Recommendations for promoting physical activity in older adults and levers to influence policy

Key recommendations Successful components of physical activity interventions fall into three categories: Planning and developing physical activity initiatives Working with the individual Working in partnership with others Research has identified the common components of successful interventions to promote physical activity in older adults. These fall into these three categories: Planning and developing physical activity interventions: These slides outline the evidence-based recommendations for actions that should be taken or components that should be put into place when planning and developing physical activity initiatives for older adults. Working with the individual: These slides outline the evidence-based recommendations for actions that should be taken or components that should be put in place when working with individual older adults. Working in partnership with others: These slides will cover evidence-based recommendations for working in partnership with others to promote physical activity in older adults.

Planning and developing physical activity initiatives Focus solely on changing physical activity levels as opposed to multiple health behaviours For example, home hazards for fall prevention Firstly, we will outline strategies for planning and developing physical activity initiatives. Evidence is limited that it is beneficial to combine physical activity interventions with other non-physical activity interventions, eg, home hazard assessments during fall prevention initiatives. Therefore, targeting activity levels has a larger effect than addressing several health behaviours.

Planning and developing physical activity initiatives Offer a choice of group-based activities and provide advice for activities they can do in their own time Group or centre-based activities offer social participation Group sessions that have an impact on social participation are more successful than initiatives run in the home.

Planning and developing physical activity initiatives Incorporate elements of behaviour change into the initiative, for example: self-monitoring personalised goal setting self-reinforcement corrective feedback. Behaviour change elements incorporated in interventions are more effective than providing health information alone. Self-monitoring shows the most consistent results for increasing physical activity levels in older adults, eg, a log book or diary to track progress. Using these four behaviour change components have been shown as effective methods for increasing physical activity levels.

Planning and developing physical activity initiatives Ensure opportunities are available which encourage older adults to sustain the increase in their physical activity levels Activity must be maintained to gain the benefits Determine critical elements for adherence For the benefits of physical activity to be maintained, individuals must continue to be active. It is essential to understand the individualised factors that will enable/prevent individuals to continue being active, eg, cost of activity, time commitment, accessibility, enjoyment.

Planning and developing physical activity initiatives Ensure activity leaders have sufficient qualifications and experience Qualified staff are most effective for supporting physical function, fall prevention and increasing mobility. Non-specialist instructors should be considered where cost is an issue. Training the public to be walk leaders as effective as professionals for walking interventions. Specialist and qualified exercise instructors are most effective for delivering physical activity programmes. Programmes focused on physical function, reducing falls and increasing mobility are more effective when using qualified instructors. NB. While this yields the best results, non-specialist instructors have been successful in increasing activity in some situations and should be considered when qualified individuals are outside of the programme budget. Walking interventions have demonstrated no difference between professionals and members of the public trained as walk leaders on physical activity levels.

Working with the individual Encourage older adults to work towards the physical activity guidelines Some activity is better than none Set personal achievable goals In this next section, the slides outline effective strategies for working with individuals. The UK physical activity guidelines recommend that older adults should be encouraged to achieve 150 minutes of moderate intensity activity per week as well as strength training activities on two days per week. It is important that older adults understand that some activity is better than none. You should work with individuals to set realistic and achieveable goals within a realistic timescale that work towards the physical activity guidelines, eg, over the next month working towards walking two laps of the local park.

Working with the individual Determine with individuals the type of support most beneficial for them Level of support is a good predictor of activity Type of support may vary according to programme phase More contact time has a bigger impact Telephone calls offer valuable support Receiving support, eg, from family, friends, programme staff and other participants is a good predictor of changes in physical activity levels but older adults’ preference on who provides support may vary at different stages of a programme, eg, a qualified instructor at the initial adoption phase In general, a higher level of contact time and support have a bigger impact than those with less contact time. Telephone calls offer a valuable means of providing support.

Working with the individual Tailor activity information to the individual, eg, potential/actual health risks environment goals Personalised information has a positive effect on physical activity levels. Tailor information according to the: Individual’s potential/actual health risk Environment – provide information on activity opportunities within a locality, eg, local walking groups or activities Individual goals – advice on reaching goals according to ability and interests

Working with the individual Review participants’ progress towards their personal goals on a regular basis Realistic timetable for improvements Review yearly The benefits of a programme may not be apparent for some time, eg, improvements in mental health may not be noticed for up to six weeks. Regularly review progress and adapt goals to maintain older adults’ engagement with a programme. Research suggests that progress reviews should take place at least every year, if not more frequently.

Working in partnership with others Collaborate with medical professionals to provide strong and consistent messages about physical activity Brief interventions from healthcare professionals are linked with increased physical activity Written prescription and verbal advice may further increase physical activity Provide training to healthcare professionals The next section provides strategies on working in partnership with others. Support from healthcare professionals has been linked to increases in physical activity, eg, a brief intervention providing information on physical activity and health Professionals are encouraged to work in partnership with healthcare professionals through Support to promote physical activity within their practice Provide training on how to approach and address the issue of physical activity with older adults Working to reach the older adults already under their clinical care.

Implications for practice - Commissioners Impact and cost effectiveness. Multi-level interventions. Underpinned by physical activity guidelines. Specific and tailored programmes. Long term participation. Monitoring and evaluation. Ensure that programmes are based on a solid evidence-base for impact and cost effectiveness when commissioning and designing programmes for older adults. Commission multi-level interventions that include population wide, community-based and one-to-one components. Underpin programme design by the UK physical activity guidelines. Make sure programmes are targeted to specific interests, needs and abilities of older adults, both individuals and group. Commission programmes that support sustained participation in the long term – beyond 12 months. If physical activity participation ceases, the benefits will be lost. Build robust monitoring and evaluation into local programmes.

Implications for practice – policy makers Policy measures to promote activity to older adults of all abilities and needs. Impact on physical activity participation. Engagement in policy development. Promote social cohesion and active environments. Educational opportunities for the workforce. Equal gender opportunities. Take action to promote physical activity to older adults of all ability and needs through policy measures Assess in advance the intended and unintended impact policy proposals might have on older adults’ physical activity participation. Ensure older adults are engaged in all aspects of policy development Work to promote social cohesion and environments which are safe and appropriately support physical activity in local communities. Provide educational opportunities focusing on physical activity promotion for professional groups who work with older adults, eg, carers in residential settings, practice nurses, occupational therapists. Ensure that programmes meet the needs of both men and women (as there are significant differences in motivation, interests and goals). Ensure equality of opportunities for both men and women

Implications for practice – practitioners Review and improve knowledge. Underpin by UK physical activity guidelines. Coordinate community services. Include older adults in planning and implementing programmes. Monitoring and evaluation. Offer tailored and appropriate programmes. Work with people who can support older adults. Ensure providers are trained. Review and improve knowledge and understanding of ageing and physical activity through appropriate education, training and resources. Ensure programmes are underpinned by the UK physical activity guidelines for older adults. Develop a local coalition or alliance to ensure the coordination of community physical activity services and programmes. Ensure older adults are included in the planning and implementation of local programmes Implement robust monitoring and evaluation of local programmes. Work with ‘significant others’, eg, instructors, care givers, family members, who are positioned to support older adults to become more active. Ensure that those providing opportunities for older adults are appropriately trained to deliver experiences that are enjoyable, effective and safe.

Practice briefing Practical strategies to effectively promote physical activity with older adults Our practice briefing uses research evidence to provide practical strategies to effectively promote physical activity with older adults. The briefing particularly focuses on people aged 65 and over who are already active or in transition towards becoming frailer. It focuses on enabling them to continue living independently.