Audsley, Sarah E.
(2019)
Keeping adults physically active: intervention development and randomised controlled feasibility study.
PhD thesis, University of Nottingham.
Abstract
Introduction
Physical inactivity contributes to disability and falls in community dwelling older adults. Regularly attending falls prevention exercise programmes improves health, physical function and reduces falling rates in older people. However, older adults rarely maintain moderate to vigorous physical activity (MVPA) beyond 12 months after exercise programmes end, which results in the beneficial health effects being lost. Research is needed to examine whether physical activity (PA) can be maintained in older adults exiting falls management exercise (FaME) programmes.
Aim
The aim of this PhD was to develop and investigate the feasibility of an intervention to maintain PA in community-dwelling adults aged 65 years and older exiting FaME programmes.
This aim was achieved by the following research objectives:
1. To identify effective intervention strategies for maintaining PA in older adults by conducting a systematic review.
2. To use the findings of the systematic review alongside an intervention development tool and an expert steering group to design an intervention that aims to maintain PA in older adults who have attended a FaME programme.
3. To conduct a study to test the feasibility, acceptability and fidelity of delivering the PA maintenance intervention to a group of older adults exiting the FaME programme. To examine the acceptability of, and adherence to the intervention by the participants and Postural Stability Instructors (PSI). To estimate the study parameters needed for a future definitive trial.
Methods
Systematic review: Controlled studies assessing interventions for maintaining PA, in people aged 65 years and older, were identified from electronic bibliographic databases and hand searching. Two researchers independently assessed for eligibility, risk of bias and extracted data. Only studies assessing community dwelling older adults aged 65 years old and older were included. Study characteristics, behaviour change strategies, intervention features, delivery modes and PA outcomes were synthesised narratively.
Intervention development: The Keeping Adults Physically Active (KAPA) intervention was developed using Bartholomew’s intervention mapping (IM) framework. The IM process involved creating intervention objectives by reviewing qualitative data on older adults’ PA determinants. Effective PA intervention strategies were identified in the systematic review and the National Institute of Clinical Excellence (NICE) guidelines for PA and behaviour change. The intervention strategies and programme design was built from the output of these initial stages. An expert steering group guided the design of the KAPA intervention and its implementation plan.
KAPA Feasibility study: A feasibility study was conducted in 8 FaME classes (4 intervention and 4 control groups) between January 2017 and January 2018. The study design was a two-arm, cluster randomised, multi-site feasibility study comparing the KAPA intervention with usual care controls. A sample of 10 PSIs and 50 community-dwelling adults aged 65 years old or older were recruited.
Quantitive and qualitative research methods were used to examine the KAPA intervention. Acceptability, feasibility, adherence and fidelity were assessed by:
i) Estimating study recruitment, retention and attendance rates.
ii) Examining acceptability by conducting semi-structured interviews with the participants in receipt of, and the PSIs delivering, the KAPA intervention.
iii) Investigating adherence by: a) analysing the PSI’s completion rates of the class registers; b) examining class registers for the KAPA participants’ adherence with the PA diaries and goals.
iv) Examining the fidelity of the KAPA intervention using class observations and PSI interviews.
v) Investigating parameter estimates for a future definitive trial by: a) estimating the potential effect size in terms of MVPA, b) estimating the intraclass correlation coefficient (ICC) for MVPA.
vi) Describing usual care by its intervention components.
vii) Identifying the data collection tools needed to cost the intervention in a definitive trial.
viii) Recording adverse events and assessing them for causality in relation to the delivery of the KAPA intervention.
Results
Systematic review: The search yielded 25,761 publications and 19 studies met the inclusion criteria. Of the 19 studies, 13 reported significantly maintaining PA. There was considerable heterogeneity between the studies and interventions delivered. Interventions delivered on a monthly, or quarterly basis over an intervention period of 6 months to 2 years most consistently maintained significant PA effects. Interventions were effective regardless of delivery mode, setting, intervention provider or whether delivered to groups or individuals. Providing pedometers, counselling and motivational interviewing helped to sustain PA. Most studies (n=17) were judged to be of an unclear or high risk of bias.
Intervention development: The KAPA intervention comprised of six group sessions of motivational interviewing, delivered by a trained and mentor supported PSI. Participant manuals, illustrated exercise books and PA monitoring tools supported the KAPA intervention. KAPA sessions lasted between 60 to 90 minutes and were delivered in community-based venues over a 6-month duration. Participants unable to attend group sessions received the KAPA intervention via telephone.
KAPA Feasibility study:
Recruitment, retention and adherence rates: The aim of recruiting 120 participants was not achieved. Fifty of the sixty-seven participants (74.6%) invited into the study agreed to take part. Forty-five participants (92.3%) provided outcome data at the 6-month time point. Attendance rates to the KAPA intervention sessions were high as 94.2% of the total available sessions were attended.
Acceptability: Delivering KAPA was acceptable from the perspective of the PSIs. KAPA participants often expressed positive views about the venues and PSIs and talked about gaining enjoyment from group interactions. Many discussed the writing activities to be the least enjoyable element of the KAPA intervention. PA engagement was reinforced by peer support. During the interviews the KAPA intervention participants discussed increasing their walking and home-based exercise activities. Participants believed the illustrated home exercise booklet and the PA monitoring tools helped them keep active.
Adherence: Participant and PSI adherence with the KAPA intervention could not be assessed due to missing register data.
Fidelity: Fidelity observations showed that 75% of the intervention components were delivered. Three intervention PSIs discussed adapting KAPA during the semi-structured interviews.
Parameter estimates: The proportion of participants reporting at least 150 minutes of MVPA per week rose from 56.3% to 62.5% in the intervention arm and from 41.4% to 52.0% in the usual care arm (OR 1.25, 95% CI 0.26 to 5.88, p=0.78). The ICCs for reaching the target 150 minutes of MVPA weekly was 0.000 (95% CI 0.000 to 0.237).
Usual care descriptive: Usual care was described as the continued provision of FaME as an exercise maintenance class.
Data collection tool: Cost data relating to telephone usage was inaccurate. The current cost proforma needs adapting before its use in a definitive trial.
Adverse events: Three adverse events, possibly relating to KAPAs delivery, were reported.
Conclusion
The systematic review suggested that PA maintenance programmes can help older adults stay active. The findings suggested that intervention time periods and contact frequency may influence effectiveness. The knowledge gained from the review, NICE guidelines and the expert steering group helped to develop the KAPA intervention.
The KAPA intervention consisted of six-monthly group sessions of motivational interviewing, supported by written materials and self-monitoring tools. PSIs found the KAPA intervention feasible to deliver. Participants reported the illustrated home exercise booklet, peer support and the PA monitoring tools encouraged them to keep active. A definitive trial is needed to assess whether PA can be significantly maintained in response to the KAPA intervention.
| Item Type: |
Thesis (University of Nottingham only)
(PhD)
|
| Supervisors: |
Orton, Elizabeth
Kendrick, Denise
Logan, Pip |
| Keywords: |
Behaviour change, PA maintenance, Community-dwelling, Older adults, Feasibility, Motivational interviewing, Falls management exercise programme |
| Subjects: |
QS-QZ Preclinical sciences (NLM Classification) > QT Physiology |
| Faculties/Schools: |
UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine |
| Item ID: |
56055 |
| Depositing User: |
Audsley, Sarah
|
| Date Deposited: |
19 Jul 2019 04:40 |
| Last Modified: |
07 May 2020 11:47 |
| URI: |
https://eprints.nottingham.ac.uk/id/eprint/56055 |
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