Walk with Me: a protocol for a pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults

WeWalk: walking with a buddy after stroke-a pilot study evaluating feasibility and acceptability of a person-centred dyadic behaviour change intervention

BACKGROUND

Evidence for benefits of physical activity after stroke is unequivocal. However, many people with stroke are inactive, spending > 80% of waking hours sedentary even when they have physical capacity for activity, indicating barriers to physical activity participation that are not physical. WeWalk is a 12-week person-centred dyadic behaviour change intervention in which a person with stroke (PWS) and a walking buddy form a dyad to work together to support the PWS to increase their physical activity by walking outdoors. This pilot study examined the feasibility of recruiting dyads, explored their perceptions of acceptability and their experiences using WeWalk, to identify required refinements before progression to a clinical trial.

METHODS

Design: A single-arm observational pilot study with qualitative evaluation.

INTERVENTION

WeWalk involved facilitated face-to-face and telephone sessions with a researcher who was also a behaviour change practitioner, supported by intervention handbooks and diaries, in which dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking.

EVALUATION

Descriptive data on recruitment and retention were collected. Interview data were collected through semi-structured interviews and analysed using thematic analysis, guided by a theoretical framework of acceptability.

RESULTS

We recruited 21 dyads comprising community dwelling PWS and their walking buddies. Ten dyads fully completed WeWalk before government-imposed COVID-19 lockdown. Despite lockdown, 18 dyads completed exit interviews. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants' confidence developed as they experienced physical and psychological benefits of walking. WeWalk worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals. Tailoring intervention components to individual circumstances and values supported dyads in participation and achieving meaningful goals.

CONCLUSION

Recruiting dyads was feasible and most engaged with WeWalk. Participants viewed the dyadic structure and intervention components as acceptable for promoting outdoor walking and valued the personally tailored nature of WeWalk. Developing buddy support skills and community delivery pathways are required refinements. ISCTRN number: 34488928.

We Walk: a person-centred, dyadic behaviour change intervention to promote physical activity through outdoor walking after stroke-an intervention development study

OBJECTIVES

To develop We Walk, a theoretically informed, 12-week person-centred dyadic behaviour change intervention to increase physical activity (PA) in community-dwelling people with stroke (PWS) through outdoor walking.

DESIGN

Three-phase intervention development study. Phase 1: we reviewed literature on barriers and facilitators to PA after stroke and mapped them to the Behaviour Change Wheel and Theoretical Domains Framework to define intervention components. The Health Action Process Approach determined intervention structure underpinned by person-centred principles. Phase 2: stakeholder focus groups involving PWS, their companions and health professionals reviewed the draft intervention, and experts in behaviour change were consulted. Phase 3: informed by phases 1 and 2, the intervention and form of delivery were refined, with final review through patient and public involvement.

SETTING

Three Scottish community rehabilitation stroke services.

PARTICIPANTS

Twenty-three ambulatory community-dwelling PWS and their companions, thirty-seven health and exercise professionals, seven behaviour change experts.

RESULTS

Phase 1 determined key intervention components: information about benefits of walking; developing motivation and confidence to walk; facilitating dyadic goal setting and making plans together; monitoring walking, overcoming challenges; and maintaining walking behaviour. Phase 2 review by stakeholder focus groups and behaviour change experts endorsed intervention components and structure, emphasising dyadic relational aspects as central to potential success. In phase 3, intervention content and handbooks for PWS and buddies were finalised. Healthcare professionals proposed third-sector delivery as most appropriate for intervention delivery. A detailed delivery manual was developed. Participants preferred facilitated face-to-face and telephone delivery.

CONCLUSIONS

Our multilens intervention development approach ensured this novel intervention was evidence-informed, person-centred, theoretically coherent provided appropriate social support, and addressed issues of concern to PWS. This study established intervention components and structure and identified operational issues critical to future success. Future research will pilot and refine We Walk and evaluate acceptability, feasibility, effectiveness and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN34488928.

Physical activity promotion in community pharmacies: pharmacists' attitudes and behaviours

Background

Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active.

Objective

This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice.

Methods

A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies.

Results

In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3).

Conclusions

Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.

Healthcare Professionals Promotion of Physical Activity with Older Adults: A Survey of Knowledge and Routine Practice

Healthcare professionals have a key role in promoting physical activity, particularly among populations at greatest risk of poor health due to physical inactivity. This research aimed to develop our understanding of healthcare professionals knowledge, decision making and routine practice of physical activity promotion with older adults. A cross-sectional survey was conducted with practicing healthcare professionals in general practice, physiotherapy, occupational therapy and nursing in Ireland and Northern Ireland. We received 347 eligible responses, with 70.3% of all respondents agreeing that discussing physical activity is their job and 30.0% agreeing that they have received suitable training to initiate conversations with patients about physical activity. Awareness of the content and objectives of national guidelines for physical activity varied considerably across the health professions surveyed. Less than a third of respondents had a clear plan on how to initiate discussions about physical activity in routine practice with older adults. Assessment of physical activity was not routine, neither was signposting to physical activity supports. Considering the COVID-19 pandemic and its implications, 81.6% of all respondents agreed that healthcare professionals can play an increased role in promoting physical activity to older adults as part of routine practice. Appropriate education, training and access to resources are essential for supporting healthcare professionals promotion of physical activity in routine practice. Effective physical activity promotion in healthcare settings has the potential for health benefits at a population level, particularly in older adult populations.

Interventions Promoting Physical Activity Among Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Frequent participation in physical activity (PA) has benefits across the lifespan but is particularly important for older adults. PA levels are either measured by objective or self-reported survey methods. Objective PA measurement is used to increase accuracy. This systematic review investigated the effect of physical activity-based interventions on objectively measured PA levels among community-dwelling adults aged 60 years and older.

RESEARCH DESIGN AND METHODS

Literature searches were conducted in five electronic databases and four clinical trial registries. Randomized controlled trials investigating the effect of physical activity-based interventions on objectively measured PA levels (e.g., accelerometers or pedometers) in community-dwelling adults aged 60 years and older compared with no/minimal intervention were considered eligible. Data were pooled using the most conservative estimates reported from each study using the standardized mean difference (SMD). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the overall quality of the evidence.

RESULTS

Fourteen published trials and 3 ongoing trials were identified. There were significant effects favoring physical activity-based interventions compared with minimal intervention at short-term (less than or equal to 3 months) (SMD: 0.30, 95% CI: 0.17 to 0.43) and intermediate-term (more than 3 months and less than 12 months; SMD: 0.27, 95% CI: 0.06 to 0.49) follow-ups. The quality of evidence was moderate according to GRADE (downgraded for risk of bias).

DISCUSSION AND IMPLICATIONS

Our findings suggest that physical activity-based interventions may increase objectively measured PA levels in community-dwelling older adults. Further studies are still needed to identify the optimal dose, intensity, and mode of delivery of physical activity-based interventions.

Perceived Neighborhood Environment Associated With Older Adults' Walking and Positive Affect: Results From the Health and Retirement Study

The current study examined how a perceived neighborhood environment was associated with older adults' walking activity and the experience of positive affect. Study sample comprised 10,700 older adults, aged 65+, sampled from the Health and Retirement Study 2014-2015 in the United States. Results indicated that neighborhood social cohesion was significantly predicting older adults' walking and positive affect. It was also revealed that walking engagement significantly contributed to the measure of positive affect. However, perceived neighborhood physical disorder did not account for additional variance in walking and positive affect. Final structural model involved three latent factors-neighborhood social cohesion, walking, and positive affect-and the goodness-of-fit indices of the model indicated an acceptable fit to the sample data. Public health and physical activity intervention in the context of neighborhood environment should facilitate social integration and informal social support that the neighborhood creates.