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Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale.

ABSTRACT: BACKGROUND:Despite known health benefits of physical activity (PA), older adults remain among the least physically active age group globally with 30-60% not meeting guidelines. In Canada, 87% do not meet recommended guidelines. To influence population health, interventions that are effective in small trials must be disseminated at scale. Despite evidence for efficacy, few PA interventions are scaled up to reach the wider community. In 2015, British Columbia (BC) Ministry of Health released a PA strategy where older adults were identified as a priority. In partnership with the Ministry, the Active Aging Research Team co-created a health promotion program called Choose to Move (CTM). CTM will be implemented in three phases at increasingly greater scale across BC. The objective of this study is to evaluate the effectiveness of CTM during Phase I (pilot) and Phase II (initial scale up) on PA, mobility, and social connectedness among older adults in BC, Canada. METHODS:We used a type 2 hybrid effectiveness-implementation study design, and herein focus on effectiveness. The implementation evaluation will be published as a companion paper elsewhere. Two community delivery partner organizations delivered 56 CTM programs in 26 large and small urban locations across BC. Outcome measurement occurred at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We collected survey data from all participants (n?=?458; province-wide) and also conducted a subset evaluation (n?=?209). RESULTS:PA increased significantly during the active intervention phase (baseline-3?months) in younger (60-74?yrs.; +?1.6?days/week; p?

SUBMITTER: McKay H

PROVIDER: S-EPMC6251145 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale.

McKay Heather H Nettlefold Lindsay L Bauman Adrian A Hoy Christa C Gray Samantha M SM Lau Erica E Sims-Gould Joanie J

BMC public health 20181123 1

<h4>Background</h4>Despite known health benefits of physical activity (PA), older adults remain among the least physically active age group globally with 30-60% not meeting guidelines. In Canada, 87% do not meet recommended guidelines. To influence population health, interventions that are effective in small trials must be disseminated at scale. Despite evidence for efficacy, few PA interventions are scaled up to reach the wider community. In 2015, British Columbia (BC) Ministry of Health releas ...[more]

PMID: 30470209

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Project description:There is compelling evidence supporting the benefits of increased regular physical activity in older adults. The Experience Corps program in Baltimore MD was designed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs. The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles designed to improve the academic outcomes of children and, simultaneously, increase the physical, cognitive and social activity of volunteers. This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps. In a pilot randomized controlled evaluation, older adults were randomly assigned to Experience Corps (EC participants) or a waiting list control group. Ages ranged from 59-86 years, 96% were African American, 94% were women, and 84% had annual incomes less than $15,000. EC participants were required to serve >/=15 h a week. At follow-up after 4-8 months, an analysis of 113 randomized volunteers revealed 53% of the EC participants were more active than the previous year by self-report, as compared to 23% of the controls (p<0.01). When adjusted for age, gender and education, there was a trend toward increased physical activity in the EC participants as calculated by a kilocalorie per week increase of 40%, versus a 16% decrease in the controls (p=0.49). EC participants who reported "low activity" at baseline experienced an average 110% increase in their physical activity at follow-up. Among the controls who were in the "low activity" group at baseline, there was, on average, only a 12% increase in physical activity (p=0.03). Among those who were previously active, there was no significant difference (p=0.30). The pilot results suggest that a high intensity volunteer program that is designed as a health promotion intervention can lead, in the short-term, to significant improvements in the level of physical activity of previously inactive older adult volunteers.

Project description:BACKGROUND:We previously developed Pisando Fuerte (PF), a linguistically and culturally appropriate version of "Stepping On", an evidence-based fall prevention program building on self-efficacy and adult learning principles. The purpose of this study is to describe the implementation of PF at two community organizations in Wisconsin. METHODS:PF consisted of 2 h sessions delivered in Spanish over the course of 8 weeks by two trained leaders, at two community sites in Wisconsin. Participants identified strategies for falls prevention and practiced progressive balance and strength exercises. The RE-AIM framework guided the mixed-methods evaluation. Falls Behavioral Risk Scale (FaB) (Outcomes), and uptake of protective behaviors (Individual Maintenance) were evaluated 6 months after completion. Fidelity of delivery (Implementation) was evaluated by an independent assessor for three sessions at each site using a-priori criteria based on key elements of Stepping On. RESULTS:Twenty-four Hispanic/Latino individuals, whose primary language is Spanish, were enrolled in two workshops. The mean age was 70.5 years; 71% were female, and five reported a fall in the year prior. OUTCOMES:There was a non-statically significant decrease in the number of falls per person [RR: 0.33 (95%CI: 0.096-1.13)] at 6 months. There was a statistically significant improvement of the mean Falls Behavioral Risk Scale (FaB) (baseline = 2.69 vs. 6-months post-intervention = 3.16, p < 0.001). Adoption: Barriers to adoption included leader training in English, time to identify Spanish-speaking guest experts, and time to prepare for each session. IMPLEMENTATION:Satisfactory fidelity of delivery was achieved in 69% of the elements; fidelity lapses were more common in the use of adult learning strategies and programmatic aspects. Eighty eight percent of participants completed the program, and 95% of them adequately demonstrated the exercises. Maintenance: At 6 months, 57.9% of participants continued doing exercises, 94% adopted safer walking strategies, and 67% executed at least one home safety recommendation. These results are similar to those seen in the original Stepping On program. CONCLUSIONS:Our study shows good fidelity of delivery with implementation of "Pisando Fuerte". Pre-post data demonstrate a significant reduction in falls behavioral risk among Hispanic/Latino participants, similar to results with "Stepping On". TRIAL REGISTRATION:ClinicalTrials.gov, NCT03895021 . Registered March 29, 2019.

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Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale.

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Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale.

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