Effectiveness of a Smartphone Chatbot to Improve Exercise Adherence in Older Adults

Population aging is associated with declines in physical function, mobility, and independence. Home-based multicomponent exercise programs are effective strategies to maintain physical function and reduce the risk of disability in older adults; however, adherence to exercise programs remains a major challenge, particularly when exercises are performed without direct supervision. Effectiveness of a Smartphone-Based Chatbot on Adherence to a Home-Based Multicomponent Exercise Program and Physical Function in Older Adults: A Randomized Controlled Trial addresses this challenge by evaluating a digital intervention specifically designed to support exercise adherence.

This study is a two-arm, parallel-group randomized controlled trial conducted in community-dwelling adults aged 60 years and older. Participants are randomly allocated in a 1:1 ratio to either a chatbot-supported exercise program or a paper-based exercise program. Both groups receive the same 12-week home-based multicomponent exercise program, consisting of three exercise sessions per week. The intervention includes strength, balance, flexibility, and walking exercises with a predefined progression throughout the program.

Participants assigned to the intervention group receive exercise prescriptions through a Telegram-based chatbot. In addition to delivering the exercise program, the chatbot provides instructional videos, automated reminders, exercise monitoring, adherence tracking, scheduling adjustments, and feedback based on participants' reported exercise completion. Participants allocated to the control group receive the same exercise program in a printed booklet together with a paper calendar for recording completed sessions. Both groups receive standardized follow-up telephone calls during the intervention period.

The primary outcome is exercise adherence, defined as the percentage of prescribed exercise sessions completed during the 12-week intervention. Participants are also classified according to whether they achieve at least 80% adherence to the prescribed sessions. Secondary outcomes include physical function assessed using the Short Physical Performance Battery (SPPB), 4-meter walking test, Five Times Sit-to-Stand Test (FTSST), and Timed Up and Go (TUG) test. Additional outcomes include physical activity measured with the International Physical Activity Questionnaire for Older Adults (IPAQ-E), participant satisfaction, perceived usability of the chatbot, and adverse events.

The study will provide evidence regarding the effectiveness of chatbot-supported exercise interventions for promoting adherence to home-based exercise programs among older adults. If effective, this approach may represent a scalable and accessible strategy to support healthy aging and the implementation of exercise programs in community settings.

Inclusion criteria

• Community-dwelling adults aged 60 years or older.
• Living independently in the community.
• Ownership and regular use of a smartphone.
• Familiarity with at least one instant messaging application and ability to access it at least three times per week.
• Ability to understand study procedures and instructions.
• Ability to provide written informed consent.
• Ability to safely perform a home-based exercise program.

Exclusion criteria

• Absolute contraindication to physical exercise.
• Inability to understand study instructions.
• Inability to read and/or write.
• Uncontrolled neurological conditions that may compromise safe participation in exercise.
• Uncontrolled cardiovascular conditions that may compromise safe participation in exercise.
• Any medical condition judged by the investigators to prevent safe participation in the study.