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Evidence-Based Disability and Disease Prevention for Elders
Developing Physical Fitness Programs
David M. Buchner, M.D., M.P.H., Chief, Physical Activity and Health Branch, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention (CDC).
Marcia G. Ory, Ph.D., M.P.H., Professor, Social and Behavioral Health, School of Rural Public Health, Texas A&M University, College Station, TX.
Susan L. Hughes, D.S.W., Co-director, Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL.
What Kinds of Evidence-based Community-level Interventions Promote Physical Activity?
The following interventions were discussed in this session:
- Informational interventions include community-wide campaigns and point-of-decision prompts (e.g., to increase stair usage).
- Behavioral and social interventions include school-based physical education, non-family social support, and individually adapted behavior change.
- Environmental interventions include providing access to places for physical activity through outreach/promotion; community-scale urban design and land use (e.g., density; connectivity of streets; proximity of residential, commercial, and school property); and street-scale urban design and land use (e.g., lighting, pedestrian access, traffic calming).
What Models Have Proved Successful?
The StairWell Project
Dr. Buchner presented the Centers for Disease Control's StairWell Project, an evidence-based approach designed to increase stair use by CDC employees in one of its Atlanta buildings. The project consisted of three phased interventions:
- Phase One involved painting and carpet to make the stairwells more attractive and inviting.
- Phase Two introduced framed pictures.
- Phase Three added motivational signage and children's art.
Electric eyes were used in the stairwells to collect baseline data and for ongoing data collection and analysis. Stair use increased 8.9 percent. Focus groups were also conducted with employees to pre-test the motivational messages.
Active for Life®
The program targeted adults 50 and older with only irregularly active or sedentary physical activity levels. One hundred participants were recruited in the pilot year, and 1,000 were recruited in total. Active for Life® includes two programs.
The first program, Active Choices, is a Stanford University program that allows individuals to choose when, where, and what type of activity they want to do. It does not require regular attendance at on-site physical activity classes. Exercise counseling happens through telephone conversations between a health educator and the participant.
The second program is Active Living Everyday (developed by Human Kinetics and the Cooper Institute), a physical activity program that is delivered in small groups and includes an on-line buddy component.
The presenters stressed that research translation involves defining essential elements. These include:
- Goal setting.
- Identification of barriers.
- Tracking of behaviors.
- Active problem solving.
- Supportive feedback.
Balancing treatment fidelity and program adaptation raise other concerns:
- How does a program maintain fidelity to essential elements?
- What is needed to tailor programs?
- What is needed to make programs sustainable?
Materials may need to be simplified for some populations. Trainers need to be trained to reduce costs and this can mean exchanging face-to-face meetings for telephone orientations, reducing the number of sessions, and merging behavioral and exercise opportunities.
Fit and Strong!
Susan Hughes discussed findings from a study of the Fit and Strong! program. Fit and Strong!, a program of the Chicago Chapter of the Arthritis Foundation, is designed to reduce disability from arthritis, a significant cause of disability and a risk factor for other future disabilities.
The program was geared to increasing self-efficacy, or confidence, and focused on arthritis disease management, exercise, and exercise adherence. Fit and Strong! provided 60 minutes of exercise and 30 minutes of education at three sessions a week for eight weeks. To help promote compliance, the program focused on making exercise easy to do, developing individual routines, and reinforcing new behaviors. Peer-led activities designed to reinforce the program goals were continued when the rest of the program ended.
Evaluation of Fit and Strong! pilot programs showed that the program improved self-efficacy and exercise adherence and reduced lower extremity stiffness and pain for up to a year after the program. These results are expected to continue as the first groups involved in the program move through their second year post-program.