Feasibility and Efficacy of A Remote Tai Chi Program in Older Adults

Fitbit Inspire 3 Tracker owned by Google (Mountain View, California), a commercially available accelerometer-based activity tracker, was used to evaluate 24-hour movement behaviors. The participants received the device by mail, and the Fitbit tracker was given to the participants as an incentive to complete the study. The participants were encouraged to wear the Fitbit on their non-dominant wrist throughout the day, except for battery charging of the device, showering, and deep-water activities. The Inspire 3 tracked participants' physical activity (lightly active, fairly active, and very active).

Fitbit Inspire 3 Tracker owned by Google (Mountain View, California), a commercially available accelerometer-based activity tracker, was used to evaluate 24-hour movement behaviors. The participants received the device by mail, and the Fitbit tracker was given to the participants as an incentive to complete the study. The participants were encouraged to wear the Fitbit on their non-dominant wrist throughout the day, except for battery charging of the device, showering, and deep-water activities. The Inspire 3 tracked participants' sedentary time.

Fitbit Inspire 3 Tracker owned by Google (Mountain View, California), a commercially available accelerometer-based activity tracker, was used to evaluate 24-hour movement behaviors. The participants received the device by mail, and the Fitbit tracker was given to the participants as an incentive to complete the study. The participants were encouraged to wear the Fitbit on their non-dominant wrist throughout the day, except for battery charging of the device, showering, and deep-water activities. The Inspire 3 tracked participants' sleep.

A shortened version of the Falls Efficacy Scale-International (Short FES-I) was used to assess fear of falling. This 7-item short FES-I has demonstrated excellent reliability (Cronbach's alpha 0.92) comparable to the original 16-item FES-I. The seven items evaluate the concerns of falling when carrying out daily activities such as getting dressed, taking a bath, or going out to a social event. Each item was rated on a 4-point Likert scale (1= "Not at all concerned" to 4= "Very concerned"). The total scores are summed from the questionnaire, and range from 7-28, with higher scores indicating more concerns about falling.

Quality of life was assessed by the brief Older People's Quality of Life questionnaire also known as the OPQOL-BRIEF. The OPQOL-BRIEF questionnaire has 13 items, with a preliminary single item on global quality of life. Each of the 13 items is scored Strongly agree=1, Agree=2, Neither=3, Disagree=4, Strongly disagree=5. The items are summed for a total OPQOL-Brief score, then positive items are reverse coded, so that higher scores represented higher quality of life.

Brief Psychosocial Scales [40] were used to assess psychosocial beliefs towards physical activity (PA). The four scales selected were: PA pros and cons (decisional balance, 8 items), PA self-efficacy (measuring confidence in PA, 6 items), PA social support (5 items), and PA enjoyment (4 items). All of these scales used a 5-point Likert format (1=not important, 5= extremely important). The PA decisional balance scale rates the importance of each statement to an individual's decision to be more active, with a higher score indicating more positive attitudes toward PA. A higher score on the PA self-efficacy, PA social support and PA enjoyments scales indicate more self-confidence, social support, and enjoyment during PA, respectively .

Card sorting, such as Wisconsin Card Sorting (WCS), has been often used to evaluate cognitive flexibility among older adults]. However, WCS takes approximately 30 minutes for older adults to complete, and it has been criticized for the potential stress it may cause older adults. Therefore, the investigators have adopted an online digital card sorting game (EFgo™), to assess participants' cognitive flexibility. The final score (ranging 0 -100, taking both trial accuracy and response time into account using a proprietary algorithm) of each participant was sent to the online database and retrieved by a research assistant for analysis.

Psychological wellbeing was assessed using the World Health Organization-Five Well-Being Index (WHO-5) scale remotely. The WHO-5 is a self-report instrument measuring mental well-being consisting of five statements relating to the past two weeks where each statement is rated on a 6-point scale, with higher scores indicating better mental well-being.