4. Discussion
anxiety
ADVERSE EVENTS
Functional fitness measures are commonly used in clinical and research settings to determine one’s functional abilities. With COVID-19 and the need to socially distance and isolate, alternative ways to conduct these measurements were necessary, as coming into a clinic or a research facility may not have been an option. While the research on the validity of virtual assessments compared to in-person assessments has been limited, our primary finding supports that virtual assessments can successfully obtain fitness measures for participants. In-person assessment may be the gold standard of fitness testing, but the advantages of virtual assessments should not be overlooked. Some of the benefits include reduced travel time to/from a clinic or research facility and decreased anxiety of visiting a hospital or facility that may be crowded or difficult to navigate. Live virtual assessments still are 1:1 interactions between the assessor and the participant and give uninterrupted time for the participant to ask questions, build rapport between the parties, and give the assessor an opportunity to observe the participant’s home environment, which may reveal potential hazards or suboptimal arrangements [The disadvantages of virtual assessments include the difficulty of ensuring the exact procedures. Detailed instructions help to describe the assessments, provide illustrations and step-by-step set-up procedures, and provide guidance on how the assessment will be performed. The assessor must be well-trained to ensure proper set-up and closely monitor the participant’s movement throughout the assessment for proper scoring. However, with preparation, this study clearly demonstrates that virtual assessments are feasible and can be conducted with high success rates.When comparing the in-person with the virtual assessment variables at matching timepoints, this study found that only the 2 min Step Test at pre-test was significantly different. While the setup and instructions for the assessments were the same, there were significantly more steps taken in the in-person modality to ensure proper set up and understanding than the virtual modality. There has been excellent intra- and inter-reliability demonstrated when previous research has delivered the 2 min Step Test in person [During COVID-19, virtual exercise training provided a method of keeping older adults physically active and engaged. As previously mentioned, the COVID-19 pandemic led to a decrease in physical activity in older adults due to several barriers, but especially due to the lack of in-person fitness training opportunities, as gyms and other facilities were closed. The results of this study show it is feasible to deliver a virtual fitness training to community-dwelling older adults and achieve improvements in overall functional fitness from baseline to post-assessment measurements. Virtual fitness training programs have benefits that should not be overlooked, including increased accessibility and convenience, social engagement through camera and microphone features on video meeting platforms such as Zoom, and individualized attention from a certified fitness professional. Participants indicated that the program of choice for this study, Vivo (A recent meta-analysis examining training programs for functional fitness in older adults, with a wide range of durations ranging from six months to over two years, showed overall improvements in muscle strength and lower-body strength [Findings from this study suggest that virtual functional fitness measures are feasible in older adults and are comparable to in-person functional assessments. While safety of participants and technological issues are primary concerns with virtual programming, this study resulted in minimal technological problems and no reported adverse events. A limitation of this study was that the program was delivered to a sample of older adults living in a higher-income suburb of a large American city. There are known to be associations between access to technology, utilization of virtual healthcare, advancing age, rural residency, and lower socioeconomic status [Additionally, the small sample size and short duration of the study may explain why some functional measures approached clinically meaningful changes and others did not. Future studies of larger size and longer duration should explore factors that may influence meaningful changes in these assessments. Another limitation of this study may have been related to the participant selection. Those who volunteered for the virtual fitness training program, may have been more confident in their technology abilities and therefore, more likely to be successful in the study. Future studies may consider expanding the inclusion criteria to include those with a wide range of technology abilities to help determine the successful delivery of virtual assessments and virtual fitness training in older adults.