Importance:A majority of men with prostate cancer have low-grade cancer and an excellent prognosis after radical prostatectomy. Hypogonadism and associated symptoms impair quality of life in prostate cancer survivors. Many guidelines, citing a lack of randomized clinical trials showing safety and efficacy of testosterone replacement therapy (TRT), consider a history of prostate cancer a contraindication for TRT. Objective:To evaluate the short-term safety and efficacy of TRT in prostate cancer survivors with symptomatic hypogonadism. Design, Setting, and Participants:This randomized, placebo-controlled, double-blind, parallel-group, phase 2 trial was conducted at 2 academic medical centers in men 40 years and older with organ-confined, low-grade prostate cancer (Gleason score of 6 [3 + 3] or 7 [3 + 4]). Participants had undetectable prostate-specific antigen (PSA) for at least 2 years after radical prostatectomy, a mean of 2 testosterone levels less than 275 ng/dL, and low libido, erectile dysfunction, or fatigue. Patients were allocated using concealed, block randomization, with stratification for age (40-60 years or >60 years) and phosphodiesterase-5 inhibitor (PDE5I) use. The first participant was randomized on May 13, 2019, and the last study visit was completed on May 16, 2025. Intervention:Testosterone cypionate, 100 mg, or placebo intramuscularly weekly for 12 weeks. Main Outcomes and Measures:The primary efficacy outcome was sexual activity. Secondary outcomes included sexual desire, erectile function, well-being, body composition, aerobic capacity, and physical function. The safety outcome was biochemical recurrence (PSA ≥ 0.2 ng/mL). Results:A total of 136 men were randomized, 68 to receive testosterone cypionate, 100 mg, and 68 to receive placebo, and 125 men completed the study. Groups were similar at baseline (mean [SD] age, 68.6 [6.5] years; 52 [38%] had a Gleason score of 6; and 84 [62%] had a Gleason score of 7). No participant in either group experienced biochemical recurrence. TRT significantly increased sexual activity more than placebo, adjusted for PDE5I use and age (between-group difference, 0.91 daily events [95% CI, 0.56-1.26]; P < .001). TRT increased sexual desire and prostate cancer quality-of-life sexual domain score, and decreased negative affect more than placebo. Erectile function did not change. TRT significantly improved body composition, loaded stair-climbing power, and peak aerobic performance (VO2 peak) compared with placebo. Conclusions and Relevance:In this randomized clinical trial, TRT for 12 weeks in men treated with radical prostatectomy for low-grade prostate cancer significantly improved sexual activity, sexual desire, well-being, body composition, physical function, and aerobic performance compared to placebo without biochemical recurrence. The trial was neither long enough nor large enough to evaluate clinical recurrence or long-term safety; this proof-of-concept trial was essential for rationalizing a larger, long-term study. These findings do not apply to men with high-grade prostate cancer or those treated with androgen deprivation therapy or radiation therapy. Trial Registration:ClinicalTrials.gov Identifier: NCT03716739.

CONTEXT:Spinal cord injury (SCI) leads to profound muscle atrophy, aerobic deconditioning, and metabolic dysfunction. Exercise-based interventions alone produce modest benefits. Whether testosterone can augment physiologic responses to exercise in this population remains untested. OBJECTIVE:To evaluate efficacy and safety of home-based intervention combining functional electrical stimulation-assisted leg cycling (FES-LC), arm ergometry (AE) and testosterone compared with FES-LC, AE plus placebo in adults with SCI. METHODS:This randomized, placebo-controlled, double-blind trial enrolled 84 adults (76 males and 8 females) aged 19-70 years with SCI (neurologic levels C4-T12; AIS grades A-D). Participants were randomized to multimodality intervention (home-based FES-LC, AE and intramuscular testosterone undecanoate) (n=38) or control intervention (FES-LC, AE plus placebo) (n=46) for 16 weeks. The primary outcome was change in aerobic capacity (peak VO2) during AE cardiopulmonary exercise testing. Secondary outcomes included lean mass, hemoglobin, cardiometabolic markers and safety. RESULTS:Mean (SD) age was 44 (13) yrs and time since injury was 13.9 (13) years). Between-group changes in peak VO2 were not statistically significant. Within-group improvements were larger in multimodality (∼19% increase; 0.10 L/min; 95% CI, 0.02-0.18 L/min) compared to controls (∼6% increase; 0.06 L/min; 95% CI, -0.01-0.13). The multimodality group gained significantly more lean mass (whole-body:1.84 kg, 95% CI: 0.52-3.16, P =.007; lower extremity 0.92 kg, 95% CI: 0.38-1.45, P =.001), and anemia was corrected in a greater proportion of participants. Adverse event rates were similar between groups. CONCLUSIONS:A home-based multimodality intervention combining FES-LC, AE, and testosterone was safe and associated with greater improvements in lean mass and hemoglobin. Although between-group differences in aerobic capacity were not statistically significant, greater within-group increases were observed in the multimodality group. These findings may inform future studies of testosterone-augmented exercise interventions for individuals living with SCI.

Introduction:Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and kidney failure worldwide. Reduced nicotinamide adenine dinucleotide (NAD) levels are mechanistically linked to DKD pathogenesis; and NAD augmentation by administration of its precursor, nicotinamide mononucleotide (NMN), has attenuated albuminuria and kidney injury in preclinical models. Methods:The NAD Augmentation in Diabetic Kidney Disease (NAD in DKD) trial is a phase 2a, randomized, multicenter, double-blind, placebo-controlled, parallel-group study evaluating the efficacy and safety of oral pharmaceutical-grade microcrystalline β-NMN (MIB-626) in adults with DKD. One hundred fifty-six participants aged ≥ 30 years with diabetes, urinary albumin-to-creatinine ratio (UACR) ≥ 100 mg/g, and estimated glomerular filtration rate (eGFR) > 25 ml/min per 1.73 m2 were randomized to receive MIB-626 (1000 mg twice daily) or placebo for 24 weeks, followed by 12 weeks of postintervention follow-up. The randomization was stratified for biological sex, age (30-44, 45-65, and ≥ 66 years), and enrolling site. The primary end point was change in UACR from baseline to 24 weeks. Secondary outcomes included serum creatinine, cystatin C, and eGFR, biomarkers of kidney injury and biological age, glycemic control, measures of muscle performance and physical function, and the circulating NAD metabolome. Conclusion:This phase 2a trial was designed to evaluate the safety and efficacy of NAD augmentation in improving UACR in albuminuric DKD. The results will inform whether NAD augmentation warrants further evaluation in larger trials statistically powered for long-term kidney outcomes. The study is registered at ClinicalTrials.gov (NCT05759468).

Physical activity (PA) is indispensable for overall health. Sub-optimal PA is linked to reduced quality of life (QOL) and premature death. In clinical research and therapeutics development, defining aspects of PA that are meaningful to patients and care providers is essential for designing tailored interventions, identifying individual contextual factors, and enhancing patient satisfaction and engagement in their own well-being. As digital health technologies (DHTs) measuring PA rapidly evolve, there is an opportunity to further define concepts. A systematic review of qualitative studies to identify concepts of PA that are meaningful to patients and care providers was conducted. Conditions covered included Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, cancer, Duchenne muscular dystrophy, chronic heart failure, sickle cell disease, osteoarthritis, and sarcopenia. We analyzed studies published in the last 20 years utilizing qualitative or mixed methods techniques to describe aspects of PA that patients want to prevent from worsening or improve. Among the 5228 articles returned, 105 studies were included. Thematic synthesis revealed five meaningful aspects of health (MAH) related to PA: ambulation-dependent activities, balance-dependent activities, activities needing upper limb function, changing body positions, and participating in activities of different intensities. Patients also reported PA as important to QOL and influenced by internal and external facilitators and barriers. This research presents new findings related to PA MAHs across various therapeutic areas, which go beyond walking. The findings provide a foundation for defining concepts of interest, measures, and endpoints, with applications in clinical research and care, including patient-focused development of digitally derived measures.

Indroduction:Bioelectrical Impedance Analysis (BIA) is a widely used method to assess body composition. Traditional BIA models use predictive equations without considering individual characteristics such as age, sex, and activity level. Classic Bioelectrical Impedance Vector Analysis (BIVA) standardizes raw BIA data by height, while specific BIVA (spBIVA) normalizes by body segment areas and lengths, offering a potentially more accurate assessment. With aging populations, there is growing interest in assessing age-related body composition changes - especially sarcopenia, characterized by reduced muscle mass and function. While BIVA is promising for such assessments, limited studies compare classic and specific BIVA approaches in older adults based on physical activity and muscle strength. Thus, the objective of the study is to compare classic and specific BIVA values in older adults according to their physical activity level and muscle strength. Methods:This cross-sectional study involved 187 community-dwelling older adults (143 women and 44 men, ≥60 years), recruited via public advertisements. Exclusion criteria included medical conditions affecting muscle mass. The Assessments included: Anthropometry (weight, height, BMI, waist, arm and calf circumferences); BIA (resistance - R, reactance - Xc, and phase angle - PhA), measured using a 50 kHz analyzer (classic BIVA was normalized by height and specific BIVA by segmental area/length using upper arm); physical activity (measured using the Baecke Habitual Physical Activity Questionnaire); muscle strength (measured by handgrip dynamometry, cut-off values <27 kg for men and <16 kg for women indicated low strength). For the statistical analyses, differences in BIVA parameters were evaluated using Hotelling's T2 test and Mahalanobis D distances (p < 0.05). Results:Men had significantly higher body weight, height, waist circumference, and handgrip strength (p < 0.05). Classic BIVA consistently showed higher values of R and Xc than specific BIVA (differences up to 30%). PhA was higher in men, especially due to lower resistance values. Among women, those with higher physical activity levels had significantly higher PhA, indicating better cellular health. Among men, no significant differences in PhA were observed between activity levels. For muscle strength, stronger men had higher PhA values and significant vector displacement in both models; women did not show significant differences by strength level. Discussion and Conclusion:Both classic and specific BIVA approaches identified differences in impedance parameters related to physical activity and strength. Classic BIVA tends to overestimate resistance and reactance due to height normalization, while specific BIVA, using body segments, may better reflect individual morphological characteristics.

The increasing prevalence of obesity among older adults is a significant clinical and public health challenge. In this population, obesity contributes to numerous chronic diseases, functional decline and elevated mortality. This growing concern highlights the urgent need for more effective weight management strategies for older adults. Pharmacologic treatments, particularly GLP-1 receptor agonists and dual agonists, have emerged as promising treatments for weight loss, but their effects remain understudied in older adults. In this article, we discuss the potential musculoskeletal implications associated with the use of weight loss pharmacotherapy among older adults. We emphasize the consequences of lean mass loss, particularly the loss of skeletal muscle mass, which represents a critical determinant of ambulation, physical function and major regulator of metabolic health in older adults. We also describe the adverse risks of weight regain and weight cycling, and the significance of lean mass preservation during weight loss for older individuals. Finally, we identify knowledge gaps associated with safe and effective obesity pharmacotherapy in older adults and emphasize the potential benefits of combining GLP-1 therapies with promyogenic agents, structured exercise, and targeted nutritional interventions for optimizing weight loss quality in this population. These integrated approaches merit further investigation in clinical trials to determine their synergist effects for enhancing body composition while promoting independence, vitality and wellbeing in older adults undergoing pharmacologic weight loss.

Falls are a common public health problem; one-third of individuals 65-years or older fall annually. A digitally delivered home exercise program could be an effective way to deliver fall prevention interventions to at-risk older adults. The aim of this study was to explore the experiences and perceptions of at-risk older adults enrolled in a 12-week digitally delivered home-based fall prevention exercise program. Semi-structured interviews ( N = 16) were conducted by a user-experience specialist (75% female, age 77.3 years). Participants reported that the program increased exercise intensity and introduced new exercises, such as balance training. Participants highlighted the exercise physiologist motivational coach as a fundamental element of the program to support motivation and adherence. Recommendations for the exercise program included more variety of exercises, individualization of the exercise program, and live virtual interactions. This qualitative analysis provides insight into the acceptability of a digital fall prevention exercise intervention through participant feedback and perception.

BACKGROUND:Androgen deprivation therapy (ADT) in prostate cancer (PCa) has been associated with development of insulin resistance. However, the predominant site of insulin resistance remains unclear. METHODS:The ADT & Metabolism Study was a single-center, 24-week, prospective observational study that enrolled ADT-naive men without diabetes who were starting ADT for at least 24 weeks (ADT group, n = 42). The control group comprised men without diabetes with prior history of PCa who were in remission after prostatectomy (non-ADT group, n = 23). Prevalent diabetes mellitus was excluded in both groups using all three laboratory criteria defined in the American Diabetes Association guidelines. All participants were eugonadal at enrollment. The primary outcome was to elucidate the predominant site of insulin resistance (liver or skeletal muscle). Secondary outcomes included assessments of body composition, and hepatic and intramyocellular fat. Outcomes were assessed at baseline, 12, and 24 weeks. RESULTS:At 24 weeks, there was no change in hepatic (1.2; 95% confidence interval [CI], -2.10 to 4.43; p = .47) or skeletal muscle (-3.2; 95% CI, -7.07 to 0.66; p = .10) insulin resistance in the ADT group. No increase in hepatic or intramyocellular fat deposition or worsening of glucose was seen. These changes were mirrored by those observed in the non-ADT group. Men undergoing ADT gained 3.7 kg of fat mass. CONCLUSIONS:In men with PCa and no diabetes, 24 weeks of ADT did not change insulin resistance despite adverse body composition changes. These findings should be reassuring for treating physicians and for patients who are being considered for short-term ADT.

BACKGROUND:Falls are a leading cause of disability, institutionalization and mortality for older adults. More effective strategies to prevent falls are essential and may help at-risk older adults continue to live independently. While exercise programs with in-person supervision reduce fall risk, there are numerous barriers associated with older adults' participation in such programs. Digitally delivered exercise interventions utilizing wearable technology may be an alternative fall prevention strategy for many vulnerable older adults. OBJECTIVES:To evaluate the feasibility of a scalable, multicomponent, remotely delivered, digital fall prevention exercise intervention for community-dwelling older adults with elevated fall risk. DESIGN:This single arm intervention trial enrolled older adults who reported ≥ 2 falls, or ≥ 1 injurious fall in the past year, or fear of falling. STUDY SETTING AND PARTICIPANTS:Community-dwelling adults aged ≥ 65 years were recruited from the greater Boston region, MA, USA. INTERVENTION:The 12-week multicomponent intervention was delivered via tablet and wearable sensors and consisted of a program of progressive moderate-intensity strength, power and balance training, adaptive aerobic walking exercise, regular coaching calls and digital motivational messaging. MEASUREMENTS:Intervention adherence and measures of intervention feasibility, acceptability, and appropriateness were evaluated. Intervention effects on measures of fall risk, physical and cognitive performance, and other measures of well-being were also examined. RESULTS:Twenty-three participants enrolled in the study and 20 completed the intervention (mean age: 76.3±5.5 yrs; BMI: 26.9±4.6 kg/m2; short physical performance battery score: 8.8±2.2; 70% female). Overall adherence rates were 84.4±14.6% with no serious adverse events. Significant reductions in fear of falling and improvements in cognition and technology readiness were elicited (p≤0.04). CONCLUSION:This study has demonstrated the feasibility of a multicomponent digital fall prevention exercise intervention for at-risk older adults. Additional studies are warranted to establish the efficacy of this highly scalable fall prevention strategy.

Spinal cord injury is associated with skeletal unloading, sedentary behavior, decreases in skeletal muscle mass, and exercise intolerance, which results in rapid and severe bone loss. To date, monotherapy with physical interventions such as weight-bearing in standing frames, computer-controlled electrically stimulated cycling and ambulation exercise, and low-intensity vibration are unsuccessful in maintaining bone density after SCI. Strategies to maintain bone density with commonly used osteoporosis medications also fail to provide a significant clinical benefit, potentially due to a unique pathology of bone deterioration in SCI. In this review, the available data is discussed on evaluating and monitoring bone loss, fracture, and physical and pharmacological therapeutic approaches to SCI-associated disease of the skeleton. The treatment of SCI-associated disease of the skeleton, the implications for clinical management, and areas of need are considered for future investigation.

Motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by subjective memory complaints and gait impairments that may be related to lower prefrontal cortex (PFC) function. Acute bouts of aerobic exercise are shown to improve PFC function, however, the acute effects of exercise on PFC oxygenation have not yet been examined in MCR. This study aims to characterize the PFC oxygenation responses during acute exercise in older adults with MCR. Nineteen older adults with MCR performed a submaximal cycling exercise protocol. Functional near-infrared spectroscopy (fNIRS) is used to measure concentrations of oxygenated (OxyHb) and deoxygenated (DeoxyHb) hemoglobin from the PFC. There is a trend for increased OxyHb concentrations and decreased DeooxyHb concentrations during exercise. Exercise also induced significant increases in ratings of perceived exertion (RPEs) and heart rate. A significant, positive correlation between PFC OxyHb and RPEs during the cycling exercise are also observed. The findings reveal that PFC oxygenation increases during exercise in an intensity-dependent manner and the subjective perception of exertion is associated with the magnitude of PFC oxygenation. These results suggest that moderate-intensity cycling exercise may have beneficial effects on increasing cerebral blood flow in the PFC of older adults with MCR.

The motoric cognitive risk syndrome (MCR) is a syndrome characterized by subjective memory complaints and slow walking speeds that can identify older adults at increased risk for developing Alzheimer’s disease or a related dementia (ADRD). To date, the feasibility of community-based physical activity (PA) programs for improving outcomes in MCR have yet to be examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) comparing 24-weeks of PA to a healthy aging education (HE) control intervention delivered within the infrastructure of an urban senior center in Greater Boston (clincaltrials.gov identifier: NCT03750682). An existing senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit, of whom 29 met the MCR criteria and 25 were randomized to PA or HE (mean age: 74.4 ± 7 years; BMI: 32.4 ± 7 kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1 m/s; SPPB score 4.8 ± 1.9). Due to the Covid-19 pandemic the study was stopped prematurely. Participants could successfully adhere to the study interventions (overall attendance rate: PA: 69% vs. HE:70% at study termination). Participants also successfully completed baseline and follow-up study assessments that included a computerized cognitive testing battery and objective tests of physical performance and functional exercise capacity. No study-related adverse events occurred. Notable trends for improved cognitive performance, gait speed and 6-min walk distance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs of PA that may help to preserve the independence of vulnerable older adults at high risk for ADRD in community-based settings.

CONTEXT:People living with spinal cord injury (SCI) are at high risk for bone fractures. Neural, hormonal and metabolic contributors to bone microarchitectural alterations are incompletely understood. OBJECTIVE:To determine the relationship of physical, metabolic and endocrine characteristics with bone microarchitecture, characterized using high-resolution peripheral quantitative computed tomography (HRpQCT) in SCI. DESIGN:Cross-sectional analyses of bone properties in people with SCI. PARTICIPANTS:Twenty adults with SCI and paraplegia (12) or motor incomplete quadriplegia (8). OUTCOME MEASURES:Distal tibia and radius HRpQCT parameters, including density, microstructure and strength by microfinite element anaysis (μFEA); sex hormones; metabolic and inflammatory markers. RESULTS:The mean age of the participants with SCI was 41.5 ± 10.3 years, BMI 25.7 ± 6.2 kg/m2, time since injury 10.4 ± 9.0 years. Participants with SCI had significantly lower median total (Z score - 3.3), trabecular (-2.93), and cortical vBMD (-1.87), and Failure Load by μFEA (-2.48) at the tibia than controls. However, radius vBMD, aBMD and microarchitecture were similar in participants with SCI and un-injured controls. Unexpectedly, C-Reactive Protein (CRP) was positively associated with tibial trabecular vBMD (β = 0.77, p = 0.02), thickness (β = 0.52, p = 0.04) and number (β = 0.92, p = 0.02). At the radius, estradiol level was positively associated with total vBMD (β = 0.59, p = 0.01), trabecular thickness (β = 0.43, p = 0.04), cortical thickness (β = 0.63, p = 0.01) and cortical porosity (β = 0.74 p = 0.04). CONCLUSIONS:Radius vBMD and microarchitecture is preserved but tibial total, cortical and trabecular vBMD, and estimated bone strength are markedly lower and bone microarchitectural parameters substantially degraded in people with SCI. The alterations in bone microarchitecture in people with SCI are likely multifactorial, however marked degradation of bone microarchitecture in tibia but not radius suggests that unloading is an important contributor of site-specific alterations of bone microarchitecture after SCI. Fracture prevention in SCI should focus on strategies to safely increase bone loading. CLINICALTRIALS:gov registration #: (NCT03576001).

Drs. Reid and Storer report no conflicts of interest. Dr. Bhasin reports receiving research grant support from AbbVie, Transition Therapeutics, FPT, and Metro International Biotechnology, Inc. and has received consulting fees from OPKO Pharmaceuticals and POXEL, Inc, and has equity interest in FPT, LLC and Xyone Therapeutics.

Abstract In cancer cachexia trials, measures of physical function are commonly used as endpoints. For drug trials to obtain regulatory approval, efficacy in physical function endpoints may be needed alongside other measures. However, it is not clear which physical function endpoints should be used. The aim of this systematic review was to assess the frequency and diversity of physical function endpoints in cancer cachexia trials. Following a comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990–2021), records were retrieved. Eligible trials met the following criteria: adults (≥18 years), controlled design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a physical function endpoint. Physical function measures were classified as an objective measure (hand grip strength [HGS], stair climb power [SCP], timed up and go [TUG] test, 6‐min walking test [6MWT] and short physical performance battery [SPPB]), clinician assessment of function (Karnofsky Performance Status [KPS] or Eastern Cooperative Oncology Group‐Performance Status [ECOG‐PS]) or patient‐reported outcomes (physical function subscale of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaires [EORTC QLQ‐C30 or C15]). Data extraction was performed using Covidence and followed PRISMA guidance (PROSPERO registration: CRD42022276710). A total of 5975 potential studies were examined and 71 were eligible. Pharmacological interventions were assessed in 38 trials (54%). Of these, 11 (29%, n = 1184) examined megestrol and 5 (13%, n = 1928) examined anamorelin; nutritional interventions were assessed in 21 trials (30%); and exercise‐based interventions were assessed in 6 trials (8%). The remaining six trials (8%) assessed multimodal interventions. Among the objective measures of physical function (assessed as primary or secondary endpoints), HGS was most commonly examined (33 trials, n = 5081) and demonstrated a statistically significant finding in 12 (36%) trials (n = 2091). The 6MWT was assessed in 12 trials (n = 1074) and was statistically significant in 4 (33%) trials (n = 403), whereas SCP, TUG and SPPB were each assessed in 3 trials. KPS was more commonly assessed than the newer ECOG‐PS (16 vs. 9 trials), and patient‐reported EORTC QLQ‐C30 physical function was reported in 25 trials. HGS is the most commonly used physical function endpoint in cancer cachexia clinical trials. However, heterogeneity in study design, populations, intervention and endpoint selection make it difficult to comment on the optimal endpoint and how to measure this. We offer several recommendations/considerations to improve the design of future clinical trials in cancer cachexia.

EDITORIAL article Front. Aging, 22 December 2023Sec. Musculoskeletal Aging Volume 4 - 2023 | https://doi.org/10.3389/fragi.2023.1347674

We used qualitative methods to better understand wearable activity monitor (WAM) use and its relationship with physical activity (PA) among older adults. Four focus groups, stratified by current/past (“ever”) WAM users and “never” WAM users, were conducted with 57 participants aged ≥60 years. Data were coded with deductive and inductive approaches. Among ever WAM users, those with low pre-WAM PA levels reported higher PA related to WAM use while those with high pre-WAM PA levels reported they used WAM for tracking and monitoring their activity. Ever WAM users were motivated to increase PA through rewards and social support. Many never WAM users reported that WAM was unnecessary. WAM may be helpful for some older adults to increase their PA, particularly those who are motivated by setting and achieving PA goals. The results could help develop strategies to overcome barriers to WAM adoption and promote WAM use among older adults.

Abstract Falls are a significant public health problem; one third of individuals aged 65 years or older fall each year. Strength and balance exercises reduce fall risk, but most older adults are inactive. Individuals at risk of falls need clear guidance to ensure exercises performed at home are safe and provide adequate challenge. The aim of this qualitative study was to investigate the experiences and perceptions of older adults with increased fall risk enrolled in a 3-month digitally delivered home-based fall prevention exercise program (DFP). Semi-structured interviews were conducted by an interview specialist on a sample of 16 participants (81% female, age 77.3±5.8 years). Interviews were transcribed, imported, and coded into Dedoose, a tool for qualitative analysis. Codes were refined with each interview and themes were generated from the final codes. Three themes were identified: adherence to a home-based digitally delivered fall prevention exercise program, impact of fall prevention exercises on activities of daily living (ADL), and benefits of home-balance exercises. Participants attributed adherence to the home exercise program with minimal in-person visits. Participants reported fear of falling increased as they aged; upon completion, participants felt reduced fear of falling in their ADL. Balance exercises were the most appealing due to the level of difficulty and motivation to improve balance. Participants recommended changes to improve the DFP exercise program, with majority wanting to continue the program. This qualitative analysis provides guidance to health professionals about the acceptability and recommended changes for a digitally delivered home fall prevention exercise program.