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(MRC CASE) Developing a web-based digital platform to encourage activity, healthy eating and hydration to promote healthy ageing in people over 70-years.

Faculty of Biology, Medicine and Health

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Dr E Stanmore , Dr S Burden No more applications being accepted Competition Funded PhD Project (European/UK Students Only)

About the Project

Background: There is strong evidence that strength and balance exercises reduce falls by up to 42% 1, 2 and that strength and balance exercise as a stand-alone intervention may be the most cost-effective approach to falls prevention at a population level. There has been some success demonstrated with Exergaming which are video games combining gameplay with physical exercise and may include virtual reality simulations. These Exergames may be a feasible option for older people to improve exercise uptake, challenge and progression 3. There is growing evidence that Exergaming may also improve function and adherence and provide other health outcomes4, 5 and that such technology-based approaches can be attractive to older people5. The advantages of using gaming systems to deliver exercise are that they can be immersive, entertaining and enjoyable, potentially improving adherence, frequency and duration of an interventional programme 6, 7. The gamified elements of Exergames (levels, points, progress) may also encourage uptake and adherence to exercise7. Although Exergaming is used and evaluated in exercise there is paucity of evidence in relation to using gamification to promote other healthy behaviours. From a recent James Lind Alliance priority setting partnership understanding good nutrition and hydration for older people and the communication of healthy eating messages to older people was in the top five research priorities8. Poor nutritional status in older people often leads to decreased functionality, weight loss, malnutrition and detrimentally effects independence 9. The proposed project plans to build upon the success of gamification in exercise and plans to incorporate healthy eating and hydration in a similar format to promote healthier behaviours not only on strength and balance exercises but also on food and hydration suitable for older populations.

Aim: To develop a platform using gamification and digital technology to promote activity, healthy eating and drinking in people over 70-years.

Vision of the Intervention: The intervention would focus on activity and how to incorporate strength and balance exercises into everyday tasks along with healthy eating and drinking. The healthy eating component would incorporate nutrition and hydration. It would look to develop health literacy games that would centre around hydration messages in drinking and quick checks to assess hydration status, which could be “what colour is your wee”. For nutrition it would look at basic assessment weight and height and body mass index with some simple questions to look for people who have lost weight, which may include are your trousers becoming lose? Have you found your skirts are too loose? Can you get more than three fingers in your shirt collar? Is your belt buckle moving up a couple of notches?
These key questions if answered would then lead on to sign posting to more formal assessment and encourage people to seek further advice. This would be combined with self-help information to eat a healthy diet and drink enough fluids using an engaging, interactive digital interface with gamification. Types of games could include what to put in your shopping bag, what’s good in your food cupboards, what is on your plate?
Developing the intervention: The development of the intervention will liaise and work in partnership with key stakeholders and also with end-users. Initial ideas and a story board will be discussed with key stakeholder and we will encourage an open debate of the key messages behind the games and key themes that need to be covered. This initial consultation material will be used to format a story board for the prototype. This story board will then be discussed in focus groups with up to ten participants in different locations in Greater Manchester. We will plan to run 3-4 focus groups with 8-10 people who will be either key stakeholders or potential end-users. From the information gained from the focus groups the prototype will be designed and produced in the form of a web-based application (accessible using tablet, mobile or computer).
The online application will then undergo preliminary evaluation by end-users who will be asked to undertake a formal assessment of the new technology, usability, acceptability and practicality of information gained. After this evaluation there will be an opportunity to modify the content and also change user experience as required. This will inform the methods for a future (post-doc) randomised controlled effectiveness study.

Entry requirements:Applications are invited from UK/EU nationals only. Applicants must have obtained, or be about to obtain, at least an upper second class honours degree (or equivalent) in a relevant subject.

Funding Notes

This is a CASE studentship in partnership with Reason Digital and will be funded under the MRC Doctoral Training Programme. If you are interested in this project, please make direct contact with the Supervisor to discuss the project further as soon as possible. You MUST also submit an online application form - full details on how to apply can be found here

As an equal opportunities institution we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.


1: Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012. DOI: 10.1002/14651858.CD007146.pub3.
2: Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine 2017; 51: 1750-1758. DOI: 10.1136/bjsports-2016-096547.
3: Vieira ER, Palmer RC and Chaves PH. Prevention of falls in older people living in the community. BMJ (Clinical research ed) 2016; 353: i1419. 2016/04/30. DOI: 10.1136/bmj.i1419.
4: Corbetta D, Imeri F and Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. Journal of physiotherapy 2015; 61: 117-124. 2015/06/22. DOI: 10.1016/j.jphys.2015.05.017.
5: Helbostad JL, Vereijken B, Becker C, et al. Mobile Health Applications to Promote Active and Healthy Ageing. Sensors 2017; 17: 622. 6: Meekes W and Stanmore EK. Motivational Determinants of Exergame Participation for Older People in Assisted Living Facilities: Mixed-Methods Study. Journal of medical Internet research 2017; 19: e238. 2017/07/08. DOI: 10.2196/jmir.6841.
7: Stanmore E, Mavroeidi A, Meekes W, et al. Exergames to reduce falls risk in older people in the K Innovation in Aging 2018; 2: 362-363. DOI: 10.1093/geroni/igy023.1340.
8: Jones DJ, Baldwin C, Lal S, et al. Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance. Journal of Human Nutrition and Dietetics 2020; 33: 274-283. DOI: 10.1111/jhn.12722.
9: Volkert D, Beck AM, Cederholm T, et al. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. Journal of clinical medicine 2019; 8 2019/07/07. DOI: 10.3390/jcm8070974.
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