Award Title: Effectiveness and cost-effectiveness of a peer-led walking programme to increase physical activity in inactive older adults: “Walk With Me Study”
Funder: Public Health Agency, NI

Abstract: Many older adults would benefit from being more physically active, especially those living in areas of socioeconomic disadvantage. Interventions delivered by peer mentors (trained members of the public) have shown promise at increasing people’s physical activity levels in previous research, but their effectiveness in this population was unknown._x000D_
‘Walk with Me’ is a 12-week peer-led intervention developed to enable older adults from areas of socioeconomic disadvantage to become more active. The intervention was developed using guidance from previous successful interventions and with input from older adults who lived in these communities. They indicated that despite having ‘busy’ lives, having a peer mentor to walk with would help them become more active._x000D_
In a pilot study, 50 people aged 60–70 years agreed to take part. Participants that were interviewed following the intervention rated it favourably and reported increasing their activity. The study showed that it would be possible to conduct a larger study to test if a walking intervention delivered by peer mentors can increase older adults’ physical activity._x000D_
The aim of the proposed project is to further examine if a peer mentor can help older adults increase their physical activity over 1 year compared to a control group. We hope to find out the costs and benefits to the health service and the experiences of people taking part._x000D_
In this we aim to recruit 348 inactive older adults aged 60 years and over living in socio-economically disadvantaged communities, mainly through General Practices as this approach worked best previously in the pilot study, but also through community groups. Participants will be allocated by chance to one of two groups. One group will be paired with a peer mentor for a 12-week walking programme. The other group will be a 12-month wait list group. The peer mentor will meet with the participant each week with the aim of supporting them to increase their activity and find opportunities in the local community to engage in other programmes so they can maintain their activity._x000D_
We will measure if the programme works using an activity monitor. All participants will be asked to wear this for one week at the start and end of the programme and after 12 months. We will also discuss the impact of the programme with some participants and peer mentors to understand their views of the Walk with Me programme._x000D_
The Community Development and Health Network and the Institute of Public Health in Ireland are partners in the research programme. Along with service users, they have helped us develop the Walk with Me programme and this research project, including outcomes that matter to older adults and the programme materials. Two independent older adults will be on the steering group._x000D_
The key questions that this study will answer are whether the Walk with Me intervention will help inactive older adults become and stay active and what the costs and benefits are for older adults and the NHS. The findings will be shared with the public, older adults groups and public health staff through social media, blogs, reports, presentations and research papers.

Lay Abstract: Research Question: What is the effectiveness and cost-effectiveness of a peer-led walking programme to increase moderate-to-vigorous physical activity in adults aged 60 years and over living in socio-economically disadvantaged communities?_x000D_
Background: The proportion of the population aged 65 years or older is increasing. Typically, physical activity and health declines with age, which is why action to promote active healthy ageing is a major public health priority, particularly in socio-economically disadvantaged older adults. This trial builds on our Walk with Me NIHR-PHR funded pilot study._x000D_
Aims: The aims of the project are to: (1) conduct a full-scale randomised controlled trial of the Walk with Me peer-led walking intervention to estimate changes in physical activity at 12 months for older adults living in socio-economically disadvantaged communities; (2) assess differences between groups in secondary outcomes; (3) assess the cost-effectiveness of the Walk with Me intervention compared to a minimal intervention control group; and (4) understand older adult’s and per mentor’s experiences of the intervention._x000D_
Methods: Two-arm, assessor blind, randomised controlled trial recruiting 348 older adults using a GP invitation letter (85%) or from community groups (15%). The Walk with Me intervention is a 12-week peer-led walking intervention based on social cognitive theory comprising three stages. Stage 1 (weeks 1–4) involves the participant setting initial pedometer step goals. Stage 2 (weeks 5–8) involves setting short- and long-term physical activity goals. Finally, stage 3 (weeks 9–12) emphasises behaviour rehearsal and practice and signposting participants to other activity programmes in their community. Participants in the control group will receive information on active ageing and healthy nutrition._x000D_
Setting: The study will target community-dwelling older adults, aged 60 years or over living in areas of socio-economic disadvantage, defined as the most disadvantaged quartile of electoral wards in Northern Ireland._x000D_
Delivery: Trained peer mentors (n=35) will deliver the intervention. These are nonprofessional individuals who are similar to the target population, but sufficiently physically active._x000D_
Primary outcome: mean between-group change in accelerometer measured moderate-to-vigorous physical activity at 12 months from baseline, powered to detect 50 mins/week difference in moderate-to-vigorous physical activity._x000D_
Secondary Outcomes: SF-12; EQ5D-5L; Warwick-Edinburgh Mental Well-Being Scale; blood pressure, body mass index and waist circumference; adverse events._x000D_
Qualitative Research: Focus groups with 30 intervention participants and their mentors at 12-weeks (post-intervention) and 6 months about their experiences._x000D_
Health Economic Evaluation: The primary economic outcome will be incremental cost per QALY. We will assess the potential benefits and return on investment via cost-consequence analysis, within-trial cost-utility analysis and a long term model._x000D_
Analysis: Using intention-to-treat approach, we will compare the primary outcome between groups within a generalized linear mixed model including mentor as a random effect._x000D_
Public health impact: Evidence-based, cost-effective interventions to promote physical activity in older adults living in socio-economically disadvantaged communities are needed to address health inequalities. Peer-led interventions have the potential to provide a timely response to this urgent problem.

Research Activity Codes: 6.7 PHYSICAL
Health Categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;MUSCULOSKELETAL;ORAL AND GASTROINTESTINAL;STROKE