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 < 0.001) and older (≥75 yrs.; + 1.0 days/week; p < 0.001) participants. The increase was sustained at 6 months in younger participants only, who remained significantly more active than at baseline (+ 1.4 days/week; p < 0.001). Social exclusion indicators declined significantly in the younger group. Mobility and strength improved significantly at 3 months in the younger group, and in both groups at 6 months.

Conclusions: CTM adopted central tenets of implementation science that consider the complicated systems where interventions are delivered to improve public health. In this iteration of CTM we demonstrate that a partner-based health promotion intervention can be effectively implemented across settings to enhance PA, mobility and social connectedness in older adults.

Keywords: Impact evaluation; Implementation science; Mobility; Older adults; Physical activity; Scale up; Seniors; Social connectedness.

Fig. 1

We present the framework for effective implementation. Implementation of the innovation (our intervention - Choose to Move) is guided by the Prevention Delivery System and its organizational capacity, the Prevention Support System and the Prevention Systhesis & Translation System. Together these three elements are deemed essential for effective implementation. Further, these critical components are embedded within a larger context of provider characteristics and community factors (outer rings). Interactions between all components in the outer and central rings are illustrated by bidirectional arrows. Reproduced with permission from the authors [25]

Fig. 2

We present the timeline and illustrate the phased delivery and key program components across the time frame of our study