor Michele Callisaya, Dr Stephanie Fu, Professor Anne-Marie Hill, Associate Professor Shylie Mackintosh, Associate Professor Frances Batchelor, and Courtney West.