Abstract
Background
Background GERAS DANcing for Cognition and Exercise (DANCE) was developed with rehabilitation and geriatric medicine expertise for older adults (age 60 +) looking to improve brain health or mobility. This trial aimed to assess the feasibility, acceptability, and safety of delivering virtual GERAS DANCE to older adults in a home-based setting.
Methods
A single-center, prospective, parallel-group randomized feasibility trial was conducted to assess the feasibility of virtual GERAS DANCE. Fifty older adults were randomized to the virtual GERAS DANCE intervention group or a control group receiving usual care. The progressive dance curriculum was live-streamed with videoconference by a certified GERAS DANCE instructor in 1-h sessions held twice weekly for 6 weeks. Participants used their personal tablets, desktop computers, and laptops. Feasibility was evaluated based on predefined criteria, including process measures (e.g., recruitment and retention rates), outcome measures, resource utilization, and the acceptability of the intervention to participants.
Results
One hundred ninety three of 206 individuals met the eligibility criteria, indicating that the inclusion criteria were well-defined and suitable for the target population. The enrollment-to-screening ratio was 25:103, with recruitment completed in 8 weeks. Fifty older adults were randomized, and 46 completed baseline assessments (mean age = 75.02(5.89) years, range 63–92, 92% female). Twelve percent of participants (6 out of 50) required phone support to access the virtual GERAS DANCE classes due to device or Zoom navigation issues. The retention rate was 84%, with participants attending an average of 78% of the virtual classes. Ninety percent of participants rated the program as good to excellent, and 93% felt it provided the right level of challenge. The program was delivered with high fidelity, maintaining consistent, high-quality sessions and adhering to the standardized curriculum. Outcome assessments were completed by 46/50 (92%) participants, with an average duration of 41 min, well below the 60-min target. There were no adverse events related to the program.
Conclusions
Pre-determined thresholds for feasibility were met for all outcomes. This study demonstrates that virtual GERAS DANCE is feasible, well accepted, and safe for older adults, laying the groundwork for a future definitive trial.
Trial registration
ClinicalTrials.gov, NCT05202522
Supplementary Information
The online version contains supplementary material available at 10.1186/s40814-026-01851-5.
Keywords: Geriatrics, Remote, Rehabilitation, Exercise
Key messages regarding feasibility
-
What uncertainties existed regarding the feasibility?
GERAS DANCE is a new rehabilitation program for older adults with early cognitive or mobility impairments. Prior to this study, there were uncertainties regarding the feasibility of virtual GERAS DANCE delivery, recruitment, adherence, and addressing technological challenges.
-
What are the key feasibility findings?
All pre-determined feasibility thresholds were met, including successful recruitment and retention rates, completion of outcome measures, efficient resource utilization, and high participant acceptability of the virtual GERAS DANCE intervention.
-
What are the implications of the feasibility findings for the design of the main study?
Virtual GERAS DANCE is feasible and well-accepted, supporting its evaluation to test its efficacy.
Background
Canada’s population is aging, with a projected 68% increase over the next two decades in the number of adults aged 65 and older [1]. As people age, mobility concerns increase, affecting independence and daily activities. The COVID-19 pandemic disrupted in-person programs for older adults, making virtual programming essential to maintain access to healthcare and social support [2]. For those with mobility challenges or living in remote areas, virtual programs remove geographic barriers, offering personalized interventions to improve mobility, cognition, and well-being [3]. Virtual programs offered a comfortable alternative for older adults hesitant about in-person group exercise. As we move forward, virtual programs continue to offer a flexible, sustainable alternative to in-person care, ensuring equitable access to healthcare for all.
GERAS DANcing for Cognition and Exercise (DANCE) was developed with rehabilitation and geriatric medicine expertise for older adults (age 60 +) looking to improve brain health or mobility [4]. Our research has shown that GERAS DANCE leads to clinically meaningful improvements in cognition and mobility [4–6]. This study marks the first time GERAS DANCE was delivered virtually to older adults. This trial aimed to assess the feasibility, acceptability, and safety of delivering virtual GERAS DANCE to older adults in a home-based setting. This trial was not designed or powered to test intervention effectiveness; rather, it was designed to evaluate feasibility outcomes to inform the design of a future definitive trial.
Methods
Study design
This study utilized a single-center, prospective, parallel-group wait-listed control randomized feasibility trial. A wait-listed control design was used in this feasibility trial to support participant recruitment and acceptability, while allowing all participants eventual access to the intervention. The trial was registered on clinicaltrials.gov (ID: NCT05202522) and reported following the CONSORT extension for pilot and feasibility studies [7]. Participants were enrolled from January to June 2022 during in-person programming closures and restrictions due to the COVID-19 pandemic in Canada.
Participants and setting
Participants were recruited from newspaper advertisements, regional specialized geriatric clinics, community groups and social media. Inclusion criteria were (i) community-dwelling adults aged ≥ 60 years of age; (ii) access, or has a caregiver who has access to a device at home that can support a videoconferencing service, (iii) able to ambulate independently with or without a walking aid or with caregiver supervision at home, and (iv) family physician’s signature on a medical clearance form to ensure they are cleared to exercise safely. Exclusion criteria include: (i) unable to speak or understand English and has no caregiver for translation, (ii) significant cognitive impairment where they may have difficulty following two-step commands, (iii) unstable angina or unstable heart failure, (iv) travel plans that would result in missing greater than 20% of the trial’s 6-week duration and (v) currently attending a group exercise program. Research staff obtained informed consent from all participants under the Declaration of Helsinki and was approved by the Hamilton Integrated Research Ethics Board (HIREB #14,400).
Randomization
The allocation sequence, generated by a computer, was used to randomly assign participants in a 1:1 ratio to either the intervention or control group. Stratification based on age (< 80 or ≥ 80 years) was employed to ensure a balanced representation across age groups in both trial arms. Research staff conducted randomization through Research Electronic Data Capture (REDCap). Participants were informed of their group allocation following randomization and prior to completion of baseline assessments due to scheduling requirements for the intervention. Baseline measurements were subsequently completed by blinded outcome assessors. The randomization sequence was concealed from investigators to prevent selection bias, and at both 0 and 6-week assessments, outcome assessors remained blinded to intervention assignments.
Intervention and control groups
GERAS DANCE has a progressive curriculum primarily focusing on the ABCs (agility, balance, and coordination) of movement and functional exercises with both seated and standing dances (preview: https://www.gerascentre.ca/our-research/geras-dance/). A detailed description of GERAS DANCE in-person intervention can be found in our development and feasibility manuscript [4]. For this study, the intervention group received a 6-week virtual adaptation of GERAS DANCE, engaging in 1-h classes delivered twice a week by certified GERAS DANCE instructors through Zoom for Healthcare. Each class followed the same sequence of activities (socialization (10 min); warm-up (5 min); structured GERAS DANCE (30 min); cool-down (5 min); review of GERAS DANCE homework (10 min)). The intervention was tailored by offering options for seated or standing exercises, adapting the intensity of movements depending on participants’ physical abilities (e.g., frailty level, balance issues). We tailored the virtual GERAS DANCE intervention by incorporating participants' favourite songs into the warm-up segment. This personalized approach enhanced engagement, making the sessions more enjoyable and fostering a sense of connection and ownership among participants. The control group received the 6-week virtual GERAS DANCE intervention following study completion for equal opportunity to participate in the program. The Template for Intervention Description and Replication (TIDieR) checklist of the virtual GERAS DANCE intervention is available in Additional file 1 [8].
Training, technology, and facilities
GERAS DANCE was delivered by a certified GERAS DANCE instructor (with online asynchronous and synchronous training) who adhered to a standardized curriculum increasing the generalizability and repeatability of results. Participants were provided with written, step-by-step instructions for accessing Zoom, along with email and telephone support provided by research staff. Individualized reminders were sent at 9 am on class days, maintaining consistency with the same Zoom link for each class for the 6-week program. Participants used their own devices, including iPads, tablets, desktop computers, and laptops. Virtual GERAS DANCE classes were live-streamed from a private studio space with a 1080-p external webcam for optimal customer experience, Windows 8/10 (operating system), and high-speed internet (minimum 3.8 Mbps upload/3.0 Mbps download speeds) into the participants’ homes from the YMCA of Hamilton Burlington Brantford. To ensure clear music and instructor guidance, we worked to optimize audio quality with certified GERAS DANCE instructors using a Bluetooth headset microphone and adjusting Zoom settings to high-fidelity music mode.
Sample size
Following feasibility guidelines outlined by Whitehead et al. [9] and Thabane et al. [10], we determined our sample size pragmatically, aligning it with our class enrollment capacity (maximum 25 participants per class) as per safety and infrastructure best practices. During the virtual GERAS DANCE live-streamed classes, an extra YMCA staff member provided technological assistance to the certified GERAS DANCE instructor and supervised participant safety by monitoring video and chat feeds.
Data collection of demographics and clinical outcomes
Data collection was conducted virtually via Zoom for Healthcare at baseline and at the 6-week follow-up by blinded assessors with rehabilitation training. These outcome assessors underwent standardized training and were observed by research staff to ensure consistency and accuracy in the assessments. Mobility was assessed using the Five Times Sit-to-Stand test, a well-established measure for mobility and fall risk [11]. The total time to complete the task was recorded in seconds, with lower times indicating better mobility. Fear of falling was measured using the Short Falls Efficacy Scale International (Short FES-I), with total scores ranging from 7 (no concern) to 28 (severe concern about falling) [12]. This validated scale is a shortened version of the FES-I, specifically designed to assess participants’ concerns about falling during various activities [12]. Balance confidence was evaluated using the ABC-6, a shorter version of the ABC-16 questionnaire. Participants rated their confidence in performing six daily activities, with total scores calculated as a percentage ranging from 0 to 100. Higher scores indicated greater confidence in balance [13]. Frailty was assessed using a 30-item self-reported Frailty Index based on the cumulative deficits approach [14]. Total scores ranged from 0 to 1, with higher scores indicating greater frailty [15, 16]. Frailty scores were categorized into three levels: robust/very mild frailty (0–0.19), early/moderate frailty (0.20–0.35), and severe frailty (> 0.35), following established empirical guidelines. Cognitive function was assessed using the Telephone-MoCA (T-MoCA), a 22-point scale derived from the Montreal Cognitive Assessment (MoCA). This tool is validated for identifying mild cognitive impairment and Alzheimer’s disease. Total scores range from 0 to 22, with higher scores indicating better cognitive function [17]. The psychological state was assessed with the Depression, Anxiety, and Stress Scale (DASS-21), a short version of the DASS-42, which was used to assess negative emotional states, with total scores ranging from 0 to 63 with higher scores indicating more severe symptoms of depression, anxiety, and stress [18].
Evaluation and analysis of program feasibility
Feasibility was evaluated based on predefined criteria adapted from Braun et al. 2019 [19] and informed by Thabane et al. 2010 [10]. Outcomes included process measures (e.g., recruitment and retention rates), outcome measures, resource utilization, and participant acceptability. Feasibility outcomes were recorded by a research assistant during recruitment, and virtual class attendance was tracked electronically. Certified GERAS DANCE instructors conducted regular check-ins with participants to monitor for any adverse safety events.
Feasibility of the processes and the study design
The enrollment-to-screening ratio was calculated as the total number of participants enrolled as a proportion of the number of individuals identified to meet the inclusion criteria. The criterion for success was derived from the pilot study to be 2:11 [4]. Recruitment time to reach 50 participants. The recruitment rate was calculated as the ratio of participants recruited within a specific timeframe with a target of 5 patients per month. The retention rate was calculated as the number of individuals who remained in the study out of the total number of participants recruited at the baseline assessment. The retention rate was considered sufficient if greater than 70%. The refusal rate was calculated as the number of individuals who declined enrollment in the study out of the total number of eligible individuals. The refusal rate was considered successful if less than 70% based on the pilot study [4]. The eligibility criteria were calculated as the number of individuals who met the eligibility criteria and were deemed successful if the rate exceeded 70%.
Feasibility of the outcome measures
Safety was defined by the adverse events recorded by the blinded assessor, and 0 total events was the criterion for success. The duration was defined as the time in minutes for the assessment to be completed, and 60 min or less was defined as the criterion for success. Acceptance of clinical outcomes was defined as the percentage of outcome assessments attempted by the participants. Acceptance was sufficient if greater than 70% of eligible participants attempted the clinical outcomes. Completeness of clinical outcomes was defined as the percentage of outcomes sufficient for total score calculation, and the criterion for success was set at greater than 70%. Interpretability was the percentage of participants that scored the lowest or highest clinical outcomes (e.g., floor or ceiling effects), and the criterion for success was deemed if less than 15% of participants scored the lowest (floor) or highest (ceiling) score [19].
Resource problems that can occur during the main study
Participants used their own devices, and we monitored any challenges related to device compatibility or Zoom for Healthcare access. Virtual classes were live-streamed from a YMCA studio, utilizing high-quality video and optimized audio through Bluetooth microphones. We assessed streaming quality and participant experience, recording any technological difficulties encountered.
Feasibility and acceptability of the virtual GERAS DANCE intervention
The adherence rate to the virtual GERAS DANCE classes was recorded by the instructor using an attendance log and calculated as the percentage of classes attended (n/12). Exercise adherence in older adults in the literature ranged from 65 to 86%, with lower adherence rates observed in those with lower cognitive and physical health [20]. Therefore, in this study, adherence greater than 65% of the virtual GERAS DANCE classes will be considered sufficient due to the increased number of barriers to exercise adherence in our cohort (e.g., poor cognitive/physical health, fatigue, low self-efficacy, lack of transportation, reliance on a care partner) [21]. An instructor log was used to record any modifications required to match functional abilities. Safety was defined by the adverse events self-reported and recorded by the dance instructor. The enjoyment rate was calculated as the proportion of participants that rated the overall program enjoyment as good or excellent on a feedback survey.
Statistical analysis
Baseline demographic and clinical data were summarized descriptively, with means and standard deviations (SDs) for continuous variables and frequencies and percentages for categorical variables. Feasibility outcomes were reported using descriptive statistics, including rates, ranges, durations, and counts. Floor and ceiling effects were examined for each outcome by determining whether ≥ 15% of participants scored the lowest or highest possible values. All descriptives were computed using SPSS V19.
Results
Figure 1 is a consort flow diagram of participants. Fifty older adults were randomized, and 46 completed baseline assessments with a mean age of 75.02 (5.89) years (range: 63–92); 92% were female and enrolled in this study. Baseline demographic and clinical characteristics are presented descriptively by randomized group to summarize the study sample (Table 1).
Fig. 1.
CONSORT flow diagram. Screened prior to eligibility assessment (n = 206)
Table 1.
Baseline participant demographics
| Variable | Intervention (n = 23) | Control (n = 23) |
|---|---|---|
| Age (mean (SD)) | 74.04 (4.69) | 76.44 (6.78) |
| Female participants (%) | 20/23 (86.96%) | 22/23 (95.65%) |
| Living alone (%) | 9/23 (39.13%) | 15/23 (65.22%) |
| Education more than high school (%) | 15/23 (65.22%) | 16/23 (69.57%) |
| No falls in the past year (%) | 14/23 (60.87%) | 16/23 (69.57%) |
| Mobility: 5xSTS (mean (SD)) | 13.6 (4.50) | 12.01 (2.74) |
| Fear of Falling: Short FES-I (mean (SD)) | 9.13 (2.50) | 9.09 (3.00) |
| Balance Confidence: ABC-6 (mean (SD)) | 56.30 (25.03) | 58.60 (22.20) |
| Frailty: Fit-Frailty Score (mean (SD)) | 0.24 (0.10) | 0.24 (0.10) |
| Cognition: Telephone MOCA (mean (SD)) | 17.96 ((2.67) | 16.65 (2.60) |
| Depression, Anxiety and Stress Scale (DASS-21) (mean (SD)) | 17.55 (16.36) | 24.91 (21.41) |
5xSTS Five Times Sit-to-Stand Test, FES-I Falls Efficacy Scale-International (Short Version), ABC-6 Activities-specific Balance Confidence Scale (6-item version), MOCA Montreal Cognitive Assessment (Telephone Version), DASS-21 Depression Anxiety Stress Scales (21-item version)
Feasibility of the processes and the study design
Table 2 outlines the feasibility of the processes and the study design. The enrollment-to-screening ratio was 25:103. This ratio aligns with expectations based on the pilot study’s target ratio of 2:11. The recruitment time to reach 50 participants was 8 weeks, with a recruitment rate of 25 participants per month, surpassing the target of 5 participants per month. The retention rate was 42 out of 50 participants (84%), exceeding the pre-defined threshold of 70%. The refusal rate was 40%, as 83 out of 206 eligible individuals declined to participate, below the 70% limit. The eligibility criteria were met by 193 out of 206 individuals, indicating that the inclusion criteria were well-defined and suitable for the target population.
Table 2.
Feasibility of process, outcomes, resources, and acceptability
| Category | Metric | Value | Criterion for success |
|---|---|---|---|
| Feasibility of the processes and study design | Enrollment to screening ratio | 25:103 | ≥ 2:11 |
| Recruitment time | 8 weeks | ≤ 20 weeks | |
| Recruitment rate (participants/month) | 25 | ≥ 5 participants/month | |
| Retention rate (%) | 42/50 (84.00%) | > 70% | |
| Refusal rate (%) | 83/206 (40.29%) | < 70% | |
| Eligibility criteria rate (%) | 193/206 (93.69%) | > 70% | |
| Feasibility of the outcome measures | Safety (adverse events) | 0 | 0 |
|
Acceptance of virtual assessment method (% completed) |
100% | > 70% | |
|
Duration of assessment (Avg time) |
41 min | ≤ 60 min | |
| Interpretability: 5xSTS | Continuous; range: 7–25 | N/A | |
| Continuous; range: 8–38 | |||
| Interpretability: Short FES-I |
Baseline ceiling: 0/46 (0%) Baseline floor: 0/46 (0%) Baseline range: 7–19 total score |
< 15% floor/ceiling effects | |
|
Follow-up ceiling: 0/42 (0%) Follow-up floor: 0/42 (0%) Follow-up range: 7–23 total score | |||
| Interpretability: ABC-6 |
Baseline ceiling: 1/45 (2.22%) Baseline floor: 1/45 (2.22%) Baseline range: 0–100 total score |
< 15% floor/ceiling effects | |
|
Follow-up ceiling: 0/42 (0%) Follow-up floor: 0/42 (0%) Follow-up range: 3–99 total score | |||
| Interpretability: Fit-Frailty Score |
Baseline ceiling: 0/46 (0%) Baseline floor: 0/46 (0%) Baseline range: 0.08–0.49 total score |
< 15% floor/ceiling effects | |
|
Follow-up ceiling: 0/42 (0%) Follow-up floor: 0/42 (0%) Follow-up range: 0.07–0.46 total score | |||
| Interpretability: Telephone MOCA |
Baseline ceiling: 1/46 (2%) Baseline floor: 0/46 (0%) Baseline range: 10–22 total score |
< 15% floor/ceiling effects | |
|
Follow-up ceiling: 0/42 (0%) Follow-up floor: 0/42 (0%) Follow-up range: 6–16 total score | |||
| Interpretability: DASS-21 |
Baseline ceiling: 0/46 (0%) Baseline floor: 1/46 (2.17%) Baseline range: 0–98 total score |
< 15% floor/ceiling effects | |
|
Follow-up ceiling: 0/42 (0%) Follow-up floor: 3/42 (7%) Follow-up range: 0–84 total score | |||
| Completeness: 5xSTS | 44/46 baseline completed (95.6%) | > 70% | |
| 40/42 follow-up completed (95.2%) | |||
| Completeness: Short FES-I | 46/46 baseline completed (100%) | > 70% | |
| 42/42 follow-up completed (100%) | |||
| Completeness: ABC-6 | 45/46 baseline completed (97.8%) | > 70% | |
| 42/42 follow-up completed (100%) | |||
| Completeness: Fit-Frailty | 46/46 baseline completed (100%) | > 70% | |
| 42/42 follow-up completed (100%) | |||
| Completeness: Telephone MOCA | 46/46 baseline completed (100%) | > 70% | |
| 42/42 follow-up completed (100%) | |||
| Completeness: DASS-21 | 43/46 baseline completed (93.5%) | > 70% | |
| 42/42 follow-up completed (100%) | |||
| Resources | Equipment Support (%) | 6/50 (12.00%) | < 15% |
| feasibility and acceptability of the virtual GERAS DANCE Intervention | Safety (adverse events) | 1 unrelated | 0 |
| Adherence (% class attendance) | 77.72% | ≥ 65% | |
| Fidelity | High | High | |
| Enjoyment rating (%) | 90% rated good to excellent | > 80% | |
| Class duration | 1-h class | 1-h class | |
| Frequency | 2 × weekly (6 weeks) | 2 × weekly (6 weeks) | |
| Intensity–just right challenge | 13/14 (92.86%) | > 80% |
5xSTS Five Times Sit-to-Stand Test, FES-I Falls Efficacy Scale-International (Short Version), ABC-6 Activities-specific Balance Confidence Scale (6-item version), Fit-Frailty Score Frailty Index, MOCA Montreal Cognitive Assessment (Telephone Version), DASS-21 Depression Anxiety Stress Scales (21-item version)
Feasibility of the outcome measures
Table 2 outlines the feasibility of the outcome measures. There were no adverse events reported during outcome assessments conducted virtually on Zoom for Healthcare. Acceptance of virtual assessment method was excellent, with 100% of participants scheduled for baseline assessments being able to log onto the Zoom for Healthcare assessment. However, outcome assessments were completed by 46/50 (92%) participants, with an average assessment duration of 41 min, well below the 60-min target. Interpretability was strong, with no significant floor or ceiling effects observed across measures. Mobility scores ranged from 7 to 38, fear of falling (Short FES-I) ranged from 5 to 23, and balance confidence (ABC-6) ranged from 0 to 100, with only 2% of participants scoring at the extremes. The frailty index (Fit-Frailty Score) ranged from 0.07 to 0.49 with no extremes, and cognition (Telephone MOCA) ranged from 6 to 22, with 2% at the ceiling. The DASS-21 showed a 7% floor effect, with scores ranging from 0 to 96. Completeness of outcome measures was high, with nearly all assessments completed by participants.
Resource problems that can occur during the main study
Some participants (12%, 6 out of 50) required additional phone support to log in to the virtual GERAS DANCE class. These challenges were primarily related to navigating their devices or accessing Zoom for Healthcare. The live streaming of classes from the YMCA studio, which used high-quality video and Bluetooth microphones for optimized audio, was generally well received. Technological difficulties were minimal, with only a few brief internet connection interruptions or audio issues reported.
Feasibility and acceptability of the virtual GERAS DANCE intervention
The virtual GERAS DANCE program was well-received and safe. Classes were held twice a week for 6 weeks, each lasting one hour. On average, participants attended 78% of the classes, which is higher than the 65% needed for good participation. The program was delivered with high fidelity, maintaining consistent, high-quality sessions throughout. Ninety percent of participants rated the program as good to excellent, and 93% felt it provided the right level of challenge. There was one unrelated adverse event during the program.
Discussion
This study demonstrates that virtual GERAS DANCE is feasible, well-accepted, and safe for older adults, laying the groundwork for a future definitive trial. Pre-determined thresholds for feasibility were met for all outcomes. This study demonstrates that virtual GERAS DANCE is feasible, well-accepted, and safe for older adults with high retention and adherence to the program.
Exercise promotes health and longevity better than any other lifestyle practice [22], but it is only effective if people do it. Adherence to exercise is challenging for people of any age and increasingly challenging for those with functional limitations. In this context, technology-based virtual models of care have shown promise in increasing and maintaining physical activity [23]. However, most existing intervention studies have focused on individual training or immersive experiences (e.g., via MS Kinect and Nintendo Wii) rather than exploring the potential of online group sessions for older adults [24]. In recent years, virtual group fitness classes have become increasingly popular, offering the convenience of exercising from home without the need to travel to a community center. Virtual classes also provide a valuable alternative for those hesitant to participate in in-person classes due to health concerns, mobility issues, or personal preferences. These classes can be easily accessed via computers, tablets, or smartphones. While older adults have historically been slower to adopt computers and the Internet, their usage rates are rising. In 2016, 67% of older adults (65 + years of age) reported using the Internet, a significant increase from just 12% in 2000 [25]. In our study, older adults were willing to engage with virtual interventions using Zoom technology in a group setting. The willingness of this demographic to embrace virtual platforms represents a key shift in older adults’ digital engagement. The average class attendance was 77%, which not only exceeded attendance rates for our in-person classes (72%) [4] but also fell within the attendance range reported in the literature, which varies from 65 to 86% [20]. Although participants were aware of their allocation prior to baseline assessment, dropout rates were comparable between groups, suggesting that resentful demoralization was unlikely to have substantially influenced retention. Overall, virtual classes may offer an even more accessible and sustainable model for promoting physical activity among older adults.
While virtual models of care have many potential benefits, it is important to note that they are not a one-size-fits-all solution. Virtual GERAS DANCE classes were delivered via Zoom for Healthcare videoconference software. Participants received an email every day that there was a scheduled virtual GERAS DANCE with the Zoom link at 9:00 am to prepare for the class at 1:00 pm. The Zoom meeting ID remained constant for all sessions. Some participants (12%, 6/50) required additional support via telephone to log in to the virtual GERAS DANCE class. Best practices for future cohorts would involve an open practice session utilizing this software before the first dance class. Two YMCA staff members were involved: a certified GERAS DANCE instructor for fitness and a moderator for technical and music aspects. Similar to our in-person classes, a stepwise progression in the dance curricula was observed with increases in motor complexity and balance demands (1 class to learn each GERAS DANCE foundation and 2 + classes to learn each GERAS DANCE routine). Some participants remained seated during some of the standing dance segments. The default dance step was tapping their toes to the beat if participants needed to rest or felt the steps were too complicated. Music from the 1950 s and 1960 s was enjoyed by the attendees, and requests were emailed in by participants to be played during warm-ups or cool-downs. Some perceived the socialization aspect as less effective in virtual classes than in the in-person setting, indicating that the virtual format might have limitations in replicating the social interaction and engagement experienced in physical classes. This highlights that adopting a hybrid approach, incorporating both in-person attendance and virtual GERAS DANCE options may be preferred by some individuals. The fidelity of the program delivery was high, ensuring consistent quality throughout the intervention. Additionally, 90% of participants rated the program as good to excellent, demonstrating its acceptability and potential for sustained engagement in future trials. Nearly all participants (93%) also found the intensity and challenge level appropriate, reflecting the program's capacity to balance difficulty with accessibility.
Virtual outcome assessments
Our results demonstrate that virtual outcome assessments can be a practical and efficient method for data collection for older adults who may face barriers to transportation to attend in-person assessments. The 100% acceptance rate highlights the feasibility of older adults using virtual tools when supported, indicating that remote assessments can be reliably implemented in future studies. Additionally, automating the data entry process significantly reduced the time and effort needed for data management, enhancing accuracy and efficiency. This streamlined approach can save valuable resources in larger trials and increase accessible, generalizable, scalable, and cost-effective data collection in research and healthcare settings.
Limitations
This research study was supported by grant funding, which allowed participants to have access to an internet-enabled device and enroll at no financial cost. If participants did not receive free memberships, enrollment could have been lower than reported here. The sample was predominantly female and relatively well educated, which may limit the generalizability of the findings. Future studies should consider longer intervention durations, larger sample sizes, and potentially stratifying by specific participant characteristics to delineate the differential impact of virtual dance interventions on diverse subgroups.
Conclusions
This study provides robust evidence supporting the feasibility of virtual GERAS DANCE for older adults, with all pre-determined feasibility thresholds met. High retention rates, strong adherence, and positive participant feedback highlight the potential for broader program implementation. Suggestions for a future definitive trial include incorporating practice tech sessions and allowing participants to use their preferred music.
Supplementary Information
Additional file 1: The TIDieR (Template for Intervention Description and Replication) Checklist*
Acknowledgements
The authors would like to thank the YMCA Hamilton Burlington Brantford for their continued partnership, our students for their invaluable contributions, and the participants who helped to make this program a success.
Abbreviations
- GERAS DANCE
GERAS Dancing for Cognition and Exercise
- CONSORT
Consolidated Standards of Reporting Trials
- COVID-19
Coronavirus Disease 2019
- HIREB
Hamilton Integrated Research Ethics Board
- REDCap
Research Electronic Data Capture
- ABCs
Agility, Balance, and Coordination
- TIDieR
Template for Intervention Description and Replication
- YMCA
Young Men’s Christian Association
- Five Times Sit-to-Stand
A measure for mobility and fall risk
- Short FES-I
Short Falls Efficacy Scale International
- ABC-6
Activities-Specific Balance Confidence Scale (short version with 6 items)
- Telephone-MoCA
Telephone version of the Montreal Cognitive Assessment
- MoCA
Montreal Cognitive Assessment
- DASS-21
Depression, Anxiety, and Stress Scale (short version with 21 items)
- CI
Confidence interval
- SPSS
Statistical Package for the Social Sciences
Authors’ contributions
PH was responsible for the design of the study. CK, GH, JO, SM, and AP helped recruit study participants. PH and CM drafted the manuscript. All authors provided critical input and approved the submission of the final manuscript version.
Funding
This study was funded by the Hamilton Health Sciences New Investigator Fund to PH.
Data availability
The datasets generated during and/or analyzed during the current study are not publicly available (individual privacy of the participants could be compromised) but are available from the corresponding author at a reasonable request.
Declarations
Ethics approval and consent to participate
A research coordinator obtained informed consent from all participants in accordance with the Declaration of Helsinki and was approved by the Hamilton Integrated Research Ethics Board (HIREB #144000).
Consent for publication
Consent for the study was obtained for GERAS DANCE in accordance with the Declaration of Helsinki and was approved by the Hamilton Integrated Research Ethics Board (HIREB #144000).
Competing interests
PH, CK, GI, and AP are co-developers of the GERAS DANCE intervention with McMaster University with a Canadian Copyright # 1156625 and Trademark # 0925640. All other authors declare that they have no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Infographic: Canada’s seniors population outlook: Uncharted territory. CIHI. Cited 2024 Sep 23. Available from: https://www.cihi.ca/en/infographic-canadas-seniors-population-outlook-uncharted-territory
- 2.Morrow-Howell N, Galucia N, Swinford E. Recovering from the COVID-19 pandemic: a focus on older adults. J Aging Soc Policy. 2020;32(4–5):526–35. [DOI] [PubMed] [Google Scholar]
- 3.Dykeman CS, Markle-Reid MF, Boratto LJ, Bowes C, Gagné H, McGugan JL, et al. Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study. BMC Geriatr. 2018;18(1):1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Hewston P, Kennedy C, Ioannidis G, Merom D, Hladysh G, Marr S, et al. Development of GERAS DANcing for Cognition and Exercise (DANCE): a feasibility study. Pilot Feasibility Stud. 2022;8(1):1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hewston P, Bray SR, Kennedy CC, Ioannidis G, Bosch J, Marr S. Does GERAS DANCE improve gait in older adults? Aging Health Res. 2023;3(1):100120. [Google Scholar]
- 6.Kennedy CC, Hewston P, Ioannidis G, Egbujie B, Marr S, Negm A. Effect of the GERAS DANcing for cognition and exercise Program on physical function in older adults. J Aging Phys Act. 2022;31(2):182–90. [DOI] [PubMed] [Google Scholar]
- 7.Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355: i5239. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348: g1687. [DOI] [PubMed] [Google Scholar]
- 9.Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25(3):1057–73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: The what, why and how. BMC Med Res Methodol. 2010;10(1):1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Bohannon RW. Measurement of sit-to-stand among older adults. Top Geriatr Rehabil. 2012;28(1):11–6. [Google Scholar]
- 12.Kempen GIJM, Yardley L, Van Haastregt JCM, Zijlstra GAR, Beyer N, Hauer K. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008;37(1):45–50. [DOI] [PubMed] [Google Scholar]
- 13.Schepens S, Goldberg A, Wallace M. The short version of the Activities-specific Balance Confidence (ABC) scale: Its validity, reliability, and relationship to balance impairment and falls in older adults. Arch Gerontol Geriatr. 2010;51(1):9–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kennedy CC, Ioannidis G, Rockwood K, Thabane L, Adachi JD, Kirkland S. A frailty index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int. 2014;25(12):2825–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Blodgett JM, Rockwood K, Theou O. Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study. Lancet Healthy Longev. 2021;2(2):e96-104. [DOI] [PubMed] [Google Scholar]
- 16.Li G, Thabane L, Ioannidis G, Kennedy C, Papaioannou A, Adachi JD. Comparison between Frailty Index of Deficit Accumulation and Phenotypic Model to Predict Risk of Falls: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. PLoS ONE. 2015;10(3): e0120144. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Jennings LA, Araujo KLB, Meng C, Peduzzi P, Charpentier P, Reuben DB. Utility of a short, telephone-administered version of the Montreal Cognitive Assessment. J Am Geriatr Soc. 2021;69(10):2741–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Zanon C, Brenner RE, Baptista MN, Vogel DL, Rubin M, Al-Darmaki FR, et al. Examining the Dimensionality, Reliability, and Invariance of the Depression, Anxiety, and Stress Scale-21 (DASS-21) Across Eight Countries. Assessment. 2021;28(6):1531–44. [DOI] [PubMed] [Google Scholar]
- 19.Braun T, Grüneberg C, Süßmilch K, Wiessmeier M, Schwenk I, Eggert S, et al. An augmented prescribed exercise program (APEP) to improve mobility of older acute medical patients - A randomized, controlled pilot and feasibility trial. BMC Geriatr. 2019;19(1):1–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Picorelli AMA, Pereira LSM, Pereira DS, Felício D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: A systematic review. J Physiother. 2014;60(3):151–6. [DOI] [PubMed] [Google Scholar]
- 21.Freiberger E, Kemmler W, Siegrist M, Sieber C. Frailty and exercise interventions: Evidence and barriers for exercise programs. Z Gerontol Geriatr. 2016;49(7):606–11. [DOI] [PubMed] [Google Scholar]
- 22.Piccardi L, Pecchinenda A, Palmiero M, Giancola M, Boccia M, Giannini AM, et al. The contribution of being physically active to successful aging. Front Hum Neurosci. 2023;17:1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Müller AM, Khoo S. Non-face-to-face physical activity interventions in older adults: a systematic review. Int J Behav Nutr Phys Act. 2014;11(1):1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OBF, Aagaard P. Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(7):845–52. [DOI] [PubMed] [Google Scholar]
- 25.Schehl B, Leukel J, Sugumaran V. Understanding differentiated internet use in older adults: a study of informational, social, and instrumental online activities. Comput Hum Behav. 2019;97:222–30. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Additional file 1: The TIDieR (Template for Intervention Description and Replication) Checklist*
Data Availability Statement
The datasets generated during and/or analyzed during the current study are not publicly available (individual privacy of the participants could be compromised) but are available from the corresponding author at a reasonable request.