Assessing effectiveness of Weight loss and Exercise programs for older adults with Sarcopenic Obesity delivered via MobilE application/s

During the 24-week intervention period, all participants will follow the dietary intervention, and equal numbers will be randomised to either home-based Functional Intensity Training (FIT) or home-based aerobic exercise (control) as described below All participant’s diet will be modified by deducting 750 - 1000 kcal from their habitual intake, aiming for at least ~1.0 kg reduction in total body fat per week. Each participant will be oriented via an initial 30-40 minutes telephone consult by the study dietitian on how to quantify their intake using portion sizes and guides (i.e. balanced plate, household measures e.g. measuring cups and weight) and replacing energy-dense foods with those of lower energy density by tailoring their intake to reduce 2.1 MJ/day for a weight loss of 0.5-1kg per week. Appropriate dietary information will be selected by the dietitian using the clinician interface in Physitrack and individually broadcast to participants smart phone via the clinician interface in Physitrack at specified times throughout the day, using video demonstrations, and audio and written instructions designed by study investigators specifically for this study. Following each dietary advice, the Physitrack will broadcast questions to determine whether the participant adhered to the kilojoule reduction intervention. Participants’ responses to these questions will be recorded and saved to the Physitrack database, enabling the dietitian to review weekly and modify or progress the information as required. The study dietitian will also conduct follow up telephone interviews for 20 minutes once a fortnight for weeks 2, 4, 6 and 8, and reducing the follow up calls to monthly (weeks 12, 16 and 20) throughout the intervention to monitor and review dietary intakes and set behavioural goals. In total there will be 16 dietary videos, 1 initial phone consult and 7 follow up phone consults throughtout the intervention. Participants allocated to the FIT group in the present study will be given a structured 24-week, 30-minute, home-based FIT program delivered by a commercial telehealth platform Physitrack. However, each participant is also able to complete their exercise program at a local gymnasium at their own expense. All exercises will be individually-tailored and progressive, considering initial fitness, injuries or illness. Appropriate activities will be selected by the exercise physiologists using the clinician interface in Physitrack and individually broadcast to participants smart phone via the clinician interface in Physitrack at specified times throughout the day, using video demonstrations, and audio and written instructions designed by study investigators specifically for this study. Following each exercise, the Physitrack will broadcast questions to determine whether the participant completed the exercise, their self-perceived exertion, and any concerns (e.g. Pain, dizziness). Participants’ responses to these questions will be recorded and saved to the Physitrack database, enabling the exercise physiologist to review weekly and modify or progress exercise prescriptions as required. The prescribed exercise program will use body weight or additional resistance such as weight plates, dumbbells, theraband, weight vests etc if the participant has access to them unless contraindicated. In each session, participants will perform 1 set of 10 repetitions of five exercises (1 strength-focused, 1- balance-focused, and 3 impact-focused) at a low intensity of approximately 1-3 on the 10-point modified Rating of Perceived Exertion (RPE) scale to serve as a warm-up as required. Participants will be then required to perform 5 sets of 10-20 repetitions, at a moderate-intensity of approximately 4-6 on the 10-point modified Rating of Perceived Exertion (RPE) scale. Each participant will be encouraged to increase the load of all the prescribed exercises each session while maintaining the desired intensity if able. The protocol will initially deliver three exercise sessions per week for the first eight weeks of the intervention, four exercise sessions per week for the second eight weeks, and five exercise sessions per week for the final 8 weeks.