Physical activity can prove particularly challenging for frail older adults. And while there are many effective interventions to promote physical activity in this population, few end up translating from the research setting to the general public on a large scale. In this episode, Drs. Jessie Chin, Kelly Quinn, David Marquez and Naoko Muramatsu discuss "Exercise Buddy," a virtual coach that can deliver exercise programs to frail and homebound older adults through smart speakers, like Google Home.
Naoko Muramatsu, PhD
Professor, Community Health Sciences
UIC School of Public Health
Twitter: @naoko_muramatsu
LinkedIn Bio
Kelly Quinn, PhD
Clinical Associate Professor
Department of Communication
UIC College of Liberal Arts & Science
Twitter: @_kquinn_
David Marquez, PhD
Professor
Department of Kinesiology and Nutrition
UIC College of Applied Health Sciences
Twitter: @DrDavidMarquez
Marquez Lab
Jessie Chin, PhD
Assistant Professor
School of Information Sciences
University of Illinois Urbana-Champaign
Chin Lab
If you would like to see your interdisciplinary team featured on the podcast, reach out to me at laurenw@uic.edu.
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The University of Illinois Chicago Center for Clinical and Translational Science is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0:00 [TEASER] Dr. Marquez
You can still gain health benefits even if you start exercising when you're 65 and you've never done it your whole life. And it's just numerous from the physical benefits, the mental health benefits, the cognitive benefits improved memory, the actual structure and function of the brain improving.
0:16 Voice Over Introduction
Welcome to Collaborative Endeavors, a podcast about how teams of researchers from different scientific backgrounds come together to tackle society’s big health challenges, leading to better therapies and healthier communities.
It’s no secret that healthy aging is a hot topic these days. Researchers are constantly seeking ways to improve the health outcomes of older adults, and one of the best ways is through exercise. Unfortunately, physical activity can prove particularly challenging for the estimated 7-12% of Americans who are considered “frail.” Fail older adults have an increased risk of infection, illness, falls and disabilities. And while there are many effective interventions to promote physical activity in this population, few end up translating from the research setting to the general public largely due to the personnel costs of delivering the programs in person. Enter the team behind Exercise Buddy: a virtual coach that can deliver exercise programs to frail and homebound older adults through smart speakers, like Google Home.
In this episode, Drs. Jessie Chin, Kelly Quinn, David Marquez and Naoko Muramatsu who will talk about how their team came together to find an innovative solution to improve physical activity among some of our most vulnerable community members.
01:35 Dr. Marquez
I’m David Marquez and I'm a professor in kinesiology and nutrition in the College of Applied, Health Sciences, and my research primarily focuses on physical activity levels and interventions with brain health being a common outcome that's assessed in my work specifically in older Latino adults.
I like to point out that older adults are more heterogeneous than younger adults. Many of us come up with stereotypes of what older adults are like, and in reality, it is so diverse. But we know that as we get older, we lose muscle mass, our vision isn't as good, our balance isn't as good. But if we stay regularly, physically active, we can really prevent those things from declining too much and too fast. So it can be preventative like that. But when we have those issues, there are barriers present. Even starting with- what should I do? What kind of activities should I be doing? What's safe for me to be doing? And then is it available and accessible? Are older adults comfortable, are they safe walking outdoors whether it's their own sense of balance or whether it's environmental, you know, in the neighborhood that people are living in and the status of the sidewalks. So much of the research now is showing such benefits for all people, especially older adults, that it's never too late to start.
I do work with older adults in physical activity behavior and interventions. So I'm always interested when I get approached about- is this an innovative project that could be useful for older adults to be more physically active and improve their health? And when I heard about this, when they brought it to me with the smart speakers I thought it was phenomenal. You know, in the context of COVID and outside the context of COVID- older adults who might be more isolated- this is a great way to reach people and to potentially deliver a type of physical activity program.
04:39 Dr. Chin
My name is Jessie Chin. I'm assistant professor in the School of information sciences at the University of Illinois at Urbana and I have training in cognitive psychology and I'm doing research on how can we better design information and technology to support health communication and health behavior for diverse populations, especially for older adults.
So this is back to my postdoc training at the University of Waterloo. So during that time I was interested in the potential of smart speakers especially how it can increase the diverse experience for older adults. So we found several studies showing that there's no age differences in acceptability of smart speakers which is not quite often found in the literature in human-computer interaction. So I started exploring different ways we can apply this technology. So at that time, I think that goal is that we wanted to focus on the promotion of the dissemination of these kind of evidence based health programs. We identified in the literature that many evidence based physical activity programs have been studied, but it's difficult to translate to practice given that we don't have enough administration for it or it's just the cost to implement these programs.
06:12 Dr. Quinn
I'm Kelly Quinn. I'm a clinical associate professor in the department of communication at UIC, and my research really centers on the use of communication technologies and their network nature and the way people employ them with a particular focus on older adults.
Well Jessie and were connected indirectly through one of the Provost’s East-West mixers on campus here. Jessie was, at the time, in the health and bioinformatics program. She was a professor there and she connected with someone in our department who matched us up because of my work in older adult communication technologies. Jessie really brought an understanding of the processes underlying this particular device that we're using in this study, the smart speaker. My background was really in how older adults use various kinds of communication technologies and the benefits that they accomplish out of that use, and particularly I was interested in social outcomes. But as we got started in this project, I think it was Jessie who had the idea of trying to deploy a physical activity application through the devices and through the Center for Research on Health and Aging, David and I have worked together on a bunch of different things through the years. So I naturally dialed him up and said- hey, would you like to join us on this this enterprise? And David had been working closely with Naoko and he suggested Naoko might be a good addition to the research team.
08:03 Dr. Muramatsu
My name is Naoko Muramatsu. I am a professor in the division of community health sciences at school of public health at University of Illinois Chicago. And I was trained in health services research sociology especially demography and organizational studies. My research tries to enhance health equity, the quality of healthcare, and my current projects focus on vulnerable populations like frail older adults and their caregivers.
There are many rigorously tested physical activity programs for older adults, and some are for people with disabilities. However, those frail older adults with real disabilities who cannot stand, there aren't many evidence based programs for good reasons because it's difficult do that kind of study and it can be risky and also it is difficult to retain these people. And so I looked at many different programs and there was one program that is evidence based, not yet tested in a randomized control trial, but that is more like a grassroots kind of program that was very good, very simple. And I thought, oh, this is it. And, and I talked to the developer and people who have been working on the program. So this kind of program is specifically targeted to frail order adults, that is very rare. And also this program was initially developed in a Medicaid program in California. And so the assumption is that we don't have to use too many resources. And that was perfect for the population that I was working with- again, Medicaid eligible older adults. It is important to have this kind of simple program that is safe and that anybody can do that in the home. And even if there are healthier people who would like to do exercise, but it is snowing or you cannot go outside because of the pandemic- anything can help to keep moving. And this particular program is for that purpose, you can do it in the comfort of your home.
10:47 Voice Over:
The program Dr. Muramatsu described, called “Healthy Moves for Aging Well,” is a low-intensity fitness program created by a team at the University of Southern California and the Partners in Care Foundation and is endorsed by the National Council on Aging. The program features a mobility component as well as a behavioral component in which a coach reviews participant goals to help increase and maintain physical activity. Dr. Quinn described how the team translated this in-person program to a virtual platform that could operate through smart speakers like Google Home.
11:23 Dr. Quinn
So, the defining characteristic of smart speakers, is what we call the voice user interface, which means that just by giving a verbal command: Hey Google, I want to run through my exercise program. The program is activated. So, as people get older, the use of technology is greatly reduced and there's a lot of reasons for this. The ability to engage physically with technologies may be limited. Touch interfaces, for example, are difficult for some people to engage with visual cues, are harder to spot. Uh, there may be hearing loss which limits engagement with certain technologies. There's also the issue of not having skills at older ages and that's just a function of not using technology possibly in the workplace or in educational settings. And so older adults don't always have the conceptual models to use technology that younger people have. The beauty of the smart speaker is that older adults have a conceptual model, they know how to talk to other people. So to be able to say to a device, “Hey, help me do this,” is a very natural process for them. So, you know, this has been one of the huge advantages of using the smart speakers.
The way the intervention actually works is that the participant in our study would literally say, “Hey, Google, let's exercise today.” We have a couple of different versions of the application. The one we're currently using is called Exercise Buddy. And so they say, “Hey Google, talk to Exercise Buddy,” and then Exercise Buddy walks them through an exercise routine that they do using everyday weights around their house. So we suggest using a water bottle, you know, just a regular bottle of water, twenty ounces or so. It's like having a one pound weight. They do exercises both seated and standing in their apartment and the whole process takes about 20 minutes. And we suggest that they do this a couple of times a week.
13:48 Voice Over:
Dr. Chin elaborated
13:52 Dr. Chin
The most commonly used smart speakers, including Google Home or Amazon Alexa, they all have these flexibilities for users to build their own Google actions or Amazon skills that can perform some specific tasks. So we have been taking advantages of these flexibilities to build our own actions that can guide users to go through exercise programs. We want to keep in mind that we don't want to modify any fidelity of the original program, we want to make sure that even delivering by smart speakers we should reach the same kinds of effects of that original program. And because there's no human experimenters on site, so we might want to do an extra safety check. So we implemented several check-in points during the conversations that users will have the opportunity to stop the program or decide whether they want to take a break before going to the next session of the program.
15:11 Voice Over:
While the study was moving forward as intended, about a year in the team faced an unexpected challenge from within when Dr. Chin accepted a position at the University of Illinois Urbana Champaign. One would think that a PI’s move to another campus would impact progress, but that wasn’t the case. Dr. Quinn and Dr. Marquez explained how their team was able to adapt to Dr. Chin’s transition and shared other lessons they’ve learned about maintaining productive team dynamics.
15:39 Dr. Quinn
Because I'm on the East Campus and Jessie was on the west campus. We were already doing virtual meetings for our research team meetings every week. So it was very we took them to Zoom very quickly. Having a regular structure having defined roles that everyone has to execute for the project. We have several graduate students that are working with us on this particular project - that has really helped. We are pretty diligent about creating policies and procedures as we go along so that if there's a transition among our graduate assistants, we are able to navigate that fairly easily because, you know, there are things in writing that we can then refer to. So, the structure is an important element in a team collaboration like this and just documenting things like our research meeting. One of the graduate assistants is charged with taking notes during each research meeting, so that we can go back and say, oh, you know, who's responsible for XYZ? Here it is in the notes and, and we can go forward. Also, that helps when people miss meetings and the like.
16:54 Dr. Marquez
The challenge with every Grant I've led or been, a part of is, is the budget and timelines. And oftentimes things take longer than we plan or hope or expect to them to. Different pieces of a project can take longer than expected. So then there could be a time crunch and then is there still salary or is there still effort? And I plan to do the things that, you know, I said that I would do and be a part of. And so you're committed to that team, right? You're committed to getting the work done. I think if everybody can operate in that setting then you don't feel like I'm the only one who's working at this.
17:45 Dr. Quinn
I think rapport is a really important aspect of the team. It's been very challenging this last year and half to build and sustain that rapport. It's hard to do it when you're not physically present, the small talk and the joking around kind of goes out the window; it's really hard to do that via Zoom. But by the same token, having team members that you can get together with periodically- you know even if it's a quick lunch to discuss what's going on with the project or a cup of coffee- I think it's really important to have that aspect of teams because it helps to build that commitment that David talked about. That I'm going to do this to not let my team members down. I think that becomes increasingly important as the project goes on because as you're in the throes of kind of collecting data and analyzing results, there’s something very tangible there. But, you know, just those final steps of pushing project papers out the door or making conference presentations, it's helpful to have those team members to kind of get you across the finish line on that stuff.
I think the other advantage of working with team is that you are able to bring to bear knowledge in a very broad way. Just looking across how translational science works today, the interdisciplinarity is a really important element. There are lots of things that, as a researcher, I just don't know enough about. And it's not only rewarding to be able to turn to David or Jessie or Naoko to say, “How do we do solve this problem or what do we do when this happens?” but it makes for a richer and more nuanced set of findings. Because not only can we see and interperet what’s going on, but we can interpret them through a variety of lenses that actually pushes us forward in some really important ways.
20:07 Voice Over:
From Dr. Chin’s perspective, Dr. Quinn was also integral in supporting her career development as a junior faculty member.
20:15 Dr. Chin
I would say that I need to thank her and she's the major reason that we can still like working together. And Naoko and David, they are good mentors, so they not only support my research by providing expertise, but they are also senior scholars to give me advice about how to build my career and how to support me to lead a grant.
20:48 Voice Over:
The team has exciting ideas regarding future uses of smart speakers and virtual coaches for both physical and mental wellness. However, taking these applications to the next level requires a significant development investment and a lot more programming and infrastructure support. Here’s Dr. Quinn.
21:07 Dr. Quinn
Getting these devices in older people's homes is also an issue. We've increasingly found that because of the personalized nature of smart speakers, it’s much harder to get these things set up in people's homes in ways that are useful for researchers. We've had to provide Wi-Fi connections to participants because they don't have it. In fact, I had a participant contact me today because they had changed residences and they didn't have the other tools that are needed to get a smart speaker set up in their new residence. So he reached back out to me to say, “Can you help me with this?” And, of course, we're happy to do that. But these are the kind of everyday challenges that we face in deploying smart speakers on wide scale for physical health and activity.
Voice Over: Dr. Chin added
22:04 Dr. Chin
I will say in terms of bringing this to market there might be a long way to go. We have to make sure that technology is robust enough. But in terms of exploring how can we apply this kind of technology to research advance then definitely we can start exploring this space.
22:24 Dr. Quinn
So far the data’s come back and these devices have been very, very well received by older adults. They've been very well received, especially during the pandemic because it allowed the participants in our study to kind of engage in physical activity programs in ways that they were restricted from due to the social distancing requirements and things like that. So I do think that this is a really viable technology for older adults and deploying interventions. But as with all kinds of technology, there are limitations on our ability to deploy these because there are infrastructure needs that need to be present in order to deploy these devices. Right? You need a Wi-Fi connection first and foremost, but you also need- in our case- to have a Google account or if you are using an Amazon Echo, you'd need an Amazon account to use these devices. So these are the everyday hurdles that we're still working through and hope to kind of push us across the finish line for the next project to see how these can be used.
23:40 Voice Over:
Dr. Muramatsu shared her perspective on the technological barriers.
23:45 Dr. Muramatsu
There's a huge movement towards technology AI, but still there's this technology divide: racial and ethnicity barriers as well as language, age, or cohort. Older cohorts did not grow up with technology. And so we are working on very difficult populations. It is not easy to get data. And so, in a sense, all this technological development can actually potentially expand health inequity, and it takes time to adapt both this physical activity program, as well as this device to older adults, especially those people who are fail- that takes time. It may be difficult for people who are working with healthy populations with high tech knowledge and expertise, they may not see how challenging it is to actually make things work, and sometimes it is not a very lucrative area for researchers to get in. I really appreciate just the initiative to do this and stick to it. Even though it takes time. And so, I am very happy to be in this team and I'm learning a lot and that's really makes me really motivated to be part of this team.
25:08 Voice Over:
Given that the risk of frailty rises with age—from 4% of people ages 65-74 to 25% of people over 84- an awareness of the condition and its associated risks is key to maintaining good health as we age. Fortunately, translational researchers are working to apply the best evidence-based practice to new interventions and move them into the real world so they can benefit those who need them when and where they need them most. Here’s Dr. Marquez.
25:38 Dr. Marquez
I'm very happy to see that translational research has the place and presence that it does right now, in that science for science's sake, on some level, is nice. But the more we can help any individual - our parents, our siblings, our neighbors, you know, these people just us as everyday people. It's nice that the work will not just get published in a peer-reviewed journal article and then nobody has access to it. Right? It still happens, and we try not to let it happen, but to overcome that system that had been built it’s just really nice that we have the CCTS and different avenues and resources to help us make the research really applicable.
Voice Over: Dr. Muramatsu ended on this note.
26:31 Dr. Muramatsu
Personally I feel this is very, very important work because home bound, older people are probably the sickest population, especially in low resourced communities. And how to bring this health modeling activities is a real challenge and there are different ways to get there. I use home care workers who regularly visit older adults to deliver this program. This is a technology based one, which can be applied to larger populations without involving people, especially in the context of this pandemic. This is very, very important and promising, but the concept is simple. So when it comes to doing things, whether you use humans or technology, there are lots of things involved. And it takes time and it is important to understand all this and really work with communities because we need to work with older adults, we need to recruit them and how to approach them, how to approach these organizations who have access to populations that we are interested in. That involves lots of patience, collaboration, and, you know, really collaborative spirit and thoughts for others. So I think that is really critical. And without that, any research that involves interventions cannot work.
28:14 Voice Over Outro:
Collaborative Endeavors is produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois Chicago.
To learn more about the research discussed in this episode, visit the links in our show notes.
The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. Opinions expressed by guests of the show are their own and do not necessarily represent the views of myself, the CCTS or our funding agencies.
You can find more episodes of Collaborative Endeavors on Apple Podcasts, Spotify, Amazon Music & Google Podcasts. New episodes drop monthly. If you would like to see your interdisciplinary team featured on the podcast, reach out to me via the email address in the show notes.
To learn more about how you can get involved in health research, visit ccts.uic.edu or follow us on Twitter @UIC_CCTS.