Groningen active living model (GALM): stimulating physical activity in sedentary older adults; first results

BigMove: A Group Intervention for People with Physical and Mental Health Conditions

Introduction:

This article describes an innovative, integrated care intervention, called BigMove, which aims to improve the functioning, capabilities and quality of life of people with a combination of physical and mental health conditions.

Description:

Theoretical frameworks reflected in the intervention are the Capability Approach (CA) and Self-Determination Theory (SDT). Essential elements of the intervention included to expand participants’ behavioural repertoire are motivational interviewing; functional goal setting (using the International Classification of Functioning, Disability and Health (ICF); cognitive behavioural therapy; enjoyment; support of the group; and physical activity. The design combines individual sessions and group sessions.

Discussion:

By integrating the CA and the SDT, the intervention enables participants to make self-directed and value-driven choices in life and change their behaviour accordingly to strengthen their functioning and capabilities. To foster person-centred, integrated care, it is crucial to reform the interaction between professionals and patients and to re-structure the organisation and financing of care to enable the provision of complex integrated care interventions.

Conclusion:

For people with physical and mental health conditions, the intervention BigMove provides an innovative integrated care approach that addresses aspirations people have regarding their functioning and focuses on individual goal setting and behaviour change.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

BACKGROUND

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.

METHODS

Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.

RESULTS

Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.

CONCLUSIONS

Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

Pilot Randomized Controlled Trial: Elastic-Resistance-Training and Lifestyle-Activity Intervention for Sedentary Older Adults

The aim of this study was to determine the efficacy and feasibility of a resistancetraining (RT) and lifestyle-activity program for sedentary older adults. Eligible participants (N= 44) were randomized to an 8-wk intervention or a control group. The primary outcome was lower body muscle strength, and participants completed a range of secondary outcomes. There was a significant group-by-time interaction for lower body muscle strength (difference = 3.9 repetitions [reps], 95% CI = 2.0–5.8 reps;p< .001;d= 1.0). Changes in secondary outcomes were generally small and not statistically significant. Attendance and program satisfaction were both high. A combined elastic-tubing RT and lifestyle-activity program delivered in the community setting is an efficacious and feasible approach to improve health in sedentary older adults.

Social Support and Physical Activity in Type 2 Diabetes A Social-Ecologic Approach

Purpose This study utilized social-ecology to describe sources of social-environmental support for physical activity perceived by people with type 2 diabetes, and examined the relationship between support and physical activity.

Methods Multidimensional support and physical activity were measured in 58 people with diabetes. Descriptive and correlational statistics were used.

Results Support from the media scored highest, followed by the health care team, personal support, workplace, family and friends, and lowest for the community. Physical activity was related to personal, media, and community support.

Conclusions Using a social-ecological approach, health care professionals must focus on enhancing support from media sources, strengthening community context, and bolstering personal self-management. Professionals must also critically examine patient-provider interactions to motivate lifestyle change.

Psychological and physical activity training for older persons: who does not attend?

BACKGROUND

Interventions to promote successful aging include psychological and physical activity programs. Identification of determinants of attendance of older persons may be useful to develop strategies to improve attendance. For physical activity programs determinants of attendance have been investigated extensively. For psychological programs hardly any knowledge is available. Determinants of attendance at psychological and physical activity programs have never been investigated simultaneously.

OBJECTIVE

To identify demographic, physical and psychological determinants of attendance of older subjects following multifaceted psychological training - aimed at promoting active social participation - and physical activity training and to compare the variation of these determinants between the two training programs.

METHOD

118 subjects aged 65-92 years were randomized over psychological and physical activity training. Determinants of attendance were obtained at pretest with questionnaires and performance-based tests.

RESULTS

Mean attendance was 62%. Attendance was not related to type of program. Having chronic diseases facilitated attendance in the psychological training group and limited attendance in the physical activity training group. Low and high levels of Activities of Daily Living performance (ADLs) and walking endurance were related to a high attendance in the psychological training group. A low level of activities of daily living (ADL) and a low walking endurance were related to a low attendance in the physical activity training group. For both training groups, persons living with a partner had higher attendance rates than persons living alone, and persons with a low level of anxiety had higher attendance rates than persons with a moderate or a high level of anxiety.

CONCLUSION

Psychological training may be more suitable for frail older persons with chronic diseases, low ADL levels and low walking endurance than physical activity training, and may help to prepare such persons for physical activity.

Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature

Three questions guided a literature review of the transtheoretical model (TTM) as applied to exercise to address the evidence for stage-matched interventions, the description of priority populations, and the identification of valid TTM measurement tools. One-hundredand-fifty studies were reviewed. Results indicate preliminary support for the use of stage-matched exercise interventions. Most studies have focused on White, middle-class, female populations, limiting the generalizability of their findings. Valid and reliable measures exist for stage of change, decisional balance, processes of change, self-efficacy, and temptations to not exercise; however, more research is needed to refine these measures. Evidence for the construct validity of the TTM as applied to exercise is mixed. When designing and implementing TTM-based exercise interventions, practitioners and policy makers are encouraged to clearly define the term exercise, choose a valid and reliable staging tool, and employ all TTM constructs and not just stage membership.

Six-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65

OBJECTIVE

To determine the effects on energy expenditure, health and fitness outcomes in sedentary older adults aged 55-65 after 6-month participation in the GALM program.

METHODS

In three Dutch communities, subjects from matched neighbourhoods were assigned to an intervention (n = 79) or a waiting-list control group (n = 102). The GALM program consisted of fifteen 60 min sessions once a week emphasising moderate-intensity recreational sports activities.

RESULTS

The intervention group showed significant increases in energy expenditure for recreational sports activities, other leisure-time physical activity, health indicators, and perceived and performance-based fitness. Contrary to our expectations, the same increases were found for the control group. Consequently, only significant between-group differences, favouring the intervention group, were obtained for sleep, diastolic blood pressure, perceived fitness score and grip strength.

CONCLUSION

The increases in energy expenditure for physical activity from the GALM program, especially for the more intensive recreational sports activities, look promising and are in line with the expected amounts necessary to improve health. Further research is needed to evaluate long-term effects of participation in the GALM program.

PRACTICE IMPLICATIONS

These results underline that GALM can be considered successful in stimulating leisure-time physical activity and improving health and fitness in older adults.

Enhancing brain and cognitive function of older adults through fitness training

The present article provides a brief review of the human and animal literature that has investigated the relationship between fitness training and brain and cognitive function. The animal research clearly suggests that improvements in fitness can lead to both morphological and functional changes in the brains of older animals. Results of a recent meta-analysis suggest that fitness training can also have beneficial effects on human cognition, particularly on tasks requiring executive control processing. These effects are also moderated by a number of factors, including the proportion of men and women in the intervention studies, the length of training sessions, the age of the participants, and the combination of fitness training regimes. The article also discusses preliminary results that link, for the first time, fitness training and differences in human brain structure and function. Finally, we discuss the important issue of participant adherence to fitness training programs and the factors that influence fitness participation.

Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults; validation of the behavioral change model

BACKGROUND

A significant proportion of older adults in The Netherlands do not participate regularly in leisure-time physical activity. The Groningen Active Living Model (GALM) was developed to change this situation for the better. Longitudinal results of the validation of the GALM behavioral change model are presented.

METHODS

We obtained data on potentially mediating variables of physical activity behavior change (self-efficacy, social support, perceived fitness, and enjoyment) from 96 participants in a prospective study during the 18 months the GALM strategy lasted.

RESULTS

Prospective analyses revealed significant differences in several potentially mediating variables, although some of these differences were contrary to our hypothesis. Discriminant analysis resulted in canonical correlations of 0.50 after 6 months and 0.66 after 18 months of program participation between adherers and nonadherers, respectively; 73.8 and 80.0% of the subjects were classified correctly.

CONCLUSIONS

Based on the results, it can be concluded that we partially succeeded in manipulating the potentially mediating variables by means of our GALM strategy. Several mediating variables were identified that reliably discriminated long-term adherers from nonadherers, expanding the generalizability of social cognitive theory-driven variables to a Dutch population.

The Validity of the Circumduction Test in Elderly Men and Women

This article focuses on the validity of the circumduction test for measuring shoulder flexibility in older adults. Participants included 137 community-dwelling older adults. Equipment consisted of a cord with a fixed handle on one end and a sliding handle on the other. The sliding handle was adjusted so that the cord length between the 2 handles equaled the participant’s shoulder width. Holding the 2 handles, the participant must pass the cord from the front of the body over the head and as far back as possible with extended arms. The score is the fanning-out angle. Forward flexion, abduction, horizontal retroflexion, and outward rotation were also measured. The test and criterion measurements were administered within 1 wk. The criterion-related validity of the circumduction test as a measure of forward flexion and horizontal retroflexion received support from moderate correlations. Its use as a measure of abduction and outward rotation, however, received no support from the data.

Development and Evaluation of “Aging Well and Healthily”: A Health-Education and Exercise Program for Community-Living Older Adults

The Aging Well and Healthily (AWH) program consists of health education by peers and low-intensity exercise. It was evaluated via a small randomized controlled trial and a community intervention trial involving older adults in the Netherlands. Reasons stated for participation were to exercise (35%), to acquire information about health (28%), and for social reasons (12%). The program was rated 8.2 on a 10-point scale. Twenty-five percent of participants joined exercise groups after the program ended, and 28% intended to do so. The mean physical activity score improved from 2.6 to 4.6 at follow-up (F = 16.9, p = .00) and was for the least active participants significantly different from that of the control group (F = 22.9, p = .02). Four to 6 months later, 60% of respondents reported still doing the exercises regularly at home. It is concluded that AWH is a potentially effective program for older adults.

Dissemination and Implementation of “Aging Well and Healthily”: A Health-Education and Exercise Program for Older Adults

The article describes the dissemination and implementation of the Aging Well and Healthily (AWH) program in the Netherlands. In the period 1997–1999 this process was monitored by means of telephone interviews with 263 participants, 28 peer educators, and 13 organizers. The program participants were mainly physically active and relatively healthy people in their mid 70s. The peer educators were in their late 50s. The overall satisfaction with the content and delivery of the AWH program was good; 13% of the participants enrolled in related local sports activities. In total, the AWH program was run 57 times, which did not meet the target of 50 times a year. Different factors could have negatively influenced dissemination. In the first place, the organization of the program was perceived to be complex and not compatible with the values of the organizations that were to implement the program. Also, 3 national implementation partners had organizational problems of their own. The results were used to design a new social marketing strategy, which appears to be successful.