Can a Virtual “Health Coach” Increase Physical Activity among Older Adults?

In the United States and many other parts of the world, all age groups show levels of physical activity below that which is medically recommended. While increased physical activity appears to be extremely effective toward improving health and overall well-being among older adults, it is difficult for inactive individuals to increase their levels of activity. Toward addressing this difficulty, a group of researchers examined the effectiveness of a computer-based physical activity program in encouraging sedentary older adults to spend more time walking. Such computer-based programs might be particularly helpful for older adults who do not have access to community exercise programs, or who otherwise find such programs unsuitable. The study found that the virtual “health coach” led to a short-term increase in physical activity (as measured by number of steps taken) in participants with adequate health literacy, while participants with low health literacy did not experience significant benefits.

Researchers recruited 263 older adult participants from outpatient medical clinics in the Boston area. To be included in the study, participants had to be age 65 or better, English-speaking, free of any medical conditions that would make a walking program unsafe, not engaged in regular physical activity, and without significant symptoms of depression or cognitive impairment. Participants were also assessed on their walking ability and health literacy. Participants were assigned to either the computer-based program (called Embodied Conversational Agent, or ECA) or a control group.

In the ECA group, participants were given tablet computers on which the ECA “exercise coach” was installed to take home and use for two months. The ECA involved an animated, onscreen character that conversationally prompted users to input information (via touchscreen) about their activities and how they were feeling, and provided daily exercise tips as well as general encouragement toward participants’ walking goals. This two-month period was followed by a 10-month period during which participants had access to the ECA program on a computer in the clinic from which they were recruited. Both the ECA and the control group were given pedometers that recorded their monthly step counts at the end of the initial two months, during which the ECA group had their take-home tablets, and after the 10-month follow-up period during which ECA participants had access to in-clinic ECA computers.

Participants in the ECA group reported high levels of satisfaction with the system, and tended to use the program regularly, though usage decreased after the first week, from an average of 4.7 times per week to an average of 3.3 times per week at the end of the two-month in-home period. Participation was much lower during the clinical-based portion, with most participants using the clinic ECA computers on three or fewer occasions over the 10 months.

Participants in the ECA with high health literacy walked significantly more than those in the high-literacy control group at both two and 12 months, while there was no difference between the ECA and control groups among those with low health literacy. These findings highlight the difficulty in engaging older adults with low health literacy in preventive behavior, but suggest the potential of automated, computer-based exercise promotion for sedentary older adults.


Bickmore TW, Silliman RA, Nelson K, et al. A randomized controlled trial of an automated exercise coach for older adults. Journal of the American Geriatric Society. (2013). DOI: 10.1111/jgs.12449



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