Empowering Physical Activity through eHealth : Web-Based Exercise for Older Adults and People with Intellectual Disabilities

Background: Health inequalities impact older adults and individuals with intellectual disabilities (ID) significantly, increasing their barriers to a healthy lifestyle. eHealth has emerged as a promising tool for addressing these public health challenges by facilitating greater access to interventions that promote physical activity. Non-communicable diseases (NCDs) are responsible for 71 percent of all global deaths, many of which are preventable through adherence to physical activity guidelines. As WHO identifies older adults and individuals with disabilities as priority groups for health interventions, this dissertation aims to assess whether web-based exercise can promote physical activity and health markers in these populations. Therefore, the aim of this dissertation was to evaluate the effectiveness, feasibility, and sustainability of web-based exercise interventions in target groups that rarely meet the recommended levels of physical activity: older adults and people with ID. Method: This dissertation includes four studies, two with mixed method design, one with quantitative design and one with qualitative design. Study I evaluated the effectiveness and user experiences of an online resistance training program for older adults with pre- sarcopenia. Study II assessed the effects of a web-based exercise, designed for individuals with ID. Study III explored the experiences of support staff in assisting individuals with ID while participating in such a web-based exercise program. Study IV provided a long-term, 12-month, follow-up on Study II, assessing effects and experiences. Results: Both web-based exercise programs achieved high adherence rates, with 80% in Study I and 83% in Study II. The exercise improved chair stand time (95% CI: 0.8–2.3, p < 0.001) and lean muscle mass i (95% CI: 0.06–0.72, p < 0.05) for older adults (Study I) and reduced fat mass (95% CI: 0.9-2.9, P < 0.001) and waist circumference (95% CI: 0.99-5.01, P = 0.009) for individuals with ID (Study II). Additionally, older adults reported feeling more active and noticing physical improvements (Study I). Feedback from support staff (Study III) underscored the importance of communication, structure, and motivation, within support teams, to foster physical activity. Study IV observed no sustained long-term effects, though some participants reported health benefits that motivated continued exercise, while others cited low motivation or lack of post-program support. Conclusion: The conclusion from this dissertation was that a web-based program seems effective and feasible for older adults with pre-sarcopenia and adults with ID, short-term. Adaptability and accessibility were two crucial building blocks for successful implementation for these target groups. In addition, the support structure was of high importance, affecting long-term sustainability and requiring further investigation.