Physical activity for older people and people with disabilities: evidence and examples of scalable programs

Purpose:
1. To overview evidence on physical activity programs for older adults and people with disabilities.
2. To showcase approaches that are suitable for delivery at scale.
3. To brainstorm other possible approaches and ways to increase global collaboration and resource sharing.

Description:
Older people and people with disabilities face additional barriers to being active and as a result many are less active than other sections of the population. Older people and people with disabilities are different but overlapping population groups with some similarities in the likelihood of mobility impairment, need for program adaptation, and contact with health services. There is a mounting body of evidence on the effectiveness of programs and services for older people and people with disabilities.
This symposium will commence with an overview of current evidence regarding physical activity for older people and people with disabilities using the framework of the WHO Global Action Plan on Physical Activity. Reviews of: programs and services for older adults, including those in low and middle income countries; sport for older adults; and sport and recreation for people with physical and intellectual disabilities will be summarised.
Symposium speakers will then showcase different initiatives that promote physical activity for older people and people with disabilities that may be suitable for scale up. Evaluations of programs involving phone coaching (CHANGE, COMEBACK trial programs), web-based support (Active women over 50, online yoga), and group exercise (REACT) will be presented. Insights from promoting frame running (a form of adaptive running) for people with disabilities around the world will also be presented and insights from qualitative work and consultation with people with lived experience will be shared.
There will be a facilitated discussion with the audience to brainstorm other initiatives and opportunities for global collaboration in development, implementation and evaluation of programs that promote physical activity for older people and people with disabilities at scale.

Chair: Prof Cathie Sherrington, University of Sydney, Australia.
Presenter 1: Prof Anne Tiedemann, University of Sydney, Australia.
Presenter 2: Prof Afroditi Stathi, University of Birmingham, UK.
Presenter 3: A/Prof Leanne Hassett, University of Sydney, Australia.
Presenter 4: Craig Carscadden PLY MBE, Worldability Sport, UK
Discussant: Dr Juana Willumsen, WHO Physical Activity Unit

Abstract 1.
Presenter 1: Prof Anne Tiedemann, University of Sydney, Australia.
Abstract title: Online delivery of physical activity behaviour change programs: key ingredients for success with people aged 50+.
Background: Online delivery of programs that promote physical activity has the advantage of convenience, accessibility, and low cost. Online approaches are particularly appealing to some older people and those in diverse locations.
Purpose: To describe the key ingredients and participant impressions of three remotely-delivered physical activity promotion programs in: a) the CHANGE trial (n=600), including health coaching and activity trackers, for people aged 60+; b) the SAGE yoga trial (n=700), an online group-based yoga program, for people aged 60+; and c) the Active Women over 50 program (n=60), an information, coaching and support program for women aged 50+.
Methods: Three RCTs were conducted to evaluate the effectiveness of the physical activity promotion programs. Process evaluations, involving qualitative interviews and self-report surveys, conducted alongside the RCTs, evaluated the mechanisms for program effectiveness and participant enjoyment.
Results: All programs were well adhered to and demonstrated benefits for physical activity and health outcomes. Central to these benefits, important aspects of health coaching that empowered older people to increase physical included trusting relationships, deep listening, flexibility, and realistic, collaborative goal setting. Facilitation of social networks and accountability, life-stage health information and positive framing to support self-responsibility were also key to success.
Conclusions: Online delivery of physical activity behaviour change programs to people aged 50+ is feasible, effective and likely to be cost-effective. Online programs have the potential to be offered affordably at scale and are well received by many people.
Practical implications: Older people value the convenience and accessibility of remotely delivered physical activity behaviour change programs involving health coaching and supervised exercise. Successful delivery is underpinned by tailored information and resources to suit the target audience, development of therapeutic alliance and trusting relationships.
Funding: The CHANGE and SAGE trials were funded by the National Health and Medical Research Council of Australia.

Abstract 2.
Presenter 2: Prof Afroditi Stathi, University of Birmingham, UK.
Abstract title: Scaling up the REtirement in ACTion (REACT) group-based intervention targeting older adults with mobility limitations.
Background: Mobility limitation in older age reduces quality of life, generates substantial health and social care costs and increases mortality.
Purpose: The REtirement in ACTion (REACT) trial established that a community-based, active ageing intervention can prevent decline in physical functioning in older adults already at increased risk of mobility limitations.
Methods: We recruited 777 older adults (mean age 77.6 yrs (SD 6.8 yrs); 66% female; with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] mean score 7.37, (SD 1.56) from three sites (Bristol/Bath; Birmingham; Exeter) in England. In terms of ethnicity (95.11% white) and deprivation, the sample was representative of the UK population of people 65+. Participants were randomly assigned to receive three healthy ageing sessions (n = 367) or a 12-month, group-based, multimodal programme including group exercise, social and behavioural maintenance sessions (n = 410) delivered by qualified exercise specialists.
Results: At 24-month follow-up, SPPB scores were significantly greater in the intervention arm than in the control arm. Difference in lower limb function was clinically meaningful at both 12 and 24 months. The health economic analysis indicated substantial quality-of-life and health economic benefits within the 24-month trial window and across a lifetime horizon.
Conclusions: A relatively low-resource, 1-year multimodal exercise, social and behavioural maintenance intervention helps older adults to improve and retain physical functioning for at least 24 months. Currently, together with community organisations we are co-producing a strategy for rolling out REACT nationally.
Practical implications: REACT is currently being rolled out in Bristol, UK. Key successes include reaching an ethnically diverse population, good adherence to the programme and adoption of REACT by diverse organisations. Points for attention include ways to refine the referral process and create a sustainable strategy to meet demand for REACT exercise instructors.
Funding: The NIHR-PHR Programme (13/164/51). BNSSG ICB Ageing Well Programme.

Abstract 3.
Presenter 3: A/Prof Leanne Hassett, University of Sydney, Australia.
Abstract Title: Physical activity coaching and text messages for adults with walking difficulties: The ComeBACK trial
Background: Impaired mobility is a common and serious form of physical disability. Physical activity participation has enormous untapped potential to improve mobility and overall health in this population, however interventions need to be developed and evaluated that meet the needs of this population and are scalable.
Purpose: To develop and evaluate two scalable physical activity interventions (an enhanced and a less intensive intervention) for adults with walking difficulties.
Methods: A 3-arm pragmatic randomised controlled trial was conducted. Adults with self-reported walking difficulties were randomised to one of three groups receiving the following 6-month interventions: 1) Coaching to ComeBACK (physiotherapy assessment, physical activity plan, fortnightly physiotherapy-led phone health coaching supported with activity monitors and resources); 2) Texting to ComeBACK (single session of tailored phone advice, physical activity plan, text messages and resources); 3) Texting to ComeBACK Later. Intervention development was informed by stakeholder input, theories of behaviour change, and guided by the PRACTIS implementation and scale-up framework. Benefits of the interventions and intervention components were rated by participants on a 0 to 10 scale.
Results: 512 participants were randomised into the trial. Participants were on average older adults (mean(SD): 69(10)) with majority female (76%). The Coaching to ComeBACK intervention was rated as very beneficial (mean(SD): 8.4(1.6)) with the health coaching and Fitbit the highest rated components (8.7(1.7) each) and website resources the least (5.3(2.8)). The Texting to ComeBACK intervention was rated as less beneficial than the coaching intervention (5.9 (2.8)), however the single session of tailored phone advice was rated as a very beneficial component (8.3(1.9)).
Conclusions: These results indicate tailored phone-based interventions to increase physical activity in adults with walking difficulties are well received by most participants.
Practical implications: Phone-based health coaching is a scalable and valued physical activity intervention in adults with disability.
Funding: Australian NHMRC project grant (APP1145739).

Abstract 4.
Presenter 4: Craig Carscadden PLY MBE, Paralympian, Chief Development Officer, Worldability Sport, UK
Abstract title: Runfree project: global support of Frame Running
Background: Frame Running is a form of adaptive running. It allows individuals with severe motor and co-ordination impairments to run, with the help of a three wheeled frame. The frame provides the individual with the necessary support and stability which allows them to ambulate. It is one of the few activities that gives individuals with this level of impairments the opportunity to participate in aerobic exercise.
Program delivery: The Runfree project developed a strategic event series concept around the sport of Frame Running. The concept comprises replicable and adaptable tools with practical recommendations on how to reach out and engage people with cerebral palsy and related neurological conditions to take part in Frame Running at a local and national level. The tools include resources on how to hold a ‘Have a Go’ day, an entry level competition, a coaching course, and awareness raising measures including an animated video.
Evaluation: Tools were created and piloted on how to hold a Frame Running Have a Go day, an entry level competition and a coaching course. Awareness raising materials were developed including an animated video. 17 different tools were created in total for the RUNFREE project, all of which are available on the RUNFREE website in three languages. A graphic is available which shows how the tools work together and everything is free to download and translate as appropriate. Due to the success of the project the tools have now been translated into 6 languages including Cantonese, Japanese and Arabic. The Introduction to Frame Running Workshop is now being delivered regularly worldwide either in person or online to coaches, teachers, and physiotherapists by World Abilitysport or other organisations. It has also been incorporated into Athletics Federations training resources.
Conclusions and practical implications: The tools created by the project have been the catalyst for the growth of Frame Running.
Funding: Erasmus+ Programme of the European Union