Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease

This method provides insight into how to conduct virtual and in-person, older adult group walking classes, simultaneously. These classes are safe, fun, and engaging, and a great way to stay fit, and connected to others. This technique is advantageous because it allows older adults to participate virtually in a safe and fun walking group, when they're unable to participate in person due to pandemics, travel, or other reasons.

The technique of hybrid, in-person, virtual, walking classes can benefit many older adults and people with cardiovascular and neurodegenerative conditions. Exercise is one of the best ways to stay fit, both mentally and physically, and is highly recommended for older adults. This method could be applied to a variety of different hybrid group fitness classes where individuals want to participate in person, as well as at home or other locations.

One of the biggest challenges in using this technique is navigating the software. To ensure a successful session, I suggest downloading the necessary software in advance and practicing beforehand. This will allow you to become familiar with the app in any virtual meeting platform you plan to use.

It's also important for participants to do the same. After preparing a team to lead the walking groups, train staff, instructors, and volunteers to detect and prevent falls of all participants through an in-person, experiential balance management class. Practice exercises like standing, and shifting to the edges of one's feet while maintaining balance, closing eyes while standing and shifting weight from foot to foot, observing a partner's weight shift until they need to step, and learning to use body weight to support a partner's weight.

Next, select a commercially available fitness app capable of tracking time, distance, steps, pace, elevation, and other parameters. Choose a team meeting platform with video and sound capabilities, for virtual warmup sessions. To keep in contact with the virtual walk participants, opt for a one tap mobile or conference call line, and have all participants use heart rate monitors to track heart rate throughout the walk.

Plan and inspect a safe outdoor walking route. Note, rest stops, benches and shade, which can be useful during the walk, any uneven surfaces and curbs, which may present safety issues, and other important environmental assets or hazards. Ask the participants to fill out a health questionnaire during the baseline session, or prior to the first walk.

Review the completed form with each participant, ensuring the information provided is complete and accurate. Two days prior to the event, send an invitation via email to all virtual participants. The email should include a link to a one tap mobile or video conference call line, as well as guidance on how to use the technology, the fitness tracking app, safety precautions, and suitable attire.

To prepare for the hybrid walk, log into the video team meeting 15 to 20 minutes prior to the class start time. Once the in-person participants arrive at the walking location, connect the virtual participants to the conference. Provide assistance with wearable heart rate monitors and fitness tracking devices.

Also, familiarize the newcomers with the RPE scale and agenda. Take RPE measurements prior to the 25 minute warmup. Conduct a warmup featuring the whole body, large amplitude movements, including posture, weight shifting, rotation, and stepping.

Perform seated and standing exercises, providing safety, effort, amplitude, and form instructions. Ensure an assigned staff member spots participants with balance impairments for safety. Virtual participants should exercise with a buddy who can help them if necessary.

After the warmup, take the RPS, and divide the walking group into smaller groups based on speed, ability, and fall risk. Assign a leader, back marker, and/or study staff to each group, ensuring one person remains on the audio call in each group. Instruct all virtual and in-person participants on proper walking posture and gait biomechanics.

Next, inform participants about the characteristics of the chosen walking location and its terrain to prioritize safety and familiarity. Ask the virtual participants to be mindful of their environments, and to describe their surroundings. During the walk, record the participants RPE at 15, 30, and 45 minute intervals.

At the 45 minute, ensure all groups are back at the warmup location. Instruct the participants to stop their fitness tracking app. Guide the participants through a cool down period of five to 10 minutes, delivered by the instructor personally, or via audio for virtual participants.

Record the number of steps and distance traveled to assess the change in participant's fitness throughout the walking program. The heart rate and RPE of the participants increased over the course of the walk, and people with Parkinson's disease had more variable RPE than those with prodromal Alzheimer's disease. A strong correlation was found between the low RPE scores and heart rate when the participants walked at 50 to 75%of their max heart rate.

During these walks, people with Parkinson's disease walked 1, 800 meters on average, and people with prodromal Alzheimer's disease walked 3000 meters on average. Be sure to give clear instructions and maintain clear visibility for those connecting remotely. Finally, be sure that participants have chosen a safe walking route and a walking buddy to accompany them.

In this hybrid, virtual, and in-person format, more forms of exercise such as boxing, Tai-Chi, or dance could be offered. This approach would allow more older adults to participate in fun, safe, and engaging exercise while interacting with their peers. After developing this technique for hybrid walking groups, we were able to work out safely, and study the benefits of exercise for older adults during the COVID-19 pandemic, we were able to keep rehabilitation research going, and these classes meant a lot to several older adults who wanted to maintain fitness during periods of long isolation.