Safety and feasibility of an interactive workshop and facilitated outdoor walking group compared to a workshop alone in increasing outdoor walking activity among older adults: a pilot randomized controlled trial

Ruth Barclay, Sandra Webber, Jacquie Ripat, Theresa Grant, C Allyson Jones, Lisa M Lix, Nancy Mayo, Cornelia van Ineveld, Nancy M Salbach, Ruth Barclay, Sandra Webber, Jacquie Ripat, Theresa Grant, C Allyson Jones, Lisa M Lix, Nancy Mayo, Cornelia van Ineveld, Nancy M Salbach

Abstract

Background: Limited outdoor walking is a marker of frailty and a risk factor for decline in mobility and self-care functioning, social isolation, and reduced health-related quality of life (HRQL). Objectives were to evaluate the safety, feasibility, and preliminary effect of a supervised outdoor walking group and interactive workshop compared to the workshop alone in increasing outdoor walking activity and identify an optimal method for estimating outdoor walking activity among older adults who infrequently walk outdoors.

Methods: A pilot 2-parallel-group randomized controlled trial was conducted. Adults aged ≥ 65 years who reported walking ≤ 20 min/week outdoors were randomized in a 2:1 ratio to receive the GO-OUT program (1-day workshop and 9-week outdoor walking group), or the workshop alone. An external site conducted the randomization after workshop completion. The eight workshop activity stations aimed to build knowledge and skills to safely walk outdoors. The group-based outdoor walking program consisted of repetitive practice of mobility tasks at local parks. The primary outcome of outdoor walking activity used an activity monitor and GPS; secondary outcomes included aerobic, balance, and walking capacity; physical activity; participation; mood; and HRQL. Blinded outcome assessors evaluated participants at 0, 3, and 6 months. Qualitative interviews occurred after 3 months; data were analyzed with qualitative description. Quantitative data were summarized using descriptive statistics.

Results: Forty-eight individuals were screened; 9 were eligible and randomized to the GO-OUT (n = 6) or workshop (n = 3) group. Data from 9 participants were analyzed. Mean age was 77 and 74 years in the GO-OUT and workshop groups, respectively. No falls occurred during the workshop and outdoor walking program. Average attendance of the walking group was 61%. All participants attended the evaluations and workshop. An analysis method combining data from activity monitors and GPS was developed to estimate outdoor walking. Themes from the qualitative analysis included the barriers to outdoor walking, impact of the workshop and GO-OUT walking group, and feasibility and acceptance of the assessment and intervention strategies.

Conclusions: The trial protocol was deemed safe and feasible. Results were used to inform changes to the protocol to conduct a full-scale study.

Trial registration: Clinical Trials.gov: NCT02339467.

Keywords: Accelerometry; Community; Older adult; Outdoor walking; Randomized controlled trial; Walking barriers; Walking group; Workshop.

Conflict of interest statement

Ethics approval was obtained from the Health Research Ethics Board at the University of Manitoba (H2014:391). All participants received information regarding the study and signed an informed consent.NAThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual framework for the GO-OUT intervention
Fig. 2
Fig. 2
CONSORT diagram—extension for pilot and feasibility trials

References

    1. Government of Canada. Walking Data, from Canadian Community Health Survey. 2009.
    1. Rantakokko M, Manty M, Iwarsson S, Tormakangas T, Leinonen R, Heikinnen E, et al. Fear of moving outdoors and development of outdoor walking difficulty in older people. J Am Geriatr Soc. 2009;57:634–640. doi: 10.1111/j.1532-5415.2009.02180.x.
    1. Fujita K, Fujiwara Y, Chaves P, Motohashi Y, Shinkai S. Frequency of going outdoors as a good predictors for incident disability of physical function as well as disability recovery in community-dwelling older adults in rural Japan. J Epidemiol. 2006;16(6):261–270. doi: 10.2188/jea.16.261.
    1. Sirois M, Emond M, Ouellet M, Perry J, Daoust R, Morin J, et al. Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department. J Am Geriatr Soc. 2013;61:1661–1668. doi: 10.1111/jgs.12482.
    1. Denkinger M, Lukas A, Herbolsheimer F, Peter R, Nikolaus T. Physical activity and other health-related factors predict health care utilisation in older adults. Z Gerontol Geriat. 2012;45:290–297. doi: 10.1007/s00391-012-0335-1.
    1. Gardener E, Huppert F, Guralnik J, Melzer D. Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a National Survey. J Gen Intern Med. 2006;21:1091–1096. doi: 10.1111/j.1525-1497.2006.00564.x.
    1. King A, Sallis J, LD F, Salelens B, Cain K, Conway T, et al. Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults. Soc Sci Med. 2011;73:1525–1533. doi: 10.1016/j.socscimed.2011.08.032.
    1. Shumway-Cook A, Woollacott M. Motor control - translating research into clinical practice. 5th ed. Philadelphia: Wolters: Kluwer; 2017.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Patla A, Shumway-Cook A. Dimensions of mobility: defining the complexity and difficulty associated with community mobility. J Aging Phys Act. 1999;7:7–19. doi: 10.1123/japa.7.1.7.
    1. Kerr Jacqueline, Sallis James F, Saelens Brian E, Cain Kelli L, Conway Terry L, Frank Lawrence D, King Abby C. Outdoor physical activity and self rated health in older adults living in two regions of the U.S. International Journal of Behavioral Nutrition and Physical Activity. 2012;9(1):89. doi: 10.1186/1479-5868-9-89.
    1. Yang Y, Wang R, Chen Y, Kao M. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88:1236–1240. doi: 10.1016/j.apmr.2007.06.762.
    1. Simonsick E, Guralnik J, Volpato S, Balfour J, Fried L. Just get out the door! Importance of walking outside the home for maintaining mobility: findings from the Women's health and aging study. J Am Geriatr Soc. 2005;53:198–203. doi: 10.1111/j.1532-5415.2005.53103.x.
    1. Fisher K, Li F. A community-based walking trial to improve neighbourhood quality of life in older adults: a multi-level analysis. Ann Behav Med. 2004;28:186–194. doi: 10.1207/s15324796abm2803_7.
    1. Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge M. Does participation in physical activity in outdoor natural environments have a greater effect on physical and mental well-being than physical activity indoors? A systematic review. Environ Sci Technol. 2011;45:1761–1772. doi: 10.1021/es102947t.
    1. Lauretani F, Russo C, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851–1860. doi: 10.1152/japplphysiol.00246.2003.
    1. Srygley J, Mirelman A, Herman T, Giladi N, Hausdorff J. When does walking alter thinking? Age and task associated findings. Brain Res. 2009;1253:92–99. doi: 10.1016/j.brainres.2008.11.067.
    1. Li K, Lindenberger U. Relations between aging sensory/sensorimotor and cognitive functions. Neurosci Biobehav Rev. 2002;26(7):777–783. doi: 10.1016/S0149-7634(02)00073-8.
    1. Kassavou A, Turner A, French D. Do interventions to promote walking in groups increase physical activity? A meta-analysis. Int J Behav Nutr Phys Act. 2013;10:12. doi: 10.1186/1479-5868-10-18.
    1. Yamada M, Tanaka B, Nagai K, Aoyama T, Ichihashi N. Trail-walking exercise and fall risk factors in community-dwelling older adults: preliminary results of a randomized controlled trial. J Am Geriatr Soc. 2010;58(10):1946–1951. doi: 10.1111/j.1532-5415.2010.03059.x.
    1. Brach J, VanSwearingen J. Interventions to improve walking in older adults. Curr Transl Geriatr Exp Gerontol Rep. 2013;2(4):230–238. doi: 10.1007/s13670-013-0059-0.
    1. Park H, Oh D, Kim S, Choi J. Effectiveness of community-based ambulation training for walking function of post-stroke hemiparesis: a randomized controlled pilot trial. Clin Rehabil. 2011;25:451–459. doi: 10.1177/0269215510389200.
    1. Lord S, McPherson K, McNaughton H, Rochester L, Weatherall M. How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke. Clin Rehabil. 2008;22:215–225. doi: 10.1177/0269215507081922.
    1. Creswell J. Research design- qualitative, quantitative, and mixed methods approaches. Fourth ed. California: SAGE Publications, Inc.; 2014. 273 p
    1. Salbach N, Barclay R, Braun S, Brooks D, Grant T, Jones A, et al. Theory-informed development of the Getting Older adults OUTdoors (GO-OUT) program: An intervention designed to improve outdoor walking in older adults who infrequently walk outdoors. Montreal: Canadian Association on Gerontology 45th Annual Scientific and Educational Meeting; 2016.
    1. Roccaforte W, Burke W, Bayer B, Wengel S. Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc. 1992;40:697–702. doi: 10.1111/j.1532-5415.1992.tb01962.x.
    1. Panel on Prevention o fFalls in Older Persons A Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc. 2011;59:148–157. doi: 10.1111/j.1532-5415.2010.03234.x.
    1. Canadian Society for Exercise Physiology. PAR-Q+. . Accessed 19 Nov 2018.
    1. Aadland E, Ylvisaker E. Reliability of objectively measured sedentary time and physical activity in adults. PLoS One. 2015;10:e0133296. doi: 10.1371/journal.pone.0133296.
    1. Wetten Alexander Allan, Batterham Marijka, Tan Sze Yen, Tapsell Linda. Relative Validity of 3 Accelerometer Models for Estimating Energy Expenditure during Light Activity. Journal of Physical Activity and Health. 2014;11(3):638–647. doi: 10.1123/jpah.2011-0167.
    1. Rabinovich Roberto A., Louvaris Zafeiris, Raste Yogini, Langer Daniel, Van Remoortel Hans, Giavedoni Santiago, Burtin Chris, Regueiro Eloisa M.G., Vogiatzis Ioannis, Hopkinson Nicholas S., Polkey Michael I., Wilson Frederick J., MacNee William, Westerterp Klaas R., Troosters Thierry. Validity of physical activity monitors during daily life in patients with COPD. European Respiratory Journal. 2013;42(5):1205–1215. doi: 10.1183/09031936.00134312.
    1. QstarzInternational. Products GPS Travel Recorder 2013.
    1. Steffen T, Hacker T, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed up & go test, and gait speeds. Phys Ther. 2002;82:128–137. doi: 10.1093/ptj/82.2.128.
    1. Harada N, Chiu V, Stewart A. Mobility-related function in older adults: assessment with a 6-minute walk test. Arch Phys Med Rehabil. 1999;80:837–841. doi: 10.1016/S0003-9993(99)90236-8.
    1. Berg K, Wood-Dauphinee S, JI W. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27–36.
    1. Jones J, Rikli R, Beam W. A 30-s chair-stand test as a measure of lower body strength in community residing older adults. Res Q Exerc Sport. 1999;70:113–119. doi: 10.1080/02701367.1999.10608028.
    1. Asano M, Miller W, Eng J. Development and psychometric properties of the ambulatory self-confidence questionnaire. Gerontology. 2007;53:373–381. doi: 10.1159/000104830.
    1. Sheikh J, Yesavage J. Geriatric Depression Scale (GDS). In: Brink T, editor. Recent evidence and development of a shorter version. Philadelphia: The Haworth Press, Inc; 1986. p. 165–73.
    1. Ingraham F. The short geriatric depression scale. Clin Gerontol. 1996;16(3):49–56. doi: 10.1300/J018v16n03_06.
    1. Giles K, Marshall A. Repeatability and accuracy of CHAMPS as a measure of physical activity in a community sample of older Australian adults. J Phys Act Health. 2009;6:221–229. doi: 10.1123/jpah.6.2.221.
    1. Hays R, Morales L. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33:350–357. doi: 10.3109/07853890109002089.
    1. Cerin E, Conway T, Saelens B, Frank L, Sallis J. Cross-validation of the factorial strcuture of the neighborhood environment walkability scale (NEWS) and its abbreviated form (NEWS-A) Int J Behav Nutr Phys Act. 2009;6:10. doi: 10.1186/1479-5868-6-32.
    1. Brownson Ross C., Hoehner Christine M., Day Kristen, Forsyth Ann, Sallis James F. Measuring the Built Environment for Physical Activity. American Journal of Preventive Medicine. 2009;36(4):S99-S123.e12. doi: 10.1016/j.amepre.2009.01.005.
    1. Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines for older adults - 65 years and older. 2018. . Accessed 19 Nov 2018.
    1. Logan P, Gladman J, Avery A, Walker M, Dyas J, Groom L. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. Br Med J. 2004;329(7479):1372–1375. doi: 10.1136/bmj.38264.679560.8F.
    1. Talbot L, Gaines J, Huynh T, Metter E. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geri Soc. 2003;51:287–392.
    1. Marshall S, Levy S, Tudor-Locke C, Kolkhorst F, Wooten K, Ji M, et al. Translating physical activity recommendations into a pedometer-based step goal. Am J Prev Med. 2009;36(5):410–415. doi: 10.1016/j.amepre.2009.01.021.
    1. Tudor-Locke C, Craig C, Aoyagi Y, Bell R, Croteau K, DeBourdeaudhuij I, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8:80. doi: 10.1186/1479-5868-8-80.
    1. Figueiredo Sabrina, Finch Lois, Mai Jiali, Ahmed Sara, Huang Allen, Mayo Nancy E. Nordic walking for geriatric rehabilitation: a randomized pilot trial. Disability and Rehabilitation. 2012;35(12):968–975. doi: 10.3109/09638288.2012.717580.
    1. Parkatti T, Perttunen J, Wacker P. Improvements in functional capacity from Nordic walking: a randomized controlled trial among older adults. J Aging Phys Act. 2012;20:93–105. doi: 10.1123/japa.20.1.93.
    1. Helfand A. Basic considerations for geriatric footwear. Clin Podiatr Med Surg. 2003;20:593–605. doi: 10.1016/S0891-8422(03)00042-9.
    1. WinnipegRegionalHealthAuthority. Prevent Falls. 2013;2013. . Accessed 19 Nov 2018.
    1. Nelson M, Rejeski W, Blair S, Duncan P, Judge J, King A, et al. Physical activity and public health in older adults- Recommendations from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1094–1105. doi: 10.1161/CIRCULATIONAHA.107.185650.
    1. Barclay R, Ripat J, Mayo N. Factors describing community ambulation after stroke – a mixed-methods study. Clin Rehabil. 2015;29(5):509–512. doi: 10.1177/0269215514546769.
    1. Shumway-Cook A, Patla A, Stewart A, Ferrucci L, Ciol M, Guralnik J. Enivironmental demands associated with community mobility in older adults with and without mobility disabilities. Phys Ther. 2002;82(7):670–681.
    1. Brosseau L, Wells G, Kenny G, Reid R, Maetzel A, Tugwell P, et al. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): part 1: the uptake of the Ottawa panel clinical practice guidelines (CPGs) BMC Public Health. 2012;12(871):1–14.
    1. Yeom H, Keller C, Fleury J. Interventions for promoting mobility in community-dwelling older adults. J Am Acad Nurse Pract. 2009;21:95–100. doi: 10.1111/j.1745-7599.2008.00390.x.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. 10.1002/14651858.CD007146.pub3.
    1. Government of Canada. Environment and Climate Change Canada. 2017. . Accessed 19 Nov 2018.
    1. Hunt J, Poulton E, Mumford J. The effects of wind on people; new criteria based on wind tunnel experiments. Build Environ. 1976;11:15–28. doi: 10.1016/0360-1323(76)90015-9.
    1. Sandelowski M. What's in a name? Qualitative description revisited. Res Nurs Health. 2010;2010(33):77–84.
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;2000(23):334–340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>;2-G.
    1. Hsieh H, Shannon S. Three approaches to qualitative Contant analysis. Qual Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687.
    1. Troiano R, Berrigan D, Dodd K, Masse L, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40:181–188. doi: 10.1249/mss.0b013e31815a51b3.
    1. Freedson P, Melanson E, Sirard J. Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30:777–781. doi: 10.1097/00005768-199805000-00021.
    1. Matthew C. Calibration of accelerometer output for adults. Med Sci Sports Exerc. 2005;37:S512–SS22. doi: 10.1249/01.mss.0000185659.11982.3d.
    1. Gennuso K, Gangnon R, Matthews C, Thraen-Borowski K, Colbert L. Sedentary behavior, physical activity, and markers of health in older adults. Med Sci Sports Exerc. 2013;45:1493–1500. doi: 10.1249/MSS.0b013e318288a1e5.
    1. Farmer T, Robinson K, Elliott S, Eyles J. Developing and implementing a triangluation protocol for qualitative health research. Qual Health Res. 2006;2006(16):377–394. doi: 10.1177/1049732305285708.
    1. O'Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. BMJ. 2010;341:1147–1150. doi: 10.1136/bmj.c4587.
    1. City of Winnipeg. Population. 2017. . Accessed 19 Nov 2018.
    1. Tudor-Locke C, Schuna J, Barreira T, Mire E, Broyles S, Katzmarzyk P, et al. Normative steps/day values for older adults: Nhanes 2005-2006. J Gerontol A Biol Sci Med Sci. 2013;68:1426–1432. doi: 10.1093/gerona/glt116.
    1. Hopman W, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, et al. Canadian normative data for the SF-36 health survey. Can Med Assoc J. 2000;163(3):265–271.
    1. Godi M, Franchignoni F, Caligari M, Giorano A, Turcato A, Nardone A. Comparison of reliability, validity and responsivemenss of the mini-BESTest and berg balance scale in patients with balance disorders. Phys Ther. 2013;93(2):158–167. doi: 10.2522/ptj.20120171.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe