Supporting Uptake of Evidence for Physical Activity in Older Adults With Complex Health Care Needs (Moving_More)

Moving More: Supporting Uptake of Evidence for Physical Activity in Older Adults With Complex Health Care Needs

Physically frail older adults often have chronic conditions that contribute to a higher chance of them being limited in daily activities and becoming dependent. Physical activity can help to better manage chronic conditions and prevent frailty. In this project, the counselling approach using the new Canadian 24-hour Movement Guidelines will be adapted for older adults at an early state of frailty. This new approach will be tested against the one in current use by physiotherapists. This ethics application will address the pilot implementation evaluation, including interviews and focus groups, conducted to refine the new approach.

Study Overview

• Status: Recruiting
• Conditions: Frailty
• Intervention / Treatment: Behavioral: 24-hour Activity Counselling

Detailed Description

Rationale:

Physical activity is effective in preventing the progression of frailty and further disability in community-dwelling frail older adults. It is also effective in mitigating the progression of chronic conditions associated with physical frailty. Despite the benefits, many older adults in the early state of frailty and with chronic conditions are not sufficiently active. Current delivery of physical activity recommendations can be improved by applying the new Canadian 24-hour Movement Guidelines. These guidelines promote a balance of activity, rest and sleep as they play an important role for better overall health and quality of life regardless of health conditions. With advanced training in complex chronic conditions and physical activity promotion, physiotherapists (PTs) are well-suited to adapt and integrate activity counselling, based on the 24-hour Movement Guidelines, in their clinical practice.

Aim:

to assess implementation context, feasibility, and preliminary effect of the 24-hour Approach against a current goal-oriented counselling approach (i.e., focus on achieving 150 minutes/week of MVPA).

Previous Work:

A PT-led goal-oriented counselling program was previously evaluated for older adults with osteoarthritis. In 2 randomized controlled trials (RCTs), compared to controls, this program was shown to improve time spent in Moderate/Vigorous Physical Activity (MVPA) in participants after 8 weeks (n=61; 25.6 mins/day; 95% CI. 9) and 13 weeks (n=51; 13.1 mins/day; 95% CI. 5). This current approach has been modified for remote delivery during the COVID-19 pandemic.

Research Design & Data Analysis:

This is a multi-method study. PTs and their patients across Canada who have participated in the co-development of the 24-hour Approach will be invited to participate. The 24-hour Approach will be assessed in a randomized pilot study with 20 PTs and their patients (each PT will treat 4 older adult patients) who will be assigned to one of the groups:

1. Current Approach (focus on achieving 150 min/week of MVPA).
2. 24-hour Approach (focus on increasing MVPA with a balance of activity, rest and sleep in a day).

Guided by the RE-AIM framework, Reach will be assessed by comparing characteristics of older adult participants with those who are eligible yet decline to participate. Effect (Preliminary) will be evaluated at the older adult level. Adoption will be assessed by comparing the demographic and practice characteristics between the participating PTs and those who are eligible but have not enrolled. Implementation will be assessed by PT interviews when they complete their sessions with all 4 older adult patients. To assess Maintenance, PTs will be interviewed at 12 months about if/how they continue using their assigned counselling strategy after the study. Results will inform a full RCT and future scale-up.

Significance:

Results will provide necessary knowledge to inform how to improve uptake of physical activity recommendations in ways that are sensitive to the health needs of older adults and their life context.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Linda Li, PhD; Phone Number: 604-207-4020; Email: lli@arthritisresearch.ca
• Study Contact Backup: Name: Stephenie Therrien, BA; Phone Number: 604-207-4053; Email: stherrien@arthritisresearch.ca

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V5Y 3P2
      • Recruiting
      • Arthritis Research Canada
      • Contact: Stephanie Therrien, BA; Phone Number: 604-207-4053; Email: stherrien@arthritisresearch.ca
      • Contact: Shireen Divecha; Phone Number: 604-207-4041; Email: sdivecha@arthritisresearch.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Physiotherapists:

Inclusion Criteria:

• Eligible PTs are those who self-report at least 40% of their caseload is working with older adults and practice in the in the Greater Vancouver Area. In addition, they are willing to:

  1. participate in online training for the assigned physical activity counselling strategy
  2. be randomised to one of the counselling groups.

Exclusion Criteria:

• Those who do not meet the Inclusion Criteria

Older adults:

Inclusion Criteria:

1. are age > 65 years
2. live in the community
3. have 1 or 2 of the deficits in the CHS index
4. have > 1 chronic conditions
5. are able to walk 3 metres with or without an assistive device
6. have a Mini-Mental State Examination score > 24/30
7. do not have a diagnosed psychiatric condition (e.g., depression)
8. understand, speak and read English proficiently
9. are willing to have their physiotherapy sessions audio-recorded
10. are able to provide written informed consent.

Exclusion Criteria:

• Those who do not meet the Inclusion Criteria

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 24-hour Activity Counselling; Participating physiotherapists will be trained to deliver counselling that focuses on increasing moderate-to-vigorous physical activity, with a balance of activity, rest and sleep in a 24-hour day. Patients (n=4) of these physiotherapists will receive the 24-hour Activitiy Counselling	Behavioral: 24-hour Activity Counselling; Physiotherapists will participate in the self-paced brief action planning (BAP) online training (2-4 hours long), followed by 2-3 hours of practice and feedback over the phone with an experienced BAP instructor. In addition, they will attend a 2-hour session with the research team on training around on prescribing physical activity while balancing with rest and sleep. Once training is complete the PT can start implementing the counselling approach with the older adult patients.
Active Comparator: Current Physical Activity Counselling; Participating physiotherapists will continue delivering counselling that focuses on achieving 150 minutes/week of moderate-to-vigorous physical activity, which is the current practice. Patients (n=4) of these physiotherapists will receive the Current Physical Activitiy Counselling	Behavioral: 24-hour Activity Counselling; Physiotherapists will participate in the self-paced brief action planning (BAP) online training (2-4 hours long), followed by 2-3 hours of practice and feedback over the phone with an experienced BAP instructor. In addition, they will attend a 2-hour session with the research team on training around on prescribing physical activity while balancing with rest and sleep. Once training is complete the PT can start implementing the counselling approach with the older adult patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient's daily time in moderate/vigorous physical activity (minutes/day)	Minutes spent in moderate/vigorous physical activity per day	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient's daily time in moderate/vigorous physical activity (minutes/day)	Minutes spent in moderate/vigorous physical activity per day	12 months
Patient's daily time in light physical activity (minutes/day)	Minutes spent in light physical activity per day	6 months
Patient's daily time in light physical activity (minutes/day)	Minutes spent in light physical activity per day	12 months
Patient's daily time in sedentary behaviour (minutes/day)	Minutes spent in sedentary behaviour per day	6 months
Patient's daily time in sedentary behaviour (minutes/day)	Minutes spent in sedentary behaviour per day	12 months
Patient's daily time sleeping (minutes/day)	Minutes spent sleeping per day	6 months
Patient's daily time sleeping (minutes/day)	Minutes spent sleeping per day	12 months
The score of cardiovascular Health Study (CHS) index (Patient outcome)	multidimensional measure of physical frailty (0-5 points; lower = better); Weight Loss: Lost > 10 pounds unintentionally in last year; Exhaustion Self-report of either of:i. felt that everything I did was an effort in the last week ii. could not get going in the last week; Weakness Grip strength: Lowest 20% adjusted for sex and body mass index; Low Physical Activity Women: Kcal < 270 on activity scale (18 items)§ Men: Kcal < 383 on activity scale (18 items)§; Slowness Walking time: Slowest 20% adjusted by sex and height "Yes" to each of the above is 1 point.	6 months
The Cardiovascular Health Study (CHS) index score (Patient outcome)	multidimensional measure of physical frailty (0-5 points; lower = better); Weight Loss: Lost > 10 pounds unintentionally in last year; Exhaustion Self-report of either of:i. felt that everything I did was an effort in the last week ii. could not get going in the last week; Weakness Grip strength: Lowest 20% adjusted for sex and body mass index; Low Physical Activity Women: Kcal < 270 on activity scale (18 items)§ Men: Kcal < 383 on activity scale (18 items)§; Slowness Walking time: Slowest 20% adjusted by sex and height "Yes" to each of the above is 1 point.	12 months
Short Physical Performance Battery (SPPB; 0-12; higher = better; Patient outcome)	Short Physical Performance Battery (SPPB) is a standardized measure of lower extremity physical performance that includes walking, balance, and strength tasks, and has been used in a broad range of RCTs and epidemiological studies of aging. A low SPPB score is a strong risk factor for institutionalization, morbidity, mortality, and disability in initially non-disabled older persons. Participants are assessed on performances of standing balance, 4-m walking, and sit-to-stand. Each component is rated out of 4 points, for a maximum of 12 points.	6 months
Short Physical Performance Battery (SPPB; 0-12; higher = better; Patient outcome)	Short Physical Performance Battery (SPPB) is a standardized measure of lower extremity physical performance that includes walking, balance, and strength tasks, and has been used in a broad range of RCTs and epidemiological studies of aging. A low SPPB score is a strong risk factor for institutionalization, morbidity, mortality, and disability in initially non-disabled older persons. Participants are assessed on performances of standing balance, 4-m walking, and sit-to-stand. Each component is rated out of 4 points, for a maximum of 12 points.	12 months
Gait speed (meters/second; Patient outcome)	Gait speed will be calculated by dividing the 4-meter walk with the time to complete the walk	6 months
Gait speed (meters/second; Patient outcome)	Gait speed will be calculated by dividing the 4-meter walk with the time to complete the walk	12 months
Grip strength (in kg) of the dominant hand (Patient outcome)	Grip strength (in kg) of the dominant hand will be measured using a digital Jamar isometric hand dynamometer; three measures will be acquired and averaged.	6 months
Grip strength (in kg) of the dominant hand (Patient outcome)	Grip strength (in kg) of the dominant hand will be measured using a digital Jamar isometric hand dynamometer; three measures will be acquired and averaged.	12 months
EuroQol-5D-5 Level version (EQ-5D-5L; Patient outcome)	measure Health-Related Quality of Life. EQ-5D-5L is a generic preference-based utility measure composed of 5 domains of health (mobility, self-care, usual activities, pain, and anxiety/depression). Each domain contains 5 levels ('1' indicating no problem; '5' indicating major problem).	6 months
EuroQol-5D-5 Level version (EQ-5D-5L; Patient outcome)	measure Health-Related Quality of Life. EQ-5D-5L is a generic preference-based utility measure composed of 5 domains of health (mobility, self-care, usual activities, pain, and anxiety/depression). Each domain contains 5 levels ('1' indicating no problem; '5' indicating major problem).	12 months
Self-Reported Habit Index (Patient outcome)	A multi-item measure rated on a 7-point Likert scale that evaluates characteristics of habitual behavior	6 months
Self-Reported Habit Index (Patient outcome)	A multi-item measure rated on a 7-point Likert scale that evaluates characteristics of habitual behavior	12 months

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Canadian Institutes of Health Research (CIHR); Arthritis Research Centre of Canada
• Investigators: Principal Investigator: Linda Li, PhD, University of British Columbia

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2026
• Primary Completion (Estimated): January 30, 2027
• Study Completion (Estimated): December 30, 2027

Study Registration Dates

• First Submitted: February 23, 2025
• First Submitted That Met QC Criteria: March 19, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): February 20, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Sleep; Physical activity; Physiotherapy; Counselling
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Behavior; Frailty; Motor Activity
• Other Study ID Numbers: H25-03073

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The investigators plan to share individual participant data from this clinical trial, including demographics, baseline characteristics, primary outcome measures, and key secondary outcomes, with qualified researchers upon request after the study results have been published.
• IPD Sharing Time Frame: TBA
• IPD Sharing Access Criteria: Data will be provided in a de-identified format through a secure online repository, and access will require submission of a research proposal outlining the intended analysis and relevant ethics approvals.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No