Get Healthy, Get Active: A successful physical activity intervention for inactive community-dwelling older adults?
Globally, less than 12% of older adults (≥65 years) are physically active daily and over 60% spend more than ten hours per day engaged in sedentary behaviour.
In the UK there are over 11 million older adults aged 65 years and over who make up 18 per cent of the population. Aligning with the US and other developed countries this proportion is projected to increase to at least 24 per cent by 2039. Although prolongation of life remains an important public health goal, of even greater significance is that extended life should involve preservation of the capacity to live independently and function well.
Epidemiological evidence indicates that low levels of physical activity and high levels of sedentary behaviour carry considerable physical (e.g., premature mortality, chronic diseases and all-cause dementia risk) and psychosocial (e.g., quality of life, wellbeing and self-efficacy for exercise) health risks. Of concern is the ongoing lack of evidence for the successful institutionalisation of physical activity interventions in real-world settings. This, combined with unacceptably high levels of inactivity worldwide, underscores the need to address the research-to-practice gap and that this should constitute a significant public health priority.
In response to the lack of successful community-based health behaviour change interventions for older adults, in 2015 Sport England invested £398,000 into Sefton Council with the aim of providing evidence of the role that physical activity can play in engaging inactive community-dwelling older adults (≥65 years) in moderate-to-vigorous physical activity at least once a week for 30 minutes. Participant recruitment and intervention delivery were completed by qualified practitioners from Sefton Council. The intervention was comprised of 12 weekly hour-long sessions. Sessions were predominantly chair-based and included balance, endurance, flexibility, and strength exercises.
A three year Sport England funded PhD studentship completed by myself evaluated the effectiveness (i.e., did the intervention increase moderate-to-vigorous physical activity levels?) and fidelity (i.e., was the intervention delivered as intended in terms of dose and response?) of Sport England’s Get Healthy, Get Active physical activity intervention.
Sport England’s Get Healthy, Get Active physical activity intervention was not effective in increasing moderate-to-vigorous physical activity among inactive community-dwelling older adults.
Results revealed that although a high degree of intervention fidelity was maintained throughout the intervention sessions, across all venues and deliverers, the Get Healthy, Get Active physical activity intervention was ineffective in increasing time spent in moderate-to-vigorous physical activity and reducing time spent in sedentary behaviour at three, six and 12-months post-baseline. The odds of meeting moderate-to-vigorous physical activity guidelines also decreased significantly across the three follow-up time points. However, significant increases in quality of life, self-assessment of physical fitness, self-rated health and self-efficacy for exercise health outcome scores were observed at three, six and 12-months post-baseline.
The results show there is no potential for long-term implementation and scaling up of Get Healthy, Get Active in its current capacity. In line with Sport England’s Whole Systems Approach guidelines to physical activity interventions (see Figure 1), the following recommendations are outlined to aid progress and ultimate success of future physical activity interventions among community dwelling older adults.
Individual - Sessions targeting inactive people should be adaptive and based on needs identified within focus groups, market segmentation and latent demand information for the localities that are being worked in. Activity provision should fit individual’s circumstances rather than fitting them to existing provision.
Social environment - Ageing is associated with a decrease in the size of social networks and hence, older adults are at increased risks of isolation. Focus groups with Get Healthy, Get Active participants revealed the thirty minutes set aside at the end of each Get Healthy, Get Active session to allow participants to drink coffee and tea, eat biscuits and socialise were participants favourite part of the weekly sessions. Targeted intervention strategies can reduce isolation by providing an opportunity for older adults from differing socio-economic areas to take part in physical activity within local community spaces (e.g., parks, leisure centres and churches), that promote social networking by encouraging camaraderie, adaptability and productive engagement, without the pressure to perform.
Organisations and Institutions - Local and national level organisations and institutions should consider educational strategies (e.g., physical activity guidelines infographics and local/national mass media messages) to communicate the role of physical activity in gaining health benefits for all, reducing sedentary behaviour and countering the negative implicit attitudes that may undermine physical activity participation within this population.
Physical environment - Time and day of the week are barriers to physical activity participation, as are early morning, evening and weekend sessions, especially during the winter months when daylight hours are more limited. Neighbourhood safety concerns amplify such concerns. Resultantly, intervention locations should be easy to access by both public transport and car, have appropriate toilet and kitchen facilities and avoid taking place during either early morning or afternoon rush hour periods.
Policy - Considering the large variation in participant abilities, sessions were relatively low intensity and consequently, a major limitation of the Sport England provided data collection measure (the International Physical Activity Questionnaire for the Elderly) was that any changes in light physical activity because of the intervention were not captured. This underlines the importance of researchers working in partnership with funders and stakeholders prior to intervention delivery to establish outcome measures which are fit for purpose for each specific project. Although group-based activities offer older adults the chance to gain a sense of belonging, enjoyment and establish friendships, designing sustainable exit routes to retain the provision of group activities which continue to facilitate, build and retain social bonds post-intervention should also be considered by physical activity programmers and policymakers.