Terry Bazzarre

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 of the First Year of Active for Life: Translation of 2 Evidence-Based Physical Activity Programs for Older Adults Into Community Settings

OBJECTIVESnTranslating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults.nnnMETHODSnFour community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys.nnnRESULTSnParticipants (n=838) were aged an average of 68.4 +/-9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index.nnnCONCLUSIONSnThe first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials.

Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study

OBJECTIVESnWe assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes.nnnMETHODSnWe used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program.nnnRESULTSnFor adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01).nnnCONCLUSIONSnBest-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs.

The Robert Wood Johnson Foundation Diabetes Initiative: demonstration projects emphasizing self-management.

PURPOSEnThe purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings.nnnMETHODSnThe Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination.nnnRESULTSnEcological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care.nnnCONCLUSIONSnThe Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.

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.

The National Blueprint Consensus Conference summary report: Strategic priorities for increasing physical activity among adults aged ≥50

This report summarizes the outcome of the National Blueprint Consensus Conference that was held in October 2002. At this conference, representatives of more than 50 national organizations convened in Washington DC with the goal of identifying high-priority and high-feasibility strategies that would advance the National Blueprint and that could be initiated within the next 12 to 24 months. The National Blueprint Consensus Conference has identified an ambitious agenda of 18 strategies that will need to be implemented in order to overcome societal barriers to physical activity among the middle-aged and older adult population. National organizations charged with the task of implementing the high-priority strategies will use professional networks, established delivery channels, and communication systems to translate the blueprint strategies into action.

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.

Adapting Physical Activity Interventions to Prevent Obesity in Culturally Diverse Populations

As the United States debates major health reform issues, reversing the obesity epidemic needs to be at the forefront of the discussion. The serious health and economic implications associated with obesity threaten our workforce and burden our health care system. An estimated

Older Adults’ Participation in a Community-Based Falls Prevention Exercise Program: Relationships Between the EASY Tool, Program Attendance, and Health Outcomes

117 billion is spent each year to cover the medical and indirect costs of obesity, including lost productivity. The direct health care costs of childhood obesity alone are estimated at

The National Blueprint for Promoting Physical Activity in the Mid-Life and Older Adult Population.

14 billion annually. If we fail to change the policies and environments that contribute to this epidemic, our next generation can expect even higher rates of obesity, greater health care costs, and a health care system less capable of meeting its needs. In the United States, two-thirds of adults and nearly onethird of our youth are overweight or obese. And while the prevalence of obesity has increased in all segments of our population, rates are significantly higher among AfricanAmericans, Native Americans, and Latinos. Research shows that many lower-income, culturally diverse communities have limited access to safe places to walk, bike, and play and that residents have poorer health outcomes. Physical inactivity is a major contributor to the development of obesity, and there is a great need to promote physical activity and support other healthy choices among the populations who are at greatest risk. Thus, efforts to combat obesity must test and implement economically feasible solutions that address the specific needs of these most vulnerable populations. By sharing results about what’s working to promote healthy changes in these populations, we can more rapidly establish the best practices that can inform action in communities across the country. Over the past few decades, we have learned that interventions designed solely to promote positive attitudes and increase health knowledge are insufficient to achieve longterm or sustainable behavior change. The socio-ecological model for behavior change suggests that effective community interventions must include environmental and policy solutions as key components if children and families are going to adopt healthy lifestyles. We cannot expect adults or kids to get regular physical activity or maintain a nutritious diet if they do not have convenient access to safe places to be active and affordable healthy foods. This commentary and the commentary by Kumanyika and Yancey focus on two systematic reviews of physical activity interventions: one conducted in African-American populations by Whitt-Glover and Kumanyika and one conducted in Native American populations by Teufel-Shone et al. These papers were commissioned by the Robert Wood Johnson Foundation (RWJF) to address the lack of published information concerning effective interventions that focus on physical inactivity and obesity among these populations. The literature reviews also examine how physical activity interventions can best be adapted to the cultural needs and values of each population; explore the impact of such interventions on obesity; and offer recommendations for future research. Both reviews show that there have been relatively few highquality studies within each target population. Furthermore, of the interventions that were implemented in either AfricanAmerican or Native American populations, there appeared to be little evidence of systematically adapting the original intervention to the cultural needs, values, and resources of the population studied. Addressing the policy and environmental factors that support sustainable long-term behavior changes was a challenge for all of the interventions, regardless of the specific population that was targeted. Initial findings from the literature reviews were presented at a 2-day meeting, Equal Rights to Health—Moving Forward Together, which was sponsored by RWJF in December 2003. Dr David Satcher, former United States Surgeon General, chaired the meeting, where representatives from research, practice, and media shared ideas and developed recommendations for preventing childhood obesity in the most affected communities. More than 50 experts who had worked with African-American, Latino, Native American, and rural populations participated in discussions about community-based programs, the evidence base regarding culturally diverse interventions, and the role of the media and communications in preventing childhood obesity. During the meeting, discussions revealed that many interventions designed to address obesity had not been widely translated into ‘‘real-world’’ practice, and had not been rigorously applied to culturally diverse populations that are most at risk for obesity. In some cases, the research-based programs were moderately effective, but communities lacked the resources required to implement and sustain the interventions. Many community organizations were unaware Copyright E 2009 by American Journal of Health Promotion, Inc. 0890-1171/09/