Feasibility of a Musculoskeletal-targeted Exercise and nutrition TElehealth program for Older women following bariatRIC surgery (METEORIC Trial)

Participants allocated to the Functional Impact Training group in the present study will be given a structured 32-week, 30-minute, home-based Functional Impact Training program delivered by a commercial telehealth smartphone app (Physitrack). All exercises will be individually tailored and progressive, considering initial fitness, injuries or illness. Appropriate activities will be selected by the exercise physiologists using the clinician interface in Physitrack and individually broadcast to participants smart phone via the clinician interface in Physitrack at specified times throughout the day, using video demonstrations, and audio and written instructions. Following each exercise, Physitrack 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 Physitrack database, enabling the exercise physiologist to review weekly and modify or progress exercise prescriptions as required. The prescribed exercise program will use body weight or additional resistance such as adjustable dumbbells, which will be provided. Participants will perform up to 1 set of 10 repetitions of all five exercises (1 strength-focused, 1 balance-focused, and 3 impact-focused) at a low intensity of approximately 1-3 on the 10-point modified Rating of Perceived Exertion (RPE) scale to serve as a warm-up as required. Participants will be then required to perform 5 sets of 10-20 repetitions, 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. The protocol will initially deliver three exercise sessions per week for the first eight weeks of the intervention, four exercise sessions per week for the second eight weeks, and five exercise sessions per week for the final sixteen weeks. General information on nutrition for musculoskeletal health will be presented fortnightly via Physitrack. The content delivered will be prepared by our dietitian colleagues and cover the following topic areas: “Bone Health and Bariatric Surgery”, “Dairy”, “Dairy Alternatives”, “Calcium”, “Protein”, “Vitamin D”, “Maintaining Healthy Diet Behaviours”, and “Overcoming Diet Setbacks” The delivery of information to patients will involve short (2-3 minute) educational videos as well as PDF information sheets and nutritional suggestions for increasing dairy, vitamin D and protein intake including examples of appropriate foods, meals and recipes. On a monthly basis, participants will receive questions via Physitrack to determine participants’ learning and adherence to recommendations.