Effectiveness of the On the Move group exercise program to improve mobility in community-dwelling older adults
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PROJECT SUMMARY Walking is important for maintaining independence and is highly valued by older adults. Evidence continues to accumulate on the positive impact of group exercise programs on the health of older adults. Our team developed On the Move (OTM), a group exercise program to improve walking in older adults. A PCORI-funded cluster randomized trial demonstrated that OTM was superior to a usual care exercise program for improving walking ability. Though we and others have demonstrated the benefits of improving mobility through exercise, the programs are seldom used outside of the research setting (i.e. evidence-practice gap). In our PCORI trial, we began to address this evidence-practice gap by conducting OTM in community settings, however, the intervention was delivered by research personnel. The next step in the development of OTM as a fully implementable intervention is to conduct an effectiveness (Stage IV) study in which the intervention is delivered in community settings by community providers. Interventions tested in highly controlled trials often do not yield the same outcomes when applied in a real-life context in effectiveness trials. Poor intervention fidelity may cause this dilution of effect, as it can reduce intervention potency and potentially lead to faulty conclusions about (lack of) effectiveness. When transitioning from more controlled to less controlled environments it is imperative to monitor and measure intervention fidelity to accurately interpret the research findings. Therefore, we propose a Hybrid I trial, which blends effectiveness and implementation (i.e. intervention fidelity) research aims. Using a cluster-randomized trial, we will test the effectiveness of OTM in terms of improving mobility among 502 older adults in 44 senior community centers (Aim 1) and evaluate intervention fidelity, including adherence and competence, and the impact of organizational, instructor, and participant level factors on intervention fidelity (Aim 2). We will also determine the extent to which intervention fidelity moderates the effectiveness of OTM (Aim 3). This study is significant in that it addresses walking limitations, a common and costly problem for older adults and it transitions a clinical exercise program to the community. Clinical and research programs are available to a select group of individuals. Transitioning to a community-based program delivered by community instructors will greatly increase the reach of OTM. By meeting older adults where they live (urban, rural, high/low resource areas), OTM will have a much wider impact on walking and health. Our results will impact the field by demonstrating the real-world effectiveness of OTM as a health promotion program for improving mobility in older adults thus decreasing the research-practice gap.
