texercise select: building an evidence-based program in your own backyard doris howell, mph texas...

Texercise Select: Building an Evidence-Based Program in

your own backyardDoris Howell, MPH

Texas A&M Program on Healthy AgingCindy Quinn

Texas A&M Program on Healthy Aging

Aging in Texas Conference 2015

Acknowledgement

The evaluation of the Texercise program was funded through the Texas Department of Aging and Disability Services and completed through a partnership between the Texas A&M Health Science Center’s Program on Healthy Aging and the Scott & White Healthcare Community Research Center for Senior Health.

Background

• Lifestyle behaviors including physical activity are seen as key to healthy aging and well-being

• Increasing number of evidence-based programs

• Yet, a concern with program dissemination, costs and sustainability

What can we learn from practice-based

programs?

Purpose

• Introduce Texercise Select including example of program tools

• Examine effectiveness of 2012/2013 Texercise Select study on lifestyle behaviors, mental health outcomes, and physical functioning

• Discuss conclusions

• Review current and future

steps

Texercise Classic

• 12 week program• Community Cheerleader• 1 time a week• 12 week Daily Fitness logs and Pledge sheet

“No fancy gear, no health club dues – just a fun,practical guide to looking and feeling your best.”

Texercise Materials

Handbook DVD Pedometers Exercise bands Fact sheets

Texercise Select: Formation

September 2012 – August 2013 Implementation of Texercise Select for evaluation

September/October 2012 Creation of Texercise Select structured program incorporating behavioral change principles

September 2012 Texas A&M Health Science Center awarded RFI to evaluate Texercise program

2010/2011 DADS seeking evidence-based status for existing program

Texercise Select: Program Components

Participant Engagement• Physical

activity 30-45 min

• Education focusing on physical activity and nutrition topics

Trained Facilitators• Classes

led by at least one trained facilitator

Program Length• 12 Week

Program-10 weeks of classes

• 2 x/week for 90 min each

Potential Benefits of Participation• Increased self-

efficacy (pre/post)

• Improved physical activity and nutrition behaviors

• Improved mobility (TUG)

Texercise Select: Program Component Examples

Two-Step Action Plan

Texercises

Texercise Select: Two-Step Action Plan

• Participants set two (one physical activity and one nutrition based) broad goals

• Each week they set a two-step action plan, a task that they can accomplish in one week’s time that helps them towards their broader 10 week goals.

• Step 1 is what task they wish to do that week

• Step 2 is how often they will do that task within the week

Texercise Select: Texercises

• Facilitators lead participants through a series of exercises for 30-45 minutes.

• Exercises focus on improving endurance, strength, balance and flexibility

Warm-up/

Study Methods• Participants completed assessments at baseline

and the 10-week follow-up • Multiple domains assessed including physical

activity, eating behaviors, physical functioning, and quality of life with standard instruments

• Percent improvement and effect sizes were calculated to compare study results with other programs

• See papers for more detailed analyses

Study Characteristics

• Program Infrastructureo 4 training sessions-29 trained facilitatorso 14 workshopso 7 senior centers, 4 multipurpose facilities, 2 faith-based organizations, 1

senior housing facility

• Workshop Participantso Older: 74 years old o Female: 85% female o Non-Hispanic white : 93%o Multiple chronic conditions :

2.4 conditions

• Class attendanceo On average, attended 12 of the

20 workshop sessions

• 220 older adult enrollees with 127 completing the post test

Physical Activity and Nutrition*

Variable Baseline Mean

Post-Tx Mean

Improvement

Effect Size

Aerobic PA 3.9 4.6 16.3% .64

PA Confidence 6.1 7.4 18.9% .38

Fruit/Veggie consumption

3.3 3.8 12.7% .31

Dietary behavior confidence

7.6 8.2 7.4% .21

Social Support for Lifestyle Behaviors

9.0 11.4 26.7% .45

*significant at p<.05

Physical Functioning and Quality of Life*

Variable Baseline Mean

Post-Tx Mean

Improvement

Effect Size

Timed get up and go

12.9 s 11.7s 10.8% .27

General health status

2.9 2.8 7.2% .24

Unhealthy physical /mental health days

7.7 4.9 31.6% .24

Days Limited from usual activity

2.2 1.4 39.6% .17

*significant at p<.05

Texercise Select: Program Products

Structured Program Implementation Manual

Facilitator Training Protocol

Review of Texercise History and Reach

Report on Stakeholders Perceptions

Published Manuscript on Outcomes

Current Study• Study groups in Denton and Montgomery County• Accelerometers and TUG testing• Intervention and non intervention groups • Quality of life measures

Texercise Select: Feedback

“(Texercise is) a win- win for everyone; the older adults are happier and healthier and have a better quality of life and there is less need for the costly services.” 

“Great program!! I now carry a pedometer and walk at least 6,000 steps a day. And I try to eat 5 fruits and veggies a day. Plus the exercises are very appropriate for seniors. Thank you for hosting this program!” 

Future Directions

• Online Training• Achieve highest EBP

criteria• Offer program in

additional communities throughout Texas

• Offer Texercise program as complementary to other evidence-based programs/bundling (AMOB, CDSMP, DSMP, etc.)

Conclusions

• A multi-component lifestyle program can have many positive effects, with some variability across domains

• Program manualization and structured training are important for ensuring lifestyle programs are delivered with fidelity.

• Important to reduce barriers to full program participation

• Widespread dissemination requires capitalizing on and expanding traditional delivery systems

Resources• Ory, M. G., Smith, M. L., Jiang, L., Howell, D., Chen, S., Pulczinski, J. C., & Stevens, A.

B. (2014). Texercise effectiveness: Impacts on physical functioning and quality of life. Journal of Aging and Physical Activity, (in-press).

• Ory, M. G., Smith, M. L., Howell, D., Zollinger, A., Quinn, C., Swierc, S. M., & Stevens, A. B. (2014). The conversion of a practice-based lifestyle enhancement program into a formalized, testable program: From Texercise Classic to Texercise Select. Frontiers in Public Health Education and Promotion, (in-press).

• Ory MG, Smith MLS, Howell D, Zollinger A, Quinn C, Swierc S, and Stevens A. The Establishment and Evolution of Texercise: A Lifestyle Enhancement Program for Older Texans. Frontiers in Public Health Education and Promotion. In Review.

• Stevens AB, Thiel S, Thorud JL, Smith ML, Howell D, Cargill J, Swierc SM, and Ory MG. Increasing the Availability of Physical Activity Programs for Older Adults: Lessons Learned from Texercise Stakeholders. Journal of Aging and Physical Activity. In Review.

• Smith ML, Ory MG, Jiang L, Howell D, Chen S, Pulczinski J, Swierc S, and Stevens AB. Texercise Select Effectiveness: An Examination of Physical Activity and Nutrition Outcomes. Trans Behav Med. Provisionally Accepted 2014

Questions