More balance: development, validation, and usability of a mobile application to support home-based physical exercise in older adults (Preprint)

BACKGROUND The global aging population and the high incidence of falls among this population highlight the need for effective preventive strategies. Home-based exercise programs, such as the Otago protocol, have demonstrated efficacy in reducing fall risk but often face barriers related to user adherence. Mobile health (mHealth) applications offer promising tools to support health promotion and enhance autonomy in older adults. OBJECTIVE To develop and validate a prototype mobile application, Mais Equilíbrio (“More Balance”), designed to guide older adults in performing home-based physical exercises adapted from the Otago protocol. METHODS This methodological study was conducted in two phases: (1) Content validation by 22 experts in Physical Education and Physiotherapy using the Suitability Assessment of Materials (SAM) scale; and (2) Usability testing with 24 older aldults (aged 60 to 80 years), using the System Usability Scale (SUS). An overall score above 70% on the SAM and above 85 on the SUS were considered indicators of high quality and excellent usability, respectively. RESULTS The Mais Equilíbrio app was developed based on the Otago protocol and tailored for independent home use. A Content Validity Index (CVI) above 0.95 was observed for all items. An overall score of 81.20 (±15.78) on the SAM scale was found, classifying the material as “superior.” Usability tests with older adults showed an average score of 95.98 (±5.58) on the SUS, indicating excellent usability. The highest scores were observed in “ease of use” and “user confidence”. CONCLUSIONS The Mais Equilíbrio app has proven to be a valid and highly usable technological tool for guiding home-based physical exercises for older adults, with the potential to promote fall prevention and autonomy. Future studies should explore its effectiveness in long-term programs and its potential integration into clinical practice.