Community-based Exercise Program Research Articles

'The illness isn't the end of the road'-Patient perspectives on the initiation of and early participation in a multi-disease, community-based exercise programme.

Exercise is the cornerstone of cardiac rehabilitation (CR). Hospital-based CR exercise programmes are a routine part of clinical care and are typically 6-12 weeks in duration. Following completion, physical activity levels of patients decline. Multi-disease, community-based exercise programmes (MCEP) are an efficient model that could play an important role in the long-term maintenance of positive health behaviours in individuals with cardiovascular disease (CVD) following their medically supervised programme. To explore patients experiences of the initiation and early participation in a MCEP programme and the dimensions that facilitate and hinder physical activity engagement. Individuals with established CVD who had completed hospital-based CR were referred to a MCEP. The programme consisted of twice weekly group exercise classes supervised by clinical exercise professionals. Those that completed (n = 31) an initial 10 weeks of the programme were invited to attend a focus group to discuss their experience. Focus groups were transcribed and analysed using reflexive thematic analysis. Twenty-four (63% male, 65.5±6.12yrs) patients attended one of four focus groups. The main themes identified were 'Moving from fear to confidence', 'Drivers of engagement,' and 'Challenges to keeping it (exercise) up'. Participation in a MCEP by individuals with CVD could be viewed as a double-edged sword. Whilst the programme clearly provided an important transition from the clinical to the community setting, there were signs it may breed dependency and not effectively promote independent exercise. Another novel finding was the use of social comparison that provided favourable valuations of performance and increased exercise confidence.

Barriers and Benefits of Online Group Exercise Programs for Older Adults.

Engaging in regular physical activity offers a myriad of benefits, including the improvement of mental health, social well-being, and cognitive function. Unfortunately, obstacles, such as transportation constraints, time limitations, and inadequate exercise facilities, hinder the regular participation of older adults in physical activity. Online group physical activity programs present a promising solution to enhance the involvement of older adults; however, several barriers impede their effective utilization. To explore these barriers and benefits, we conducted semi-structured interviews with participants and instructors of a community-based exercise program. Thematic analysis of interviews with 12 physical activity instructors and eight program participants unveiled key hindrances, including limited awareness and accessibility of online programs, challenges in assessing performance during exercise sessions, lack of social component, and technological difficulties. On the positive side, the benefits encompass convenience, wide accessibility, and enhanced social comfort. We also deliberate on future considerations to further bolster participation in these programs.

How to Build and Sustain a Transdisciplinary Community-based Exercise Program for Older Adults

We have built a community-based program called Stay Strong, Stay Healthy, which helps older adults improve muscle strength and flexibility while reducing fall risk. This report details lessons learned and keys to success for Extension practitioners. First, maximize the potential of your state’s Extension framework by building a program that centers around your target population and is fun and easy to implement. Second, partner with researchers who can help to improve program effectiveness and logistical feasibility on larger scales. Lastly, continue to evaluate and adapt based on feedback from those who utilize and implement the program.

Examining Model Similarity for Exercise Self-Efficacy among Adults Recovering from a Stroke: A Community-Based Exercise Program

We used a single-case experimental research design to examine the effect of modelling (peer versus non-peer) on exercise self-efficacy in stroke survivors who participated in a community-based exercise program. Data were obtained using an ABCA design: (A1) no model/baseline 1 (3 weeks); (B) peer model (6 weeks); (C) non-peer model (6 weeks); and (A2) no model/baseline 2 (3 weeks). Four participants completed self-efficacy questionnaires after each weekly session. Overall, participants reported higher exercise self-efficacy in the model conditions (Cohen’s d range from −0.37 to 4.22), with ratings appearing highest for the non-peer model. Modelling in general may help stroke survivors increase their exercise self-efficacy. Lastly, we provide our reflections on the pragmatics of completing a study within a community setting.

Losing Ground Following Community Exercise Program Closures: A Qualitative Descriptive Study of the Impact of COVID-19 Related Pandemic Restrictions on Exercise Participation, Physical Activity, and Health of Older Adults with Balance and Mobility Limitations

Purpose: To understand the impact of COVID-19-related closures of community-based exercise programs (CBEPs) on exercise participation, physical activity, and health of older adults with balance and mobility limitations; facilitators, and barriers to exercise and physical activity; and preferred support from recreation centres and healthcare providers. Method: This qualitative descriptive study involved semi-structured interviews with seven older adults (aged 50–76 years) with balance and mobility limitations, enrolled in CBEPs at a recreation centre in a suburban area in Canada prior to the COVID-19 pandemic. We conducted a thematic analysis. Results: One major theme, losing ground in the absence of structured exercise, was identified. Despite engaging in alternative at-home or outdoor activities, participants perceived a worsening of their balance and mobility, dissatisfaction with the extent of exercises and physical activity, and loss of social connectedness. Participants desired structured, individualized exercise resources, and frequent check-ins from exercise instructors to stay physically active during program suspension. Conclusions: Following CBEP closures, older adults with balance and mobility limitations from a single recreation centre perceived declines in physical and mental health, exercise participation and social interaction, and desired personalized exercises and communication from exercise instructors. The small sample size may have limited achievement of saturation.

Community-based exercise program, self-reported health-related symptoms, and quality of life in persons with traumatic brain injury 45 + years old.

Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise. To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI. Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45-80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality. AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms. This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI.

The impact of digitalized community-based square-stepping exercise program on cognitive and balance functions among older adults living in senior facilities: a pilot study

Abstract Objectives: Older adults exhibit a high desire for active and healthy aging without physical or mental dysfunction, particularly those living independently in senior facilities. Preserving or improving cognitive function and minimizing fall risks are essential for older adults to live a happy and active lifestyle. The purpose of this pilot study was to examine the feasibility, safety, and preliminary effectiveness of the innovative digitalized community-based square-stepping exercise program (DC-SSEP) in improving cognitive and physical function among older adults residing in senior facilities. Methods: Guided by the Health Promotion Model and Social Cognitive Theory, this pilot study used a quasi-experiment design with one intervention group. A total of 17 older adults recruited from a senior facility in Southern Texas participated in 40 sessions of DC-SSEP over 20 weeks. Cognitive function was measured using the latest version (8.1) of Montreal Cognitive Assessment and the balance function focusing on balance and functional mobility was measured using Berg Balance Scale and Time to Up and Go. Results: Most participants were non-Hispanic white women. The DC-SSEP was a feasible and safe exercise program for older adults living in senior facilities; and the results showed the preliminary effectiveness of the DC-SSEP in improving cognitive and balance function (P < 0.01) among older adults. Conclusion: This pilot study is distinctive as it is among the first to evaluate the multi-layered impacts of DC-SSEP using Internet of Things (IoT) technology and integrated operating software in the United States. Despite the small sample size and homogeneity of participants, this pilot study suggests multiple valuable directions for future research using DC-SSEP.

The Effect of Community-Based Exercise on Health Outcomes for Indigenous Peoples with Type 2 Diabetes: A Systematic Review.

Indigenous peoples globally experience a high burden of type 2 diabetes in comparison to non-Indigenous peoples. While community-based exercise interventions designed for type 2 diabetes (T2D) management have garnered success in non-Indigenous populations, they likely require adjustments to meet the needs of Indigenous people. This systematic review aims to determine if health outcomes in Indigenous peoples with T2D could be improved by community-based exercise programmes and the features of those programmes that best meet their needs. The CINAHL, Embase, Informit Indigenous Collection, Medline, PubMed, Scopus, SportDiscus, and Web of Science databases have been searched to identify peer-reviewed literature with original outcome data that report on the health effects of community-based exercise interventions for the management of T2D among Indigenous peoples. The Mixed Methods Appraisal Tool and Indigenous Community Engagement Tool were implemented to assess methodological quality. Three moderate-to-high-quality studies were selected for review, including participants of Polynesian or Native American Zuni Indian descent. Results indicated positive effects of group exercise on glycated haemoglobin (HbA1c), body mass index, body weight, total cholesterol, blood pressure, quality of life, and patient activation levels in high-adhering participants. This review concludes that community-based exercise interventions may improve health outcomes for Indigenous adults with T2D when conducted with strong community engagement.

Development of an exercise therapy referral clinical support tool for patients with osteoporosis at risk for falls.

The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence-based exercise therapy programs. A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one-on-one physical therapy, group physical therapy, home health, community-based exercise programs, and not acceptable for exercise therapy. Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk.

1880 Improving physical activity in hospitalised older people: The Saints Foundation - University Hospital Southampton Partnership

Abstract Introduction Deconditioning in the acute setting is associated with adverse outcomes, that cannot always be mitigated by increasingly stretched MDT workforce. We partnered with the Saints Foundation (SF), to test the feasibility and acceptability of a non-clinical Exercise Practitioner (EP) to work alongside therapies to promote physical activity (PA) of hospitalised older people. Methods Charity funded joint appointment of an NVQ3 EP with Postural stability Instructor (PSI) qualifications delivered quality education and rehabilitation programmes to hospitalised older patients. These took place in both one to one and gym-based group settings whilst working with the SF team to improve access to community-based exercise programmes. Results Between Sept 2022 and May 2023, the EP assessed 169 patients, mean age 86 yrs; male (62%), admitted after a fall. 105 patients (62%) underwent one to one rehabilitation consisting of falls education and individual exercise plans, 64 patients (38%) underwent gym-based rehabilitation, where strengthening and balance exercises were conducted in groups to improve overall function and increase confidence in functional ability. No adverse safety incidents were reported and a high level of satisfaction after interaction with the EP was conveyed. Initial focus was on patient feedback and satisfaction to ensure input o+- f an EP was well received and accepted. Conclusion Intervention by a non-clinical EP to improve the PA of hospitalised older people is acceptable, feasible, appears to be safe and is associated with increased patient satisfaction. By capitalising on SF expertise, we provided a clinical standard on exercise for older adults and built a strong relationship between our workforce to bridge community and acute services. Next steps are to increase the scope of interventions, evaluate quality of life pre and post hospitalisation, capture trust level metrics including length of stay, readmission rates and discharge destination to further evaluate the impact on service users.

Experiences and perspectives of integrating nutrition education into an exercise program for people with chronic medical conditions.

Community-based healthy eating and exercise programs are effective interventions to support some people with chronic conditions. This research aimed to explore the experiences and perceptions of participants regarding the integration of nutrition education into a successful group based exercise program for people with chronic medical conditions. Semi-structured interviews were conducted with past participants of a community based group exercise program (Health Moves) with embedded nutrition advice based in a regional area of New South Wales. A total of 60 individuals who had participated in the Health Moves program between 2017 and 2019 were invited to participate and 19 (32%) randomly selected participants consented to be interviewed. Interviews explored participants' experiences, program impacts, and barriers to sustaining changes post program. Similar concepts and patterns were grouped into themes. Four themes were identified that described the experiences with a community-based group exercise intervention with a nutrition component. The major themes evident were that Health Moves facilitated motivation (via access to health professionals, peer support, accountability, affordability); and there were challenges identified to sustaining change (including cost, comorbidities, end of program support, environmental factors); Nutrition advice was valuable for some but not for all (difficulty recalling nutrition components, superficial coverage) Practical and interactive nutrition advice is desired. Participants expressed a high degree of satisfaction with the program but require ongoing support to sustain changes post program. The position and integration of nutrition education within this exercise program was perceived by participants to be suboptimal. Increased access to practical, interactive nutrition education components may improve participant satisfaction and engagement. SO WHAT?: Key findings from this research include a desire for removal of didactic nutrition education sessions and request for increased peer support. Modifications to the program include the integration of interactive self-paced nutrition modules. Peer support partnerships are now encouraged by trainers to support ongoing motivation of participants to keep training together outside the structured exercise program and transition to managing their own exercise routine. Discussions between organisations involved about ongoing pathway/program support or reduced cost 'off peak' gym membership is underway to help with costs incurred by participants.

Scoping Review of Videoconference Online Exercise Programs for Cancer Survivors in Community Settings

ABSTRACT Context Given the rapid transition of many cancer-specific community-based exercise programs to videoconference-delivered online exercise (VOE) during the coronavirus disease 2019 pandemic, little is known about the reach, effectiveness, adoption, implementation, and maintenance of these programs. Objective The purpose of this scoping review was to synthesize practice-based information regarding VOE programs for cancer survivors in community-based settings. Design To identify relevant programs, searches were conducted for peer-reviewed articles published in electronic databases and programs listed in the Moving Through Cancer directory. Eligibility Criteria To be included, programs had to meet the following criteria: 1) participants were adult (>18 yr) cancer survivors, 2) included one or more VOE sessions in addition to any preprogram assessment/intake, and 3) defined as a community-based program with a primary focus of delivering a service to cancer survivors. Study Selection A total of 16 programs were included in the review. Main Outcome Measure Descriptions of 1) reach, 2) effectiveness, 3) adoption, 4) implementation, and 5) maintenance of the identified programs. Results All studies described at least one element of reach (80%), adoption (86%), and implementation (80%). Fewer programs reported on indicators of efficacy/effectiveness (25%) and individual-level maintenance (0%). Conclusions VOE programs may be viable for engaging cancer survivors, but more information is needed to understand VOE programs in community-based settings. Findings from this review reveal that more work is needed, particularly in the elements of reach, efficacy/effectiveness, and individual-level maintenance. Research on community-based programs should continue in order to better understand what contributes to successful implementation of VOE programs and the effects for cancer survivors.

건강증진을 위한 지역사회 기반 비대면 운동프로그램의 개발 및 적용 지역사회 주민 대상 건강증진프로그램 참여 효과 검증을 위한 일차 연구

건강증진을 위한 지역사회 기반 비대면 운동프로그램의 개발 및 적용 지역사회 주민 대상 건강증진프로그램 참여 효과 검증을 위한 일차 연구

Connecting Older Adults and Doctor of Physical Therapy Students Through a Community-Based Exercise Program: A Qualitative Study

ABSTRACT The purpose of this qualitative study was to develop an understanding of the perspectives of older adults regarding their experiences participating in a service learning project with doctor of physical therapy students engaged in an integrated clinical experience (ICE). The students designed and implemented individualized fitness plans for older adult participants. A descriptive phenomenological approach obtained the perspectives of 16 older adults. Six themes emerged from the thematic analysis: blending of the generations, it motivated me, I can do it now, mental and social boost, program tailored to me, and learn and modify habits. Participant interviews highlighted how older adults valued the relationships with students, and how the intergenerational environment of the program benefited their physical, social, and mental well-being. These findings support existing literature on intergenerational programs, but this is one of the few studies that looked specifically at an intergenerational ICE experience from the perspective of the participants.

CONNECTING OLDER ADULTS AND DOCTOR OF PHYSICAL THERAPY STUDENTS THROUGH A COMMUNITY-BASED EXERCISE PROGRAM

Abstract The purpose of this qualitative study was to explore the perspectives of older adults regarding their experience participating in an intergenerational Integrated Clinical Experience (ICE) with Doctor of Physical Therapy (DPT) students. This ICE was designed as a community-based exercise program for older adults. DPT students designed individualized one-hour fitness plans for participants every week over the course of a semester. To obtain the perspectives of older adults, a descriptive phenomenological approach was chosen. A purposive sample of 16 older adults involved in the wellness program participated in 6 focus groups and one interview. Results of the thematic analysis revealed six themes; Blending of the Generations, It Motivated Me, I Can Do It Now, Mental and Social Boost, Program Tailored to Me, and Learn and Modify Habits. Participant interviews highlighted how older adults highly valued the relationships with students, and how the intergenerational environment of the program benefited their physical, social, and mental well-being. They also noted how students served as a source of motivation, leading to behavioral change and improvements in functional outcomes. These findings support existing literature on intergenerational programs, but this is one of the few studies that looked specifically at an intergenerational ICE. This ICE provided an innovative manner to meet the physical challenges faced by many older adults, and the intergenerational nature of the experience may have contributed to the well-being of all those involved. Future research using quantitative methods are needed to extend what was learned beyond the specific context of this study.

"It has to be more than exercise": exploring multiple perspectives to community-based exercise program design for persons with breast cancer.

Connecting persons with cancer to exercise resources and/or supports requires a diverse team of professionals. As such, there is merit to engaging multiple individuals or "partners" along the cancer pathway to explore the relevant features of community-based exercise program (CBEP) design. The purpose of this study was to explore multi-partner perspectives to CBEP design for persons diagnosed with breast cancer (PWBC) to inform the implementation of a CBEP in a local setting. PWBC, health care professionals and qualified exercise professionals participated in one of four 60-min focus group discussions. Rich dialogue about preferred program environments, program delivery teams, and core program practices was encouraged using a semi-structured discussion guide. Focus groups were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Five main themes were identified based on focus group discussions, each pointing to an important feature of CBEP design for PWBC. Themes included the desire for CBEPs to incorporate elements designed to improve cancer literacy, provide opportunities to participate with peers, foster self-efficacy, prioritize program accessibility, and meaningfully integrate CBEPs within a network of supportive cancer care. The collective effect of fostering such elements in CBEPs may serve to increase the uptake and maintenance of exercise among PWBC; ultimately enhancing their overall well-being and quality of life.

O.4.4-3 Developing a bespoke undergraduate physical activity course for a Portuguese Medical School - the VANGUARD European Union Erasmus+ project

Abstract Purpose Embedding physical activity in the undergraduate curricula of frontline health professionals is one of the policies recommended by the World Health Organization and the European Commission to promote health-enhancing physical activity (HEPA). The VANGUARD project is supported by the European Union Erasmus+ Programme, and aims to embed physical activity in the undergraduate curricula of healthcare professionals in European countries. Within this project, this work aimed to describe the bespoke development of a physical activity and health course integrated into the undergraduate medical curriculum of a Portuguese Medical School. Project or policy description The School of Medicine and Biomedical Sciences of the University of Porto (ICBAS) was the invited Medical School to implement the VANGUARD project in Portugal - led by the Institute of Public Health of the University of Porto (ISPUP). An auscultation process with the undergraduate medical students was held to evaluate the importance of HEPA in their curriculum and assess the preferred operational characteristics of including a physical activity and health course in the Integrated Master’s degree in Medicine. A course proposal structure was then developed by the VANGUARD project Portuguese team from ISPUP, the Director of the Integrated Master’s degree in Medicine, and the Coordinator of the Medical Education Office of ICBAS, based on the students’ acceptability, the Medical School constraints, and VANGUARD project goals and resources. The course integrates 26 lessons, from physical activity technical terminology, epidemiology and guidelines, going through its relation with noncommunicable diseases (using #MovementForMovement resources), to Portuguese National Health Service brief intervention tools and community-based exercise programs - in a total of 20 hours of contact, including continuous evaluation and final case studies analysis. The course will be offered on an optional basis to 2nd-year medical students, on an online training platform, using a self-paced learning method. After embedding this course in ICBAS, it will be presented to the Council of Portuguese Medical Schools to be scaled up nationally. Conclusions Medical doctors and Medical Schools are key stakeholders in HEPA promotion, especially in the health sector. Successful implementation of HEPA policies requires tailored solutions to organizations and direct involvement of target groups in policy development.

Attrition Of Well-healed Burn Survivors To A 6-month Community-based Exercise Program: A Retrospective Evaluation

Attrition Of Well-healed Burn Survivors To A 6-month Community-based Exercise Program: A Retrospective Evaluation

Perspectives of professional experts in relation to the development of community-based exercise for young adults with schizophrenia: a qualitative study

Physical activity is a key modifiable factor in protecting physical and mental health in people with severe mental illness including schizophrenia. Therefore, early promotion of physical activity is recommended and...

What matters to program partners when implementing a community-based exercise program for people post-stroke? A theory-based qualitative study and cost analysis.

Community-based exercise programs integrating a healthcare-community partnership (CBEP-HCP) can facilitate lifelong exercise participation for people post-stroke. Understanding the process of implementation from multiple perspectives can inform strategies to promote program sustainability. To explore stakeholders' experiences with undertaking first-time implementation of a group, task-oriented CBEP-HCP for people post-stroke and describe associated personnel and travel costs. We conducted a descriptive qualitative study within a pilot randomized controlled trial. In three cities, trained fitness instructors delivered a 12-week CBEP-HCP targeting balance and mobility limitations to people post-stroke at a recreation centre with support from a healthcare partner. Healthcare and recreation managers and personnel at each site participated in semi-structured interviews or focus groups by telephone post-intervention. Interviews and data analysis were guided by the Consolidated Framework of Implementation Research and Theoretical Domains Framework, for managers and program providers, respectively. We estimated personnel and travel costs associated with implementing the program. Twenty individuals from three sites (4 recreation and 3 healthcare managers, 7 fitness instructors, 3 healthcare partners, and 3 volunteers) participated. We identified two themes related to the decision to partner and implement the program: (1) Program quality and packaging, and cost-benefit comparisons influenced managers' decisions to partner and implement the CBEP-HCP, and (2) Previous experiences and beliefs about program benefits influenced staff decisions to become instructors. We identified two additional themes related to experiences with training and program delivery: (1) Program staff with previous experience and training faced initial role-based challenges that resolved with program delivery, and (2) Organizational capacity to manage program resource requirements influenced managers' decisions to continue the program. Participants identified recommendations related to partnership formation, staff/volunteer selection, training, and delivery of program activities. Costs (in CAD) for first-time program implementation were: healthcare partner ($680); fitness coordinators and instructors ($3,153); and participant transportation (personal vehicle: $283; public transit: $110). During first-time implementation of a CBEP-HCP, healthcare and hospital managers focused on cost, resource requirements, and the added-value of the program, while instructors and healthcare partners focused on their preparedness for the role and their ability to manage individuals with balance and mobility limitations. Trial Registration: ClinicalTrials.gov, NCT03122626. Registered April 17, 2017-Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03122626.