Intelligent health promotion system-based construction and implementation of exercise intervention for older adults with frailty and prefrailty.

Background: Frailty in the elderly population is increasing, and the development of high-quality clinical practice guidelines or consensuses can guide medical staff to better provide health services for frail elderly individuals. In recent years, scholars at home and abroad have actively explored exercise intervention management in elderly individuals with frailty or prefrailty. How to rapidly generalize interventions with "known and definite effects" for the community-dwelling frail elderly population is the core issue of the research on frailty. There is a lack of study regarding whether digital interventions can improve exercise adherence for older adults with frailty and prefrailty. Objective: In accordance with the Comprehensive Framework for Implementation Research (CFIR), this study implemented scientific strategies for exercise interventions for elderly people with community frailty and prefrailty. Empirical research was conducted via the cloud platform of the home‒community integration system to provide a theoretical basis for improving the physical, psychological and social frailty of frail elderly people and reducing the incidence of adverse outcomes caused by frailty in the community. Methods: Qualitative and quantitative research methods were fully integrated. Semistructured interviews were conducted with 64 older adults who designated family doctors and 44 community workers in the community to identify the regular exercise adherence of frail or prefrail older adults as well as the promoting and hindering factors of community workers in the implementation of scientific exercise interventions. Following the guidance of the Comprehensive Framework for Implementation Research (CFIR), scientific exercise intervention strategies for frail elderly people in the community were implemented. The control group received routine nursing, and the intervention group received a scientific nursing intervention. After 3 months of intervention, the effects of the strategy on implementation outcomes (feasibility, acceptability, fidelity, etc.), intervention outcomes (physical function, emotional state, social support, self-efficacy), process outcomes (skills or cognition), and resource utilization in older adults with frailty or prefrailty were evaluated. Results: In the qualitative interviews conducted with CFIR as the theoretical guiding framework, a total of 22 influencing factors, 12 promoting factors and 10 hindering factors in 4 areas were identified to construct scientific strategies for implementation。The implementation results revealed that the feasibility (P = 0.003), acceptability (P = 0.002) and fidelity (P = 0.001) of the intervention group were significantly better than those of the control group. The intervention results revealed that, compared with those in the control group, physical fitness (gait: P = 0.016; balance: P < 0.001; grip strength: P < 0.001; body fat percentage: P < 0.001), depression (P < 0.001), social support (P < 0.001), and self-efficacy (P < 0.001) significantly improved Conclusion: Guided by the implementation of the scientific theoretical framework, this study used a whole-process, systematic, diversified and scientific online and offline joint exercise implementation strategy, proving that the strategy can be used to create a safe, effective and sustainable exercise intervention for frail or prefrail elderly individuals in the community that effectively improves their physical fitness, depression, social support and self-efficacy, delays the progression of frailty, and reduces the incidence of adverse outcomes such as disability, falls, hospitalizations and even death.