Exploring the Feasibility of Voice-Controlled Intelligent Personal Assistants for delivery of home-based lifestyle interventions in older adults with type II diabetes

Working with an industry partner, we have developed innovative web-based software (Buddy Link) which allows Health professionals to deliver individually tailored lifestyle programs via an Amazon Alexa Echo Show 8 (Alexa) in patients' homes. Health professionals use our software to select various lifestyle behaviour instructions from a wide range of evidence-based options (or can easily create their own program), and these instructions are scheduled for broadcasting (using video and audio) by the Voice-Controlled Intelligent Personal Assistants (VIPA) at times specified by the health professional. The intervention group will receive, via courier, an Alexa and will also be provided with instructions on connecting the device to their home WiFi and using standard Alexa functions like using voice instructions to set reminders and search for information. They will also receive access to our health professional facing software “Buddy Link” which enables delivery of an individualised lifestyle program, at specified times throughout the day, using video demonstrations, and audio and written instructions. The VIPA will broadcast questions to determine whether the participant completed the activity, self-perceived exertion, self-efficacy, and any concerns. Participants can respond to all questions using natural conversation. The exercise physiologist will prescribe a personalised exercise program delivered by the Alexa to the intervention group for 12-weeks. Exercises will be selected by the exercise physiologist using the health professional interface in Buddy Link, and individually broadcast to participants via Alexa at specified times throughout the day, using video demonstrations, and audio and written instructions based on Exercise and Sport Science Australia guidelines. The prescribed exercise program will use body weight or additional resistance such as weight plates, dumbbells, theraband, weight vests etc if the participant has access to them unless contraindicated. Participants will perform up to 3 sets of 5 repetitions of upper limb and lower limb exercises at a moderate-intensity of approximately 4-6 on the 10-point modified Rating of Perceived Exertion (RPE) scale. Each participant will be encouraged to increase the load of all the prescribed exercises each session while maintaining the desired intensity if able. throughout the intervention duration. Each session will be 20-30 minutes in duration. The protocol will initially deliver two exercise sessions per week for the first four weeks of the intervention, three exercise sessions per week for the second four weeks, and four exercise sessions per week for the final four weeks. Following each exercise, the Alexa will broadcast questions to determine whether the participant completed the exercise, their self-perceived exertion, and any concerns (e.g. Pain, dizziness). Participants’ responses to these questions will be recorded and saved to the Buddlink database, enabling the exercise physiologist to review weekly and modify or progress exercise prescriptions as required. In addition, we have developed a novel automated “decision to exercise tree” based on the current recommendations of American Diabetes Association. VIPA devices will provide Blood glucose level (BGL) monitoring reminders pre and post each exercise session for the first 3 sessions (minimum) to establish exercise response/patterns/control. For example, the decision tree not deliver exercise if participants have signs or symptoms of hypoglycaemia or have self-reported BSL less than 4.0mmol/L or are not feeling well enough to exercise. Instead the decision tree will deliver audio and video instructions on how to self-administer their personalised hypoglycaemia action plan. If a pattern of three sessions in a row of self-reported BSLs less than 4.0mmol/L or greater than 15.0mmol/L occurs the decision tree system will request a referral to their GP or endocrinologist for completion of a Diabetes Management Plan. The study dietician will prescribe a healthy eating program delivered by the Alexa to the intervention group for 12-weeks to increase whole grains, vegetable and fruit daily intake in line with the Australian Dietary Guidelines. In addition, generalised dietary educational videos tailored for type 2 diabetes management will be displayed by Alexa. Examples of videos delivered by Alexa include “meal planning”, “making shopping lists using VIPA” and “healthy snacking”. We will access the Buddy Link platform to quantify the regularity with which participants watch these health eating videos (this will be determined by voice response from participants to questions we deliver via VIPAs, e.g. “Did you find this video useful? Please respond yes, no, or I did not watch the video”). The protocol will deliver two videos per week for the duration of the 12 week intervention.