Four main superordinate themes emerged as the essence of the lived experience of tele-exercise among the oldest-old women (Fig 1).

Fig. 1

Outline of superordinate and subordinate themes developed from interpretative phenomenological analysis

Ambivalent perception of safety

The superordinate theme “ambivalent perception of safety” was supported by four subordinate themes: “home is the safest place”, “manageable and adjustable exercise intensity”, “compromised supervision” and “exercise according to ability”.

The oldest-old had ambivalent feelings on the safety of tele-exercise participation. Participant Siu Fong was aware of the lack of immediate and specific supervision and adjustment from the instructor, as reflected by her statement:

“…if there’s anything, he (the instructor) will tell us immediately. Now on zoom, to be honest, we follow (his instructions), if it’s not correct... not correct, um my hands’ position isn’t correct, he can’t tell us how to do it.”

Mei Ling shared similar thoughts:

“Well, I think of course it's good in the classroom. (In) face to face (mode), if there is incorrect (movement), I can listen to you (the instructor). He spoke clearly. On the Internet, there was a burst of sound "ChaChaCha", (the sound is) not clear. In face to face mode, I can hear (the feedback) clearly, and (the instructor can) easily communicate (the feedback). In this sense, face to face mode is better.”

Although supervision might be compromised in tele-exercise, participant perceived the experience of tele-exercise as safe. They highlighted that they felt safe in their home. It was their own “territory”, where they were so familiar with the setting:

“Of course, it feels safer to be at your own place, without illness, you should be safe. They (instructors) can see us, can see us exercising, what are we doing, they're able to see, so we're not worried at all. If you stay at home, you don’t have to wear a mask. In fact, it’s really difficult when the weather’s hot. So, it’s the best to stay home, lots of people like it (tele-exercise at home).” (Siu Ling).

Yuet Ho even asked rhetorically, “How come I’d say it’s safe? Of course it’s the safest to stay at home, isn’t it?”.

Apart from the perceived safeness from the familiar home environment, participants perceived tele-exercise to be safe as they can exercise according to their own ability.

Mui Mui mentioned the instructor would teach them how to make adjustment to exercise movement according to their own ability:

“I can do 4 (repetitions) or 10 (repetitions). But I have to hold a chair to walk. Mr Au (the instructor) taught us, if you feel unstable, hold the chair to support.”

Another participant, Yuet Ho, explained that participant can make own judgement and act according to own ability:

“If you can do it, you follow those movements like others, but if you can’t, I rely on myself and only follow a little bit, it’s also okay…You don’t have to follow all the steps completely. If you… if you feel tired you can rest awhile, no one will scold at you, just take a break, and start again.”

Similarly, Siu Ling also explained that she made her own judgement and avoided those tele-exercise class that was not suitable to her health condition:

“From lying to sitting, um I feel a bit dizzy, so I didn’t attend that class, I told Mr Choy (instructor), he said ‘OK OK OK, don’t come today’. Like when I lie on the ground, and I get up, I feel a bit dizzy, that’s why I didn’t go to that (tele-exercise) class.”

Participants also appreciated the manageable exercise intensity of tele-exercise classes:

“Now on zoom, for us, um… follow him and do it slowly, very good, follow him (instructor) is good, I think he instructs really well, I really have to be slow! People in my age isn’t really fit, can’t be too fast. So, it’s good! Like those aerobic exercise… aerobic exercise, very good. So, it certainly targets those heart and lung function. Those aerobic exercise, those are good. Watched the "TV", follow him doing slowly.” (Siu Fong).

As observed by the researcher, participants were all able to use nearby furniture at home to support exercise movements and participants with weaker physique were seated in most part of the exercise session. They were exercising at an intensity that was manageable to them.

Reminded and guided to move the aged body

The superordinate theme “reminded and guided to move the aged body” was supported by three subordinate themes, “move the aged body”, “reminder”, and “guided”.

Oldest-old participants acknowledged the importance of “move” or “movement” to avoid stiffness of the body at very old age:

“Now that we’re old, people at this age have to move. Moving is better than not moving, you will feel stiff if you don’t move… If you don’t mind, I’m so old and making mistakes, I will keep doing (tele-exercise). It is pathetic if you can no longer walk.” (Mui Mui).

Yuet Ho understood the importance of exercising her legs:

“For my legs, because I am heavy, I need to better use my legs. I cannot straighten (perform heel raise exercise) my legs for long, other people can straighten it for a few minutes, but I cannot. It keeps shaking. (I feel that) my legs become better after I straighten (perform heel raise exercise) it, it is good for the muscles. For single leg stance, it is good for the muscles, the legs will have strength. With the strengths, you can stand longer, very good. If you do not have the chance (to do exercise), you will fear for fall when you go out, you will also fear that you cannot walk a long distance.”

While it was important to “move”, oldest-old participant appreciated that tele-exercise remind them to ‘move’, as they received reminder message from their phones:

“For “online” (tele-exercise), when it is about time (right before the class starts), the phone will receive a reminder (message), so I will remember. If you don’t remind me, I forget sometimes.” (Siu Ling).

They also appreciated there was no need to remember the exercise by themselves. The exercise steps were being reminded by the instructor by watching the “monitor”:

“For this (type of) exercise, it's my first-time doing exercise facing a “mon” (monitor). Occasionally I also move a bit, I think (this exercise mode) is good, very clear. It’s even better doing exercise at home facing the “mon” (monitor), it is true. Because… mainly it’s because I'm forgetful, you may think I sound clear verbally, but I forget things easily.” (Mui Mui).

Mee Yee appreciated being guided to do exercise by professionals:

“I feel happy, someone is teaching me in this exercise….”

Mui Mui appreciated the knowledge come from the guidance by professionals:

“For practicing Tai Chi in parks, no one is guiding us. We just practice (Tai Chi) by ourselves. Now there is an instructor like Mr.Au, guiding us how to exercise our legs. (Now we know) there is no effect if the knee is facing the floor. Now we have the concept, we are (feel) clearer, isn’t that true?”

The researcher observed that participants responded well to the instructor’s guidance and instructions, and the interactions were similar to in-person class. With the quiet environment at home, the instructor’s voice was the only voice in the environment, making the leadership from instructor strong and positively influenced participants. It was observed that participants had high concentration during the tele-exercise class.

Ease in regular participation

This superordinate theme is supported by three subordinate themes, “balancing household duties and own activity time”, “eliminate travel barrier”, and “unaffected by weather, time and mobility competency”.

Yuet Ho appreciated the convenience of participating tele-exercise. They could manage household duties with their own activity time:

“(tele-exercise) is good, it is much more convenient. I don’t have to rush to the community centre, I can (turn on) computer first and do other stuff.”

Oldest-old participants mentioned that it was not easy for them to leave their homes and travel somewhere for exercise. The oldest-old women appreciated that tele-exercises eliminated the travel barrier and the experience was unaffected by weather and mobility issues:

“On one hand, I am old now, I have to walk on my own… The road here, the road is steep, I have to carry my walking stick, sometimes… I am afraid of falling, so I seldom go out. From my home to the community centre, it takes at least 20 min if I walk slowly. And I don’t know why, when I keep walking… I sweat a lot. I really hate to go out when the weather is hot.” (Mee Yee).

“You do not need to go out and expose to the sun, there is no need to spare extra time, in here (home), you can turn on the computer, at nine something or ten something. Turn it on, have the battery charged, just like that. Wait for a while, there will be some English words that I don't understand…after that the screen will pop out.” (Yuet Ho).

“It’s really good, at least sometimes those senior… um… (they) don’t walk so well, it is not convenient (for them to travel somewhere to join exercise class). it’s good that we can follow (instructions) and move a bit at home.” (Siu Ling).

Researcher felt the perception of “ease” perceived by participants. With minimal preparation, participants sat in front of tablet or computer just before the class started and once screen was connected and the voice of the instructor was heard, the quiet home environment was magically transformed to a vibrant “exercise class” environment. During the whole process, participant just calmly and familiarly navigated their home without any hassle.

Technological adaptation

The superordinate theme was supported by three subordinate themes, “technological exploration”, “technological support”, and “technological advancement”.

“Technology” is not something this oldest-old cohort familiar with. In their tele-exercise experience, they mentioned that they went through different stages of struggles to get familiar with tele-exercise participation:

“(I am) not used to it initially, like I don’t know how to press the buttons. (So I) learn again, and try to press again… but why I can’t press it? I press wrongly or I didn’t press?” (Yuet Ho).

“At first, we don’t know anything. O! Dying! What to do? Now I keep learning, (I can) manage so so now…” (Siu Fong).

“At first, I tried to operate by myself, but not successful, (I) call them (staff from community centre) and ask.” (Siu Ling).

Although all participants struggled at the beginning, they all acknowledged the support from staff or the instructor in troubleshooting technical issues:

“We're pretty old. We don’t know how to use those smartphones. Sometimes we need to take it to the centre, ask the staff, when the phone isn’t functioning, they'll teach us how to do and how to press those buttons, which buttons we had pressed wrongly, they'll tell us.” (Siu Fong).

“Sometimes (I) asked the instructor (about the technical problem), the beginning was like that, now (I) won’t.” (Yuet Ho).

After going through the exploration and support stage, oldest-old participants experienced technological advancement in their tele-exercise experience:

“someone helped me set up the app, he told me there's an app called 'Zoom', you click the 'plus' button, add the password to it, I can directly join this exercise class, very easy, because the setting is more or less the same.” (Mei Ling).

Yuet Ho mentioned the concept of learning new things:

“I think I have learnt one more thing, we keep learning as we grow old, if I (do not) participate this online exercise, you (i) don't know what is computer, and (I) don’t know how does the computer look like, the computer now is so thin...learn one more thing.”

All participants talked about the technological challenges they had at the beginning, but researcher’s observations revealed that all participants could turn on the tablet or computer, occasionally hiccups such as mistyping password or mis-clicking hyper link occurred, but they all successfully joined the tele-exercise class by themselves without any help from third person during researchers’ home visit.