Sara Wilcox

Active for Life : Final Results from the Translation of Two Physical Activity Programs

BACKGROUNDnMost evidence-based programs are never translated into community settings and thus never make a public health impact.nnnDESIGNnActive for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.nnnSETTING/PARTICIPANTSnNine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).nnnINTERVENTIONnIn AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.nnnMAIN OUTCOME MEASUREnModerate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.nnnRESULTSnPosttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.nnnCONCLUSIONSnActive Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adults health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Results from the Active for Life process evaluation: program delivery fidelity and adaptations

Active for Life((R)) (AFL) was a large (n = 8159) translational initiative to increase physical activity (PA) in midlife and older adults. Translational research calls for a shift in emphasis from just understanding what works (efficacy) to also understanding how it works in more real world settings. This article describes the process evaluation design and findings, discuss how these findings were used to better understand the translational process and provide a set of process evaluation recommendations with community-based translational research. AFL community organizations across the United States implemented one of two evidence-based PA programs (Active Living Every Day-The Cooper Institute; Human Kinetics Inc. or Active Choices-Stanford University). Both programs were based on the transtheoretical model and social cognitive theory. Overall, the process evaluation revealed high-dose delivery and implementation fidelity by quite varied community organizations serving diverse adult populations. Findings reveal most variation occurred for program elements requiring more participant engagement. Additionally, the results show how a collaborative process allowed the organizations to fit the programs to their specific participant base while maintaining fidelity to essential program elements.

Sustainability of evidence-based community-based physical activity programs for older adults: lessons from Active for Life

Program sustainability in community and healthcare settings is critical to realizing the translation of research into practice. The purpose of this study is to describe the implementation and assessment of an intervention to increase organizational maintenance of evidence-based physical activity programs and the factors that impede or facilitate sustainability. All organizations implemented a sustainability action plan that included identifying factors related to sustainability, examining resources available, identifying program modifications to enhance sustainability, and long-term action planning. A mixed methods approach was used. Organizational (nu2009=u200912 sites) ability to demonstrate program effectiveness, align priorities with the organizational mission, and integrate the program within the existing infrastructure were strengths related to sustainability. Sites were more optimistic about program sustainability when they had less reliance on internal financial, but more reliance on internal human resources to run the program post-funding. The study resulted in a number of tools that can help community organizations plan for sustainability of physical activity programs.

Understanding the Challenges Encountered and Adaptations Made by Community Organizations in Translation of Evidence-Based Behavior Change Physical Activity Interventions: A Qualitative Study

Purpose. Designing programs for mid-life to older adults whose sedentary behaviors are associated with increased health risks is crucial. The U.S. Task Force on Community Preventive Services strongly recommends individually adapted behavior change programs as one approach to increasing physical activity in communities. The purpose of this study is to report challenges organizations faced when translating two evidence-based programs in real-world settings, adaptations made, and whether or not fidelity was negatively impacted by these adaptations. Design: A grounded theory approach to qualitative research was used. Setting and Participants: Nine community organizations across the country participated. Two organizations had more than one site participating, for a total of 12 sites from nine organizations. Within those organizations, 2796 participants were part of the program during the first 2 years. Participants were underactive (i.e., not meeting Centers for Disease Control and Prevention and American College of Sports Medicine recommendations) mid- to older-aged adults. Methods: Community organizations participated in monthly conference calls, and program information was entered into an electronic database regularly. Data obtained from the calls and database were used for analyses. Results: Challenges and adaptations emerged in three categories: (1) program logistics, (2) program theory, and (3) program philosophy. Conclusion: Challenges were present for community organizations; however, with some level of adaptation, the community organizations were able to effectively deliver and maintain fidelity in two evidence-based physical activity programs to a large and diverse group of mid- to older-aged adults.

Changes in Physical Functioning in the Active Living Every Day Program of the Active for Life Initiative

BackgroundPhysical activity can prevent or delay the onset of physical functional limitations in older adults. There are limited data that evidence-based physical activity interventions can be successfully translated into community programs and result in similar benefits for physical functioning.PurposeThe purpose of this study is to measure the effects of the Active Living Every Day program on physical functioning and physical functional limitations in a diverse sample of older adults.MethodsAs a part of the Active for Life initiative, the Council on Aging of Southwestern Ohio implemented Active Living Every Day (ALED), a group-based lifestyle behavior change program designed to increase physical activity. Performance-based physical functioning tests (30-s Chair Stand Test, eight Foot Up-and-Go Test, Chair Sit-and-Reach Test, 30-Foot Walk Test) were administered to participants at baseline and posttest. Baseline to post-program changes in physical functioning and impairment status were examined with repeated measures analysis of covariance. Interactions tested whether change over time differed according to race/ethnicity, body mass index (BMI), and baseline impairment status.ResultsParticipants significantly increased their performance in all four physical functioning tests. The percentage of participants classified as “impaired” according to normative data significantly decreased over time. Physical functioning improved regardless of BMI, race/ethnicity, or baseline impairment status.ConclusionsALED is an example of an evidenced-based physical activity program that can be successfully translated into community programs and result in significant and clinically meaningful improvements in performance-based measures of physical functioning.

Predictors of Change in Satisfaction with Body Appearance and Body Function in Mid-Life and Older Adults: Active for Life®

BackgroundBody satisfaction has not been well studied among mid-life and older adults despite age-related changes in body appearance and function.PurposeThe objective of this study is to examine predictors of change in body appearance satisfaction and body function satisfaction in an adult sample (nu2009=u20091,839; mean ageu2009=u200969).MethodsParticipants took part in a physical activity behavior change program. Simultaneous regression analyses examined predictors of change in body function satisfaction and body appearance satisfaction.ResultsGreater improvements in body function satisfaction were associated with being younger and white, better baseline health ratings, greater reductions in body mass index (BMI) and depressive symptoms, and greater increases in physical activity. Greater improvements in body appearance satisfaction were associated with being white, obtaining a college degree, greater reductions in BMI and depressive symptoms, and greater increases in physical activity.ConclusionsThese findings suggest the importance of physical activity in enhancing body satisfaction in mid-life and older adults. Future research aimed to better understand effective methods for increasing physical activity remains essential.

Maintenance of Change in the Active-for-Life Initiative

BACKGROUNDnThere is a notable gap in translating efficacious interventions to community-based organizations. Further, physical activity interventions have been less successful in promoting longer-term maintenance.nnnPURPOSEnThis study examined 6-month maintenance of improvements seen in Active for Life (AFL), a translational research initiative.nnnMETHODSnParticipants from seven of 12 AFL sites enrolled in Years 3 and 4 were surveyed 6 months after completing the 6-month telephone-based Active Choices program (AC, one site) or the 20-week or 12-week group-based Active Living Every Day program (ALED, six sites). Repeated measures analyses controlled for site clustering and covariates. Programs were implemented from 2003 to 2007 and analysis was conducted in 2009.nnnRESULTSnFor the AC (n=368) and ALED (n=2151) programs, respectively, participants were aged 72.0 and 70.8 years on average, were 70% and 78% non-Hispanic white, and were 72% and 83% women; 46% and 50% returned 6-month follow-up surveys. For AC, improvements from pre- to post-test were maintained at follow-up for physical activity; satisfaction with body function (SBF); and BMI. For ALED Year 3, there was a decrease at follow-up for physical activity and SBF. Body mass index decreased from pretest to follow-up. For ALED Year 4, increases in physical activity and reductions in BMI were maintained at follow-up. Satisfaction with body function increased from pretest to 12 weeks post-test, declined at 20 weeks, and was maintained at follow-up.nnnCONCLUSIONSnImprovements were generally maintained at the 6-month follow-up. When behavioral decay occurred, follow-up values remained more favorable than at pretest. Given the broad reach of this translational initiative, the results suggest the viability of evidence-based programming as an effective public health practice.

Psychosocial Mediators of Two Community-Based Physical Activity Programs

BackgroundPrevious findings are inconclusive regarding the mediators of physical activity behavior change.PurposeTo test self-efficacy and social support as mediators of Active Choices, a telephone-delivered physical activity intervention, and Active Living Every Day, a group-based physical activity intervention, implemented with midlife and older adults in community settings.MethodsMacKinnons product of coefficients was used to examine social support and self-efficacy as mediators of change in physical activity. The proportion of the total effect mediated was calculated. Each model controlled for age, gender, race (white vs. non-white), body mass index (BMI), and education (high school graduate or less vs. at least some college).ResultsIncreases in self-efficacy mediated increases in physical activity among Active Choices (nu2009=u2009709) and Active Living Every Day (nu2009=u2009849) participants. For Active Living Every Day, increases in social support also mediated increases in physical activity in single mediator models.ConclusionsIncreasing self-efficacy and social support may help increase physical activity levels in older adults.

Effectiveness of two evidence-based programs in participants with arthritis: findings from the active for life initiative.

Arthritis is the leading cause of disability in the US. Strong evidence suggests that physical activity (PA) is beneficial to those with arthritis. This study examined whether changes in PA and PA‐related outcomes from two general evidence‐based PA programs (Active Choices [AC] and Active Living Every Day [ALED]) differed in participants with and without arthritis.

Predictors of Physical Activity 6 Months Postintervention in the Active for Life Initiative

BACKGROUNDnUnderstanding who is most and least likely to remain active after the completion of physical activity (PA) interventions can assist in developing more targeted and effective programs to enhance prolonged behavior change. The purpose of this study was to examine predictors of meeting PA recommendations 6 months postintervention in participants enrolled in Active for Life.nnnMETHODSnParticipants from 2 behavioral PA programs [158 Active Choices (AC); 1025 Active Living Every Day (ALED)] completed surveys 6 months after completion of the active intervention. Analyses examined predictors of meeting PA recommendations at follow-up.nnnRESULTSnThe following were significant predictors: In ALED: self-report health status, satisfaction with body function, and self-efficacy at baseline; PA status at posttest; changes in self-efficacy, perceived stress, and satisfaction with body function and appearance from baseline to posttest. In AC: PA status at post-test.nnnCONCLUSIONSnThe ultimate goal of health promotion programs is to teach the behavioral skills necessary to sustain behavior change once an active intervention is complete. The findings from this study suggest that predicting PA behavior after cessation of PA interventions may not be straightforward, and predictor variables may operate differently in different intervention approaches.