Research articleActive for Life: Final Results from the Translation of Two Physical Activity Programs
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:
- 1
How do the characteristics of program participants differ across study years?
- 2
How effective are the programs in increasing physical activity and improving related outcomes for older adults?
- 3
How consistent are effect sizes over time and settings as different cohorts of study participants undergo the same intervention?
- 4
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)?
Section snippets
Program Overviews
In the AFL initiative, Active Choices was a 6-month program delivered through one face-to-face meeting and up to eight one-on-one telephone counseling calls.14, 15, 16, 17 During the face-to-face meeting, the health educator established rapport with the participant and covered key programmatic material including a review of program expectations; the formulation of a physical activity plan and goals; a discussion of interests, motivation, perceived benefits, and perceived barriers to physical
Results
All Year-1 results were published elsewhere13 but are included in this manuscript to show data across years.
Discussion
Translational studies of evidence-based physical activity programs are needed to determine the feasibility of implementing physical activity programs in a variety of real-world settings with diverse populations over time, and once implemented, to determine if they produce comparable results.1, 3, 43, 44 AFL is an excellent example of a translational study and demonstrated the successful translation of two programs into a variety of real-world settings with a diverse older adult population. AFL
Conclusion
Better studies of the translation of research to practice are required in order to assess the external validity of evidence-based interventions.43 The AFL initiative demonstrates that a range of community-based organizations can not only implement evidence-based programs, but that substantial numbers of diverse older adults can receive physical and mental health benefits by participating in them.
References (50)
- et al.
Telephone interventions for physical activity and dietary behavior change: a systematic review
Am J Prev Med
(2007) - et al.
Reduction in cardiovascular disease risk factors: 6-month results from Project Active
Prev Med
(1997) - et al.
Evaluating the impact of behavioral interventions that target physical activity: issues of generalizability and public health
Psychol Sport Exerc
(2003) External validity
- et al.
Why don't we see more translation of health promotion research to practice?Rethinking the efficacy-to-effectiveness transition
Am J Public Health
(2003) - et al.
Diffusion and dissemination for increasing physical activity in world populations
Am J Prev Med
(2006) - et al.
How can we increase translation of research into practice?Types of evidence needed
Annu Rev Public Health
(2007) - et al.
Translating scientific discoveries into public health action: how can schools of public health move us forward?
Public Health Rep
(2006) - et al.
Pushing the boundaries of evidence-based research: enhancing the application and sustainability of health promotion programs in diverse populations
- et al.
Evidence-based interventions to promote physical activity: what contributes to dissemination by state health departments
Am J Prev Med
(2007)
From research to “best practices” in other settings and populations
Am J Health Behav
Translating effective clinic-based physical activity interventions into practice
Am J Prev Med
Recommendations to increase physical activity in communities
Am J Prev Med
The Behavior Change Consortium: setting the stage for a new century of health behavior-change research
Health Educ Res
Dissemination of physical activity promotion interventions in underserved populations
Am J Prev Med
Results of the first year of Active for Life: translation of 2 evidence-based physical activity programs for older adults into community settings
Am J Public Health
Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years
Circulation
Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: a randomized controlled trial
J Gerontol
Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults
J Gerontol
Evaluation of CHAMPS, a physical activity promotion program for older adults
Ann Behav Med
In search of how people changeApplications to addictive behaviors
Am Psychol
Social foundations of thought and action: a social cognitive theory
Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial
JAMA
Revision of the Physical Activity Readiness Questionnaire (PAR-Q)
Can J Sport Sci
Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium
Ann Behav Med
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2020, Contemporary Clinical TrialsCitation Excerpt :This type of interactive pre-enrollment educational session has been linked with high levels of study retention in health behavior change trials lasting through 18 months [20]. The two physical activity interventions and nutrition-control intervention are based on theoretically derived cognitive-behavioral advice and support strategies used in the evidence-based Active Choices physical activity counseling program and similar behaviorally based, evidence-supported interventions in the field [21–24]. They are grounded specifically in Social Cognitive Theory and Self-Determination Theory (See Fig. 1), which emphasize individually-tailored self-management and self-regulation skill building, personalized advice and feedback, cultivation of social support, and user-driven choice/decision-making to promote feelings of autonomy and sustained behavior change [25].
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