Research has found that most individuals and societies are willing to enhance their physical activity and improve nutritional behavior, and they are likely to respond to strategies that increase social support for physical activity initiatives and improve access to venues where they can exercise-but how to implement and deliver such strategies in practice?
One approach is the "Please, join us exercising while you are talking us," which is the main rule of the evidence-based Exercise Looks After You (ELAY) program, an innovative and cost-effective sociosanitary strategy developed in Extremadura, Spain. The program is a community-dwelling walk-based action addressed to elderly people. Basically, general practitioners refer elderly with metabolic syndrome risk (overweight, diabetes type II and hypertensive) or moderate depression to sports-activity-linked primary care centers who periodically assess participants (fitness, psychosocial and biological tests) and deliver a structured walk-based program in a group setting (including talks and some exercises 4 days a week). Therefore, this type of program can include an inexpensive screening method and recruitment in primary care by adding the advice for usual exercise, with four major psychosocial reinforcements to enhance physical activity (primary care counseling, interaction to sports technician and peers, and periodical assessment reports about fitness level and health-related quality of life to patient and primary care team to reinforce the coordination between the community program and the public health system), and easy access to walking venues in urban and rural areas.
The program administration included: 1) The development of cross-sectoral public regional policies at the highest government levels (the departments of Health, Sports and Welfare) because the supplier of services is frequently different from the department which enlists the benefits, and the University assesses the development and evaluation and provides data to authorities for mass media; 2) The development of cross-sectoral and multilevel consensus on the delivery protocol; 3) The specific educational process of the professionals who deliver the program; 4) Publicizing of the program to different collaborators and partners.
On the whole, the program is linked to the National Health Service through Primary Care Centers, the Public Welfare Service through Centres for Old People, and the Public Sports System through its personnel ("sport-health dynamizers").
The Evaluation: Each elderly user is evaluated at baseline, 3 months, and every 6 months. The main outcomes are sociodemographic issues, referral process, health status (morbidities, Geriatric Depression Scale, cholesterol, triglycerides, blood pressure, etc.), mini nutritional assessment, health-related quality of life (EQ-5D), and use of the health system and fitness.
Results: After the first year, 22 sport technicians work weekly with more than 3,000 elderly living in 67 municipalities who changed some pills and consultations for walks and chatting. The elderly significantly improved fitness and mental health (flexibility, 6-min walking distance, agility and balance, reducing the fall risk, etc.) and 30% in depression. The program obtained high social visibility: thousands of elderly exercising outdoors, more than 120 mass media impacts, cooperation in more than 30 local health events, etc. Regional political parties included the further development of ELAY in their programs for the elderly and obese children. The current public health program was also cost-effective from both the biomedical and political perspectives.
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