Evaluation of a Computer-Tailored Healthy Ageing Intervention to Promote Physical Activity among Single Older Adults with a Chronic Disease

This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group ( n = 411; mean age = 76.75; SD = 7.75) was assessed at baseline, three months, and six months. Data of comparable older adults who completed the original Active Plus intervention served as reference group ( n = 87; mean age = 74.36; SD = 6.26). Multilevel regression analyses were applied: outcome measures were weekly minutes of moderate to vigorous physical activity (MVPA) and days per week with at least 30 minutes of MVPA. Although Active Plus65 did not outperform the original intervention, in itself Active Plus65 effectuated a significant increase in the weekly minutes of MVPA (B = 208.26; p < 0.001; Effect Size (ES) = 0.45) and in the days per week with sufficient MVPA (B = 1.20; p < 0.001; ES = 0.61) after three months. After six months, it effectuated a significant increase in the days per week with sufficient MVPA (B = 0.67; p = 0.001; ES = 0.34) but not for the weekly minutes of MVPA ( p = 0.745). As Active Plus65 increased MVPA at three months with a higher ES than average interventions for this vulnerable target group, it potentially makes an interesting intervention. Further development should focus on long-term maintenance of effects

Promoting the implementation of a computer-tailored physical activity intervention:development and feasibility testing of an implementation intervention

BACKGROUND: Although there are many proven effective physical activity (PA) interventions for older adults, implementation in a real world setting is often limited. This study describes the systematic development of a multifaceted implementation intervention targeting the implementation of an evidence-based computer-tailored PA intervention and evaluates its use and feasibility.METHODS: The implementation intervention was developed following the Intervention Mapping (IM) protocol, supplemented with insights from implementation science literature. The implementation intervention targets the municipal healthcare policy advisors, as an important implementation stakeholder in Dutch healthcare system. The feasibility of the implementation intervention was studied among these stakeholders using a pretest-posttest design within 8 municipal healthcare settings. Quantitative questionnaires were used to assess task performance (i.e. achievement of performance objectives), and utilization of implementation strategies (as part of the intervention). Furthermore, changes in implementation determinants were studied by gathering quantitative data before, during and after applying the implementation intervention within a one-year period. Additionally, semi-structured interviews with stakeholders assessed their considerations regarding the feasibility of the implementation intervention.RESULTS: A multi-faceted implementation intervention was developed in which implementation strategies (e.g. funding, educational materials, meetings, building a coalition) were selected to target the most relevant identified implementation determinants. Most implementation strategies were used as intended. Execution of performance objectives for adoption and implementation was relatively high (75-100%). Maintenance objectives were executed to a lesser degree (13-63%). No positive changes in implementation determinants were found. None of the stakeholders decided to continue implementation of the PA intervention further, mainly due to the unforeseen amount of labour and the disappointing reach of end-users.CONCLUSION: The current study highlights the importance of a thorough feasibility study in addition to the use of IM. Although feasibility results may have demonstrated that stakeholders broadly accepted the implementation intervention, implementation determinants did not change favorably, and stakeholders had no plans to continue the PA intervention. Yet, choices made during the development of the implementation intervention (i.e. the operationalization of Implementation Mapping) might not have been optimal. The current study describes important lessons learned when developing an implementation intervention, and provides recommendations for developers of future implementation interventions.</p

The added value of frequent physical activity group sessions in a combined lifestyle intervention: A cluster randomised trial in primary care

Combined lifestyle interventions (CLIs) that target both physical activity (PA) and diet have been shown to improve PA and health of adults who are overweight; however, optimal amount of guidance remains unclear. This study evaluated the effects of adding PA group sessions to a standard CLI in primary care in the Netherlands. 411 participants (BMI 34.5 ± 4.4 kg/m2) in thirty locations were randomised into a one year CLI or CLI+. CLI comprised individual meetings with lifestyle coach (LSC) and physiotherapist, and group meetings with dietician. PA group sessions were added in CLI+. Primary outcome was minutes of moderate to vigorous PA per week. Secondary outcomes of PA, diet and cardiovascular risk factors (i.e. waist circumference, HbA1c and blood pressure) were evaluated after 12 and 24 months with multilevel analyses. Data were collected from 2010 to 2015. Significant between-group effects were only found for waist circumference, which was significantly lower at twelve months in the CLI+ group (p = 0.011), no other between-group differences were found. Several within-group changes were significant. After participating in the intervention, walking time increased with 83 ± 35 min/week and 100 ± 38 min/week, and BMI decreased with 0.7 ± 0.3 kg/m2 and 1.5 ± 0.3 kg/m2 in CLI and CLI+ respectively (p < 0.001). Diet, HbA1c and systolic blood pressure changed favourably in both groups. Adding PA group sessions did not elicit added, sustained benefits. A programme with individual meetings with LSC and physiotherapist, and group meetings with dietician can be sufficient to facilitate a healthy lifestyle and reduce cardiovascular risk factors in a population with overweight