Abstract
BackgroundAs the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.Methods/designThe Peer Empowerment Program 4 Physical Activity’ (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.DiscussionUsing a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.Trial registrationClinicalTrials.gov, USA (NCT02405325). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set.
Highlights
As the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, in ethnically diverse, low income senior centers where access is limited
Less than 3% of older adults are meeting physical activity (PA) guidelines when objectively measured by accelerometer, despite well documented health benefits of PA [2]
Given the burden of inactive older adults on the healthcare system, and the relatively low costs of PA interventions, it is imperative that a greater number of older adults have access to efficacious, evidence based PA programs and neighborhoods that support PA [6]
Summary
As the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, in ethnically diverse, low income senior centers where access is limited. The National Institutes of Health is supporting more research into multi-level interventions that are hypothesized to be more scalable and sustainable [8] and is advancing a more scientific approach to dissemination and implementation studies to assess and enhance the effectiveness and sustainability of evidence based interventions [9]. These initiatives and the Surgeon General’s Call emphasize the importance of community settings with organizational infrastructure, financial support, and community reach for program delivery
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