JMIR Aging Volume 1 (2018), Issue 2 ISSN: 2561-7605 Editor in Chief: Jing Wang, PhD, MPH, RN, FAAN Contents Original Papers Influence of Anthropometrics on Step-Rate Thresholds for Moderate and Vigorous Physical Activity in Older Adults: Scientific Modeling Study (e12363) Myles O©Brien, Matthew Kivell, William Wojcik, Ghislain D©Entremont, Derek Kimmerly, Jonathon Fowles. 3 When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults (e11955) Kathy VanRavenstein, Boyd Davis. 12 Understanding Care Navigation by Older Adults With Multimorbidity: Mixed-Methods Study Using Social Network and Framework Analyses (e11054) Jolien Vos, Kathrin Gerling, Conor Linehan, Aloysius Siriwardena, Karen Windle. 20 Association Between Advanced Care Management and Progression of Care Needs Level in Long-Term Care Recipients: Retrospective Cohort Study (e11117) Sakiko Itoh, Hiroyuki Hikichi, Hiroshi Murayama, Miho Ishimaru, Yasuko Ogata, Hideo Yasunaga. 31 Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study (e10975) Lauren Albrecht, Peter Wood, Miriam Fradette, Finlay McAlister, Doreen Rabi, Pierre Boulanger, Raj Padwal. 37 Ambient Assisted Living as Support for Aging in Place: Quantitative Users' Acceptance Study on Ultrasonic Whistles (e11825) Hannah Biermann, Julia Offermann-van Heek, Simon Himmel, Martina Ziefle. 47 A Groupware Tool to Facilitate Caregiving for Home-Dwelling Frail Older Persons in the Netherlands: Mixed-Methods Study (e10697) Hanneke Breebaart, Marjolein Broese van Groenou. 64 Informal Caregivers' Use of Internet-Based Health Resources: An Analysis of the Health Information National Trends Survey (e11051) Kelly Shaffer, Philip Chow, Wendy Cohn, Karen Ingersoll, Lee Ritterband. 75 Digital Media Recruitment for Fall Prevention Among Older Chinese-American Individuals: Observational, Cross-Sectional Study (e11772) Nikki Lam, Benjamin Woo. 88 A Fall Risk mHealth App for Older Adults: Development and Usability Study (e11569) Katherine Hsieh, Jason Fanning, Wendy Rogers, Tyler Wood, Jacob Sosnoff. 93 JMIR Aging 2018 | vol. 1 | iss. 2 | p.1 XSL·FO RenderX An Interactive Home-Based Cognitive-Motor Step Training Program to Reduce Fall Risk in Older Adults: Qualitative Descriptive Study of Older Adults' Experiences and Requirements (e11975) Trinidad Valenzuela, Husna Razee, Daniel Schoene, Stephen Lord, Kim Delbaere. 106 Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis (e10763) Darren Liu, Takashi Yamashita, Betty Burston. 123 Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study (e12178) Leanne Lefler, Sarah Rhoads, Melodee Harris, Ashley Funderburg, Sandra Lubin, Isis Martel, Jennifer Faulkner, Janet Rooker, Deborah Bell, Heather Marshall, Claudia Beverly. 135 Mobile Technology for Healthy Aging Among Older HIV-Positive Black Men Who Have Sex with Men: Qualitative Study (e11723) Judy Tan, Tung Nguyen, Alyssa Tabrisky, Robert Siedle-Khan, Anna Napoles. 155 Analyzing Twitter as a Platform for Alzheimer-Related Dementia Awareness: Thematic Analyses of Tweets (e11542) Tiffany Cheng, Lisa Liu, Benjamin Woo. 165 Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study (e10254) Stephen Agboola, Mariana Simons, Sara Golas, Jorn op den Buijs, Jennifer Felsted, Nils Fischer, Linda Schertzer, Allison Orenstein, Kamal Jethwani, Joseph Kvedar. 172 Testing a Photo Story Intervention in Paper Versus Electronic Tablet Format Compared to a Traditional Brochure Among Older Adults in Germany: Randomized Controlled Trial (e12145) Shu Tan, Amanda Whittal, Sonia Lippke. 184 Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search (e12274) Lori Wozney, Luciane Freitas de Souza, Emily Kervin, Francine Queluz, Patrick McGrath, Janice Keefe. 195 The Impact of the Virtual Cognitive Health Program on the Cognition and Mental Health of Older Adults: Pre-Post 12-Month Pilot Study (e12031) Shefali Kumar, Jennifer Tran, Heidi Moseson, Caroline Tai, Jordan Glenn, Erica Madero, Caitlyn Krebs, Nicholas Bott, Jessie Juusola. 205 Feasibility and Conceptualization of an e-Mental Health Treatment for Depression in Older Adults: Mixed-Methods Study (e10973) Christiane Eichenberg, Markus Schott, Adam Sawyer, Georg Aumayr, Manuela Plöûnig. 220 Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey (e4) Callum Cruickshank, Donald MacIntyre. 230 JMIR Aging 2018 | vol. 1 | iss. 2 | p.2 XSL·FO RenderX JMIR AGING O©Brien et al Original Paper Influence of Anthropometrics on Step-Rate Thresholds for Moderate and Vigorous Physical Activity in Older Adults: Scientific Modeling Study Myles William O©Brien1,2, MSc; Matthew Jordan Kivell1, BKinH; William Robert Wojcik1, BKinH; Ghislain Richard D©Entremont2, MSc; Derek Stephen Kimmerly2, PhD; Jonathon Richard Fowles1, PhD 1Centre of Lifestyle Studies, School of Kinesiology, Acadia University, Wolfville, NS, Canada 2Division of Kinesiology, Dalhousie University, Halifax, NS, Canada Corresponding Author: Jonathon Richard Fowles, PhD Centre of Lifestyle Studies School of Kinesiology Acadia University 550 Main Street Wolfville, NS, Canada Phone: 1 902 585 1560 Email: [email protected] Abstract Background: Adults and older adults are recommended to engage in 150 minutes of moderate (MPA) to vigorous (VPA) aerobic physical activity (MVPA) per week, with the heuristic message of 3000 steps in 30 minutes (100 steps per minute [spm]). However, this message is based on adult populations, with a paucity of research on step-rate thresholds that correspond to absolute MVPA (moderate=3 metabolic equivalents [METs], vigorous=6 METs) and relative MVPA (moderate=40% estimated METmax, vigorous=60% estimated METmax) in older persons, who have lower stride lengths and a lower exercise capacity. Also, there is a need to consider the influence of anthropometric differences when quantifying the relationship between step rate and intensity-related physical activity. Objective: This study assessed absolute and relative MVPA step-rate thresholds and anthropometric factors (ie, height, leg length, and body mass index [BMI]) in older adults. Methods: Nineteen older adults (7 females; age 69 years, SD 2, BMI 26 kg/m2, SD 4) completed a staged treadmill walking protocol: six minutes at 2.4, 3.2, 4.0, 5.6, and 6.4 km/h. Steps were manually counted and volume rate of oxygen consumed (VO2) was measured via indirect calorimetry. Aerobic fitness was estimated via the submaximal single-stage treadmill protocol. Results: When BMI was considered, mixed effects modeling revealed absolute and relative MPA step-rate thresholds of 108 spm and 117 spm, respectively. Absolute and relative VPA corresponded to step rates of 135 spm and 132 spm, respectively. Neither height nor leg length improved the ability of the model to predict stepping cadence from METs. Conclusions: In general, older adults need to walk faster than 100 spm (ie, approximately 110 spm) to reach MPA and in excess of approximately 130 spm to achieve VPA, depending on BMI status. Health care professionals and researchers should adjust cadence-based recommendations for differences in BMI in their older patients and consider using relative intensity to most appropriately tailor their physical activity recommendations. (JMIR Aging 2018;1(2):e12363) doi:10.2196/12363 KEYWORDS aging; walking; public health; cadence; physical activity intensity http://aging.jmir.org/2018/2/e12363/ JMIR Aging 2018 | vol. 1 | iss. 2 | e12363 | p.3 (page number not for citation purposes) XSL·FO RenderX JMIR AGING O©Brien et al Given the disagreement in the current literature regarding Introduction appropriate MPA step cadences for older persons as well as the Leading a physically active lifestyle is associated with numerous lack of consideration for VPA, there is a need to investigate health benefits among older adults that include improved step-rate recommendations for both absolute and relative MPA cardiovascular and metabolic health and a reduction in all-cause and VPA in an aged population. Therefore, the purpose of this mortality [1-3]. When objectively measured, only 12% of study was to use mathematical modeling with anthropometric Canadian older persons achieve the national physical activity factors as predictor variables to calculate older adults' guidelines that recommend 150 minutes of moderate-to-vigorous individualized step rate. Using these models, we will determine aerobic physical activity (MVPA) per week [4]. Older adults step-rate thresholds that define both absolute and relative MPA report walking as the most common form of physical activity and VPA in our sample of older adults. [5], with research showing that MVPA is attainable in this population [6]. Methods Initially, 3000 steps in 30 minutes (or 100 steps per minute Demographics [spm]) has been proposed as a heuristic cadence-based Nineteen older adults (7 females) aged mean 68.8 (SD 2.3; recommendation to achieve moderate-intensity physical activity 65-74) years volunteered to participate in this study. All (MPA) (3 metabolic equivalents [METs]) in adults [7]. More participants were initially screened for age (over 65 years) and recent studies