1. Mathieu de Greef PhD Ger Kroes MSc Groningen Active Living Model (GALM) A health enhancing physical activity program for sedentary older adults in the Netherlands www.galm.nl

2. focussedentary older adults aimto enhance physical activity to meet ACSM guidelines age group55-85 year theory drivenbehavioral change as a multidimensional dynamic proces orientationcommunity based, recreational sportsprogram Fitweekly 60 minutes, 30 months, moderate intensity Features of the GALM program

3. -Social Cognitive Theory -Evolutionary play Theory -Toronto Model Stage Behavioral change mechanisms Theoretical concepts Campaign activities Recruitment Motivational climate Adoption Behavioral change Active Ageing Enjoyment Enhancing fitness, skills & connectedness Adherence and Social participation Selfmanagement training - Transtheroretical Model - Self-Determination Theory - Nudge Theory - Active living concept (2 months) (4 months) Group tailored exercise class (12 months) -Schema theory - Health Literacy framework -Relapse Prevention Theory Home visits Exercise introduction program GALM conceptual model - Goalsetting Theory - Social connected- ness theory 1 2 34 + + +

4. motivation PA status Fysical fitness enjoyment compliance Health education nudging engagement adherence Social connectedness Theoretical framework GALM Self determination theory Transtheoretical Model Health Literacy theory Relapse Prevention Model Social support Social Cognitieve theory Self-efficacy Community based Active Living Model Social Cognitieve theory Toronto Model; Play theory Marketing mix Social Marketing Theory empowerment Schema theory Nudge Theory Behavioral changeRecruitment and adoption Active Ageing Social Capacity Theory Expected pleasure theory Self determination theory Resilience theory social participation Social capital theory

5. Linkage theoretical framework GALM to the Socio-ecological model Health literacy framework Social Capital Theory Social Marketing Theory Resilience Theory Social cognitive Theory Transtheoretical Model Active living Model Self Determination Theory Totonto model Scheme theory

6. Interested fittest intro program after 18 mo after 30 mo 20% 18% Popkema & de Greef 2000, 16% 14% 24% The effect on behavioral change

7. percentage of fitness scores below average

8. Development and dissimination GALM 1995 GALM Sedentary elderly GALM Sedentary elderly SCALA Sendentary elderly wiih chronic conditions SCALA Sendentary elderly wiih chronic conditions 1999 SMALL DPA program sedentary elderly SMALL DPA program sedentary elderly Social Vitality Healthy Ageing program sedentary and lonely elderly in deprived neighbourhoods Social Vitality Healthy Ageing program sedentary and lonely elderly in deprived neighbourhoods GALM-ADL ADL campaign frail elderly in nursing homes GALM-ADL ADL campaign frail elderly in nursing homes FLASH PA Campaign Neth erlands on the move Differentiation dissemination National Health enhancing PA campaigns 2 local projects 20032007 National Actionplan Sportsimpuls 902 local projects European Health Promotion Award 2001

9. matrix organization structure GALM National levelRegional levelLocal level - GALM foundation - University Groningen -National Institute for Recreational Sports and Physical Activity (NISB) -Ministry of Health, Welfare and Sport -Netherlands Organization for Health Research and Development (ZonMW) - GALM foundation - University Groningen -National Institute for Recreational Sports and Physical Activity (NISB) -Ministry of Health, Welfare and Sport -Netherlands Organization for Health Research and Development (ZonMW) - Vocational Education Institutions - Regional Sports Councils - Provincial boards - Regional Health Services (GGD) - Vocational Education Institutions - Regional Sports Councils - Provincial boards - Regional Health Services (GGD) Method Funding Monitoring R&D Local project Training Funding Fitness test Selection targetgroup -Municipality - Local sports and welfare organisations - Local care institutions - Member organisations for seniors -Municipality - Local sports and welfare organisations - Local care institutions - Member organisations for seniors Network formation Run GALM program Funding Continuity

10. Theory Program Implementation Evidence summary GALM is theory driven health enhancing physical activity strategy Recruitment: 18% of sedentary older adults Increase physical fitness (stength, endurance) Feasible for euopean implementation

11. GALM-ECO model enhancement physical activity NUDGING Energy expenditure Intrinsic motivation resilience MINDSETTING Social marketing active living Health information