Nutrition and EXercise Telehealth care for Malnourished older adults post-hospital discharge (NEXT-M)

The nutrition and exercise intervention will be delivered remotely to participants in their home for 12 weeks. The intervention will be delivered using the pre-existing commercial smartphone platform Physitrack. The system allows for development of customised video clips and text to deliver the exercise and nutrition components of the intervention in this trial. The nutrition content has been developed by the research team for deliver via the Physitrack system; the exercise component will use content already available within this system. Nutrition video clips focus on increasing energy and protein intake through fortifying pre-existing meals, adding high energy/protein meals, snacks and drinks to meet estimated energy and protein requirements. Clips include education sessions spoken to camera, whilst other content will provide practical food demonstrations (eg. how to prepare fortified milk at home). These will be personalised for each participant, with dietary changes aiming to reach the European Society for Parenteral and Enteral Nutrition requirements (25–30 kcal/kg and 1.5 g/kg ideal body weight). At least 2 personalised nutrition clips will be prescribed based on requirements per participant per week, these will be allocated weekly. The duration of these clips is 5-20minutes and participants will be encouraged to view the allocated clips each week. The nutrition clips include instruction on specific nutrition interventions, eg. How to make high energy high protein milk, why full fat yoghurt is a better choice than “diet” yoghurt, how to fortify meals through adding cheese, milk powder etc. These clips will be personalised for participants through allocation by an Accredited Practising Dietitian. Personalised messages and surveys may be sent through Physitrack to evaluate adherence and engagement. A 30-minute, home-based exercise program, personalised for each participant by an Accredited Exercise Physiologist, will be delivered by Physitrack as per American College of Sports Medicine (ACSM) guidelines for chronic health conditions. The protocol will deliver two exercise sessions per week for the first four weeks, three session per week for the second four weeks, and four sessions per week for the final four weeks. Exercise clips will focus on strength, balance and aerobic exercises. It is anticipated that for most participants, resistance exercises will be body weight supported. The strength training exercise prescription will involve functional strength training exercises for the upper and lower body (e.g. sit to stand, calf raise, wall push up, step ups) using body weight only. Participants will be prescribed a three set of 10 repetition per exercise set at a moderate intensity of self-perceived exertion using the modified rating of perceived exertion scale scale (RPE) 3-6 on the 10-point modified RPE scale. The balance component involved static and dynamic balance (e.g. standing eyes open, feet together, tandem walking) with one repetitions of each balance exercise prescribed for 30 seconds at moderate intensity (3-6 on the 10-point modified RPE scale). The aerobic component of the exercise component will involve up to 10 minutes of walking in the community at moderate intensity (3-6 on the 10-point modified RPE scale). Following each exercise, the Physitrack software will 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 Phyitrack database, enabling the exercise physiologist to review and modify or progress exercise prescriptions as required. Ten participants for the qualitative interviews will be chosen at random from the 25 participants in the intervention group. The website https://www.random.org/sequences/ will be used for randomisation. Where any decline, the next participant will be chosen, until 10 interviews are complete. The Braun & Clarke thematic analysis will be used to analyse the data. Through this approach, codes will be grouped and summarised, with thematic maps drawn to realise connections and patterns in the data. Two investigators from the research team will compare content and themes. Any disagreement will be resolved by consensus moderation.