Telehealth exercise and digital tools: what the evidence says, from activity trackers to guided sessions

Most people already know that regular exercise is good for their health. Far fewer manage to do it. Only a small share of Australians meet the physical activity guidelines, and the barriers are rarely physical. Time, cost, inconvenience and lack of access come up again and again. That makes getting exercise to people a delivery problem as much as a clinical one, and it is where telehealth exercise and other digital tools come in.

A new chapter from MHEX researchers, published in the Springer book Digital Health Therapeutic Innovation (edited by Rhonda Lynne Wilson, RMIT University), looks at how those tools can help. It covers everything from activity trackers through to real-time video sessions, reviews the evidence across musculoskeletal rehabilitation, healthy ageing, chronic disease and mental health, and works through two telehealth case studies.

The chapter was written by Brett Buist, Ben Kramer, Alyssa Petrofes and Associate Professor Bonnie Furzer from The University of Western Australia, with Associate Professors Kemi Wright and Nattai Borges from UNSW Sydney. Several of the team also deliver exercise services through Thriving in Motion and the Fremantle Hospital Mental Health Service, so the practical sections draw on day-to-day clinical work.

Three ways to deliver exercise digitally

Synchronous delivery happens in real time, by phone or video. It is the closest thing to a face-to-face session: the practitioner can watch, cue and adjust as the person moves, and the conversation helps build the therapeutic relationship that supports adherence. The trade-off is scale, since one practitioner can only see one client or group at a time.

Asynchronous delivery is not live. Think recorded videos, programming apps such as Physitrack, or exergaming. Clients can fit it around their own schedule and practitioners can reach far more people, but it is hard to tailor, and without live contact it is easier to miss a change in symptoms or health.

Hybrid delivery combines the two. A practitioner might meet a client monthly by video, with app-based programs filling the weeks in between. The authors describe this as a continuum. People with complex conditions will usually need more live contact at first, then move towards more independent support as they progress.

What the evidence shows

Musculoskeletal rehabilitation

Across persistent pain, low back pain, osteoarthritis and hip and knee joint replacement, telepractice generally shows small to moderate benefits over usual care or minimal intervention. Where it has been compared directly with face-to-face rehabilitation after joint replacement, or for knee osteoarthritis and persistent low back pain, outcomes were not significantly different, whatever the type of intervention or mode of delivery. Some studies found it added little on top of usual care, so it is not automatically worth layering in. The case for access is strong, though. Musculoskeletal pain is more common in rural and remote Australia and costs the country more than $73 billion a year.

Cardiac rehabilitation and cancer care

In people with low to moderate risk coronary artery disease, cardiac telehealth produced results similar to centre-based rehabilitation for blood pressure, lipids, smoking, mortality, quality of life and psychosocial wellbeing, with similar findings in heart failure. No adverse events were reported from telehealth sessions in these cohorts when usual cardiac rehabilitation practice was followed. Evidence in higher-risk patients is still limited. In cancer care, telehealth exercise has been comparable to standard care for quality of life, self-efficacy and fatigue, and multiple reviews report no severe adverse events across a range of cancers and treatment stages.

Healthy ageing

Only around 20 to 60 per cent of older adults in Western countries meet the physical activity guidelines. Telehealth exercise has been linked with better balance, balance confidence and mobility, lower falls risk and fewer hospital readmissions, along with social benefits that help reduce isolation. Effects on strength were more variable. The authors also caution against assuming older adults will struggle with technology: familiarity is growing, and it should be assessed rather than presumed.

Mental health

People living with mental health conditions have a life expectancy estimated at 10 to 15 years shorter than the general population and are less likely to meet activity guidelines. Supervised exercise is more effective than unsupervised exercise for this group, and telehealth widens access to that supervision. The chapter is clear about the limits. Blood pressure and heart rate are hard to check remotely, and lag, dropouts and missing non-verbal cues can make communication harder for people whose symptoms already affect it.

Can you measure progress remotely?

Mostly, yes. Range of motion at the knee, lumbar spine, shoulder, elbow and wrist has acceptable reliability via telehealth, as do the Timed Up and Go and Berg Balance Scale. Manual strength grading on the Oxford scale works, though it struggles to pick up change at the top grades, and patient-reported outcome measures show excellent reliability. Diagnosis is a different matter. Clinicians’ diagnoses often differ between telehealth and in-person examination, so a face-to-face assessment may still be needed to rule out red flags before a program starts. Wearables can fill in the rest: steps, exercise duration and one consistent intensity measure (speed, power or heart rate) are enough to track progress over time.

The best delivery model is the one that removes the barriers your client actually faces.

What this means for practice

The two case studies in the chapter show how this plays out: a 68-year-old man in a rural town managing knee pain and hypertension with no equipment at home, and a 44-year-old woman living alone in the city whose GP has referred her for exercise to support her mental health. Both start with safety planning, which is easy to skip when the client is on a screen. For clinicians and referrers, a few practical points stand out:

• Record an emergency contact, the exact address (down to the room the client exercises in) and whether anyone else is usually home. For mental health clients, ask for a copy of their crisis plan.
• Match the platform to the person’s barriers, and use household items such as chairs, stairs or shopping bags where there is no equipment.
• Light yourself from the front with the camera at eye level, and skip background blur, which smears the picture when you step back to demonstrate.
• Use a Bluetooth earbud or microphone so your voice carries, and switch on captions for clients with hearing loss.
• Agree with the client on what happens if the connection drops.

Read the chapter

Buist, B.D., Wright, K.E., Kramer, B., Borges, N., Petrofes, A. & Furzer, B.J. (2026). Exercise for Health: The Use of Digital Tools from Activity Tracking Through to Guided Delivery. In: Wilson, R.L. (ed.) Digital Health Therapeutic Innovation. Springer, Cham, pp. 193–212. doi.org/10.1007/978-3-032-32552-5_10

The chapter is not open access. If you cannot get it through your institution or library, contact the authors at mhex@uwa.edu.au.