This study examines the effects of a physical activity and behavioral program, called Active for Life, to promote increased physical activity and reduced sedentary behavior of older adults who live in assisted living. A sedentary lifestyle is very common in this population and if this program is successful it will be used to promote physical activity and improve the health of older adults in assisted living.
Sedentary behavior (SB) is an emerging health risk, especially for older adults, as it is associated with chronic disease, loss of function, and increased disability and frailty. Older adults in assisted living (AL) are less active than their peers living independently. Recent evidence demonstrates there are substantial health benefits from light physical activity (LPA) and the newly published Physical Activity Guidelines for Americans recommends that older adults replace SB with LPA. An intervention to increase LPA and reduce SB has potential to reduce health risks, slow functional decline and frailty, and delay residents' needs for higher-level care such as a nursing home. We propose to test the feasibility and acceptability of a self-efficacy based intervention, "Active for Life," with the goal of increasing PA and decreasing SB of AL residents. Active for Life is a 12 week intervention. Key components include (a) exercise with functional circuit training (FCT), walking, and stretching, (b) a behavioral component with a structured self-efficacy enhancing intervention that includes self-regulation strategies, and (c) education that addresses principles of exercise, the distinct health benefits of LPA, the negative consequences of too much sedentary time, and strategies for overcoming barriers to physical activity. It is important to test the feasibility and acceptability of the intervention for AL residents because this population will be more frail than previously tested populations. The intervention has been modified to be appropriate for AL residents based on guidance from AL experts and individual interviews conducted with AL residents. We will enroll 27 participants from approximately four AL facilities. Outcomes will be measured at baseline and at conclusion of the intervention. The primary outcomes are feasibility and acceptability of the intervention, but we will also examine preliminary evidence of outcome measures of objectively-measured sedentary behavior and physical activity, self-efficacy for exercise, value of physical activity, self-rated health, physical function, anxiety, depression, pain interference, and fatigue. This study is innovative because there are no well-established evidence-based interventions to promote PA in the AL setting and none that focus on increasing LPA and decreasing SB.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Each intervention session will take place within the assisted living facility twice a week for 12 weeks. Sessions will begin with 5-10 minutes of walking in the hallway. Participants will be encouraged to walk at their own pace and allowed to take breaks if needed. Next, behavioral strategies based on the construct of self-efficacy from social cognitive theory and education about physical activity will be delivered. This component is scheduled between the walking and circuit training, lasts 15-20 minutes, and serves as a rest period. Circuit training will focus on strength and balance. Approximately 8 exercise stations will be set up, and the exercises performed at each station will be changed approximately every 4 weeks. The circuit training will last \~30-40 minutes, with participants moving from one station to the next at their own pace and taking breaks in between.
University of Michigan School of Nursing
Ann Arbor, Michigan, United States
Feasibility: Number of participants screened
Several measures will be used to describe the feasibility of the intervention. We will calculate how many participants volunteered to be screened for participation in the study.
Time frame: After completion of the 12 week intervention
Feasibility: Number of participants eligible
Several measures will be used to describe the feasibility of the intervention. We will calculate how many participants met eligibility criteria for study participation.
Time frame: After completion of the 12 week intervention
Feasibility: Numbers of participants ineligible by each eligibility criterion
Several measures will be used to describe the feasibility of the intervention. We will summarize reasons that participants were ineligible for study participation by adding up the number of people who don't meet each specific eligibility criterion.
Time frame: After completion of the 12 week intervention
Feasibility: Number of participants who enroll
Several measures will be used to describe the feasibility of the intervention. We will calculate how many eligible participants decide to enroll in the study.
Time frame: After completion of the 12 week intervention
Feasibility: Length of time for recruitment activities
Several measures will be used to describe the feasibility of the intervention. We will calculate how much time is spent to recruit the study sample.
Time frame: After completion of the 12 week intervention
Feasibility: Percentage of activity sessions attended by participants
Several measures will be used to describe the feasibility of the intervention. We will calculate the percentage of activity sessions that participants attended.
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Time frame: After completion of the 12 week intervention
Feasibility: Participant retention rates
Several measures will be used to describe the feasibility of the intervention. We will calculate retention rates of how many participants started and how many completed the study.
Time frame: After completion of the 12 week intervention
Feasibility: Documentation of stated reasons for participant dropout
Several measures will be used to describe the feasibility of the intervention. We will document stated reasons for dropout from the study as much as we are able.
Time frame: After completion of the 12 week intervention
Feasibility: Injuries and adverse events
Several measures will be used to describe the feasibility of the intervention. We will summarize any adverse events/injuries that occur during the study.
Time frame: After completion of the 12 week intervention
Feasibility: Rates of missing or unusable data
Several measures will be used to describe the feasibility of the intervention. We will summarize how much data are missing from baseline, mid-intervention, and post-intervention data collections.
Time frame: After completion of the 12 week intervention
Feasibility: Time required to complete outcome measures
Several measures will be used to describe the feasibility of the intervention. We will keep record of how long each data collection session takes and calculate average length of data collection at both baseline and post-intervention.
Time frame: After completion of the 12 week intervention
Acceptability: Exit interviews
Semi-structured exit interviews will ask questions related to acceptability of the intervention, such as how participants felt about the overall intervention and its specific components, whether the time commitment was reasonable, whether assisted living staff were supportive of their participation and goals, and any suggestions for future improvements.
Time frame: After completion of the 12 week intervention
Acceptability: Final acceptability scale
This scale consists of 13 questions related to participants' overall satisfaction with the intervention and its components. Higher score indicates greater intervention acceptability.
Time frame: After completion of the 12 week intervention
Time spent in sedentary behavior and physical activity
ActivPAL monitor will measure time spent sitting/lying, standing, and stepping for 7 consecutive days at each measurement.
Time frame: 7 days of data are gathered at baseline at after the 12 week intervention.
Self-efficacy for exercise
Exercise self-efficacy- 9 items. Potential range of scores is 0 to 90. Higher score indicates higher self-efficacy for exercise.
Time frame: Measured at baseline, three weeks, and after 12 week intervention.
Value of Physical Activity
Single item asking "How important is physical activity in your life?" with a Likert response scale ranging from 1 to 5. Higher score will indicate greater importance of physical activity
Time frame: Measured at baseline and after 12 week intervention.
Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health
Physical, social, and mental health- 10 items. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low global health and higher scores indicate higher global health.
Time frame: Measured at baseline and after 12 week intervention.
PROMIS Physical Functioning
Physical function scale- measured with computer adaptive testing. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low physical function and higher scores indicate higher physical function.
Time frame: Measured at baseline and after 12 week intervention.
PROMIS Anxiety
General experience with anxious moods- measured with computer adaptive testing. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low anxiety and higher scores indicate higher anxiety.
Time frame: Measured at baseline and after 12 week intervention.
PROMIS Depression
General experience with depressed moods- measured with computer adaptive testing. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low depression and higher scores indicate higher depression.
Time frame: Measured at baseline and after 12 week intervention.
PROMIS Fatigue
General experience of fatigue- measured with computer adaptive testing. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low fatigue and higher scores indicate higher fatigue.
Time frame: Measured at baseline and after 12 week intervention.
PROMIS Pain Interference
Extent to which pain interferes with functioning- measured with computer adaptive testing. Scores are calculated as T-scores with a mean = 50 and standard deviation = 10. Low scores indicate low pain interference and higher scores indicate higher pain interference.
Time frame: Measured at baseline and after 12 week intervention.
Positive and Negative Social Influences on PA in Older Adults
Support from family and friends for being physically active. The questionnaire has 27 items (15 items describing positive social influence and 12 items describing negative social influence). The potential range of scores for positive social influence is 0 to 180 and the potential range of scores for negative social influence is 0 to 144.
Time frame: Measured at baseline and after 12 week intervention.
Acceptability: Mid-point acceptability scale
This scale consists of 3 questions related to acceptability of intervention delivery. Higher score indicates greater intervention acceptability.
Time frame: Measured at 6-weeks (mid-point of intervention)