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Innovative Physical Activity Programs: The Implementation Challenge

This is an introduction to a symposium in which researchers explain why it is important to carry out research in the area of effective and innovative PA programs and methods for the elderly.

Marijke Hopman-Rock, TNO Quality of Life, Leiden, the Netherlands; Marcia Ory, School of Rural Public Health, Texas A&M Health Science Center; Ellen Freiberger, Institute of Sport Sciences, Erlangen, Germany; Yukitoshi Aoyagi, Exercise Sciences Research Group, Tokyo Metropolitan Institute of Gerontology, Japan; in cooperation with Roy Shephard

During the last 10 years a lot of scientific effort has been put into the development and evaluation of effective and innovative PA programs and methods for the elderly. Many programs have been evaluated and launched, but less is known about their fate. What happened to them after their introduction? Did they reach the intended public? What are the enabling factors and what are the barriers? In this symposium it is explained why it is important to carry out research in this area, and what we can learn of experiences in the introduction of new PA programs and methods for the elderly. We call this the "Implementation challenge."

There has been a recent burgeoning of evidence-based physical activity programs which are now being translated into community settings. The underlying question is the extent to which such programs can reach large numbers of adults with similar findings as in the original studies. Two examples from the American experience will be presented to illustrate the successes and challenges of such implementation efforts: 1) Active for Life-a privately funded 12 site program to increase physical activity through one of two evidence-based programs; and 2) the federal Choices for Independence Evidence-based Program which is examining several different activity related programs across 24 states. Topics to be discussed include the benefits of establishing new partnerships to further program reach, the need to balance program fidelity with program adaptation; the importance of up-front attention to sustainability issues.

During the last decades researchers have well established the important influence of physical activity in reducing the risk of chronic disease and improving health related quality of life. Less successful has been research when it comes to the part of translating evidence based results into dissemination. Many successful interventions have not made their way into a wider implementation. Different reasons are responsible for this lack of success. One is the educational aspect for certified instructors. To implement evidence based programs, educating instructors for these programs is an urgent challenge.

The presentation will demonstrate the pathway of an ongoing successful dissemination of an evidence based intervention program in community-dwelling people for fall prevention. In 2003 a research project started with the aim to reduce number of falls and fall frequency in 70-90 year old active community-dwelling older persons. Different interventions were investigated for impact on falls as well as health related outcomes, e.g., physical, cognitive, social variables. In a second step a curriculum was developed for an educational program to certify instructors. This curriculum was implemented by the German Association of Sport Therapy. Certification courses have been held now already for 2 years and data will show the impact of certification and education on the dissemination of an intervention program on a national level of Germany.

Pedometer guidelines for walking prescriptions: Habitual moderate-intensity physical activity is associated with a reduced risk of various chronic health conditions, including certain cardiovascular and musculoskeletal diseases and some cancers, in older adults as in younger individuals. However, the required pattern of physical activity has remained unclear, since most investigators have used either subjective questionnaires, or accelerometer or pedometer measurements limited to a single week, despite clear evidence of both the unreliability of questionnaires and seasonal changes in activity patterns. Since 2000, we have thus been conducting a longitudinal interdisciplinary study on the habitual physical activity and health of elderly Japanese living in a medium-sized town (the Nakanojo Study). In about one-tenth of >5,000 subjects 65 years of age, physical activity has already been assessed for >6 years by means of a specially adapted accelerometer; this has a storage capacity of 36 days and can distinguish >10 intensities of physical activity (expressed in metabolic equivalents, METs). Habitual physical activity decreases exponentially to approximately 4,000 steps/day as precipitation increases. Excluding the influence of rainfall, the daily step count peaks at a mean outdoor temperature of around 17 °C; above and especially below this temperature, physical activity decreases as a quadratic function. Seasonal changes in microclimate should thus be considered when designing interventions intended to increase the quantity and quality of habitual physical activity in elderly people.

Facing the implementation challenge of innovative physical activity programs: Who bakes the cake? The pathway from basic research to implementation of physical activity programs is viewed from the perspective of the researcher and from the perspective of the practitioner, illustrated with examples of the presenter’s research. Also, some basic principles of the diffusion theory of Rogers are given and the RE-AIM framework of Glasgow is introduced to support research on innovation processes. Finally, there will be a discussion about the possibilities of the so-called "reinvention" of programs. This means that field organizations and practitioners may "bake their own cake" (i.e., PA programs and interventions) after they have been supplied with the basic effective ingredients.

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