Active for Life

Background

Most evidence-based programs are never translated into community settings and thus never make a public health impact.

Design

Active for Life (AFL) was a 4-year translational initiative using a pre–post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008.

Setting/participants

Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white).

Intervention

In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4.

Main outcome measure

Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure.

Results

Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites.

Conclusions

Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Introduction

Translational studies focus on whether effective interventions work in real-world settings.1, 2, 3, 4, 5, 6 Their purpose is not only to examine whether evidence-based programs improve outcomes but also to understand how organizations implement these programs to reach greater numbers of people, to examine the social and environmental influences on program delivery, and even to study how practitioners may adapt these programs to better suit their needs and the needs of their constituents. Translational studies are critical in understanding key issues related to the adoption and dissemination of effective programs.7, 8

The Task Force on Community Preventive Services concluded that individually adapted behavior change programs (which can include telephone-delivered, group-based, and other program formats) are a strongly recommended approach for promoting physical activity in communities.⁹ The essential components of these interventions include strategies such as realistic goal setting, identification of barriers, problem solving, self-monitoring (tracking), and provision of feedback and reinforcement.9, 10 Furthermore, a recent review of telephone-based interventions for promoting physical activity and dietary change concluded that there is a solid evidence base to support the efficacy of this delivery method; however, the authors recommended that more studies be conducted to examine broader dissemination of this approach into population health practice.¹¹

Active for Life (AFL), an initiative of the Robert Wood Johnson Foundation, was one of the first national studies to examine whether evidence-based physical activity programs could reach large numbers of adults aged ≥50 years, have similar impacts to earlier efficacy studies, and be sustained over time within existing community or clinical settings.5, 12 Results from the first year of the study found that the two physical activity programs tested—Active Choices, a 6-month telephone-delivered program; and Active Living Every Day (ALED), a 20-week group-based program—increased physical activity with effects comparable to results reported in the initial efficacy studies.¹³

The AFL initiative has accrued three additional years of experience (outcome data collected in two of these years). The purpose of this paper is to expand prior work by examining results over multiple years. The larger sample permits a more rigorous examination of several questions about the programs that are vital for translational research:

• How do the characteristics of program participants differ across study years?

• How effective are the programs in increasing physical activity and improving related outcomes for older adults?

• How consistent are effect sizes over time and settings as different cohorts of study participants undergo the same intervention?

• What is the impact of making a substantial site-initiated modification of one of the programs (i.e., shortening ALED from a 20-week to a 12-week program)?