# Locomotive Syndrome Digital Therapeutics Provided via a Smartphone App: Proof-of-Concept Single-Group Trial Study

## TL;DR

A smartphone app-based digital therapeutic improved mobility and physical function in middle-aged and older adults with locomotive syndrome over 8 weeks.

## Contribution

This study demonstrates the effectiveness of digital therapeutics in improving locomotive function in older adults.

## Key findings

- TUG scores improved significantly after 8 weeks of DTx intervention.
- GLFS-25 results showed significant improvement compared to baseline.
- No increase in exercise refusal or amotivation was observed during the study.

## Abstract

Individuals with locomotive syndrome (LS) have muscle weakness and reduced motor function due to musculoskeletal disorders that cause reduced mobility and physical function. In Japan, musculoskeletal disorders are the most common reason for requiring home support or nursing care, highlighting the need for preventing and ameliorating LS. Middle-aged and older adults sometimes encounter difficulty making a habit of exercise therapy (the mainstay of LS treatment).

We investigated whether digital therapeutics (DTx) can prevent or ameliorate LS in middle-aged and older adults.

We conducted a prospective, longitudinal, nonrandomized, single-group study of Japanese aged 40 years and older who were eligible for LS checkups (N=47). Each participant underwent an 8-week locomotion training intervention based on DTx supervised by medical staff. We objectively assessed the participants’ subjective and objective motor abilities and motor awareness with the Timed Up and Go (TUG) test, 25-question Geriatric Locomotive Function Scale (GLFS-25), and Behavioral Regulation in Exercise Questionnaire-3 at baseline (before the DTx), an interim point (4 wk after the DTx initiation), and a final evaluation (8 wk post-DTx initiation). We compared the scores of the 3 tests at the 3 time points as dependent variables in a 3-factor ANOVA with Bonferroni correction (significance defined as 0.05/3=0.0167).

No increase in amotivation to exercise or refusal to exercise was observed. Significant improvements at 8 weeks versus the baseline were observed in the TUG scores (baseline: 9.0, 95% CI 8.4‐9.6; 8 wk: 7.5, 95% CI 7.1‐8.0; P=.001) and GLFS-25 results (baseline: 18.7, 95% CI 14.5‐22.8; 8 wk: 11.7, 95% CI 8.8‐14.7; P=.004). The Behavioral Regulation in Exercise Questionnaire-3 and its subscale data did not differ significantly at any assessment time point.

These results indicate that an 8-week locomotive training intervention using DTx significantly improved middle-aged and older adults’ TUG and GLFS-25 scores and will help prevent and ameliorate LS and establish better exercise habits among them.