Title: A multi-centre randomised controlled trial of a peer-volunteer led active ageing programme to prevent decline in physical function in older people at risk of mobility disability. The ACE (Active, Connected, Engaged) study
Funder: Department of Health and Social Care

Abstract: As people get older their physical functioning and mobility decrease. This leads to a vicious circle whereby people become less active and, as a result, even less mobile. This affects health, ability to live independently, quality of life and even how long people live. Active ageing programmes help older people who are at risk of such decline to improve or maintain their mobility through physical activity. As well as improving quality of life for older people, such programmes could reduce health and social care costs, which increase every year as the average age of people in the UK increases. However, at a national level, resources are scarce. The voluntary sector is ideally placed to mobilise older adults as volunteers to deliver active ageing programmes. Unfortunately, little evidence exists for such community-based programmes. _x000D_ _x000D_ The Active, Connected and Engaged (ACE) programme is a low-cost programme, where older volunteers support older people at risk of physical decline to improve their mobility by becoming more active within their communities. This can provide a meaningful experience for the volunteers and it may have a positive impact on their physical and mental well-being, as well as that of the participants. A feasibility study has confirmed that ACE was well-received by both participants and volunteers._x000D_ _x000D_ The proposed study will evaluate the impact on mobility and value for money of the 6-month ACE programme by delivering it in three diverse areas: West Midlands, Manchester and Wales. First, peer-volunteers will meet with participants twice to build a rapport, find local community-based activities that the participant would like to join, and identify and address any barriers to taking part (weeks 1 and 2). Then, over a 3-month period, the volunteer-participant pair will jointly visit at least three local initiatives chosen by the participant . Telephone support to continue attending local activities independently will be provided over the following three months, with two further joint visits scheduled if needed._x000D_ _x000D_ We will first conduct a pilot study with 90 participants to confirm that recruitment procedures work well and the programme can be delivered as planned. If we have problems with recruitment or delivering the programme, we will stop the study. Otherwise, it will carry on as a full-scale trial, with 515 participants aged 65 years and older and 150 peer volunteers. Participants will be randomly assigned to either the ACE programme or a comparison group who only receive information about local initiatives. All participants and volunteers will complete measurements at the start of the study and then 6 months and 18 months later. These measurements include tests of mobility (a balance test, a ‘sit-to-stand’ test and a walking speed test), physical activity and questionnaires to measure mental well-being and quality of life. _x000D_ _x000D_ The delivery of ACE will be supported by the Royal Voluntary Service, a UK-wide volunteering organisation, in collaboration with community-based organisations delivering a range of active ageing initiatives in the three study areas. If successful, Royal Voluntary Service will deliver ACE nationally. The proposed research is important because mobility makes a huge difference to older people’s quality of life and ability to live independently. We currently have no peer-volunteering programmes targeting mobility in older people that are known to be effective and provide good value for money.

Lay abstract: Research Question: What is the effectiveness of the ACE intervention compared with an information-only control group for preventing decline in lower limb physical function in community-dwelling older people at risk of mobility disability?_x000D_ _x000D_ Background: Approximately 38% of people aged over 70 are at increased risk of mobility-related disability. In the UK’s ageing population this generates major individual and societal challenges, including reduced quality of life, loss of independence, reduced productivity amongst carers and increased health and social care costs. Interventions that can prevent decline in physical functioning would therefore have great public health value. In older people, modest changes in physical activity can prevent the onset of mobility-related disability. Using peer-volunteers to support engagement in physical activity by at-risk older people has the potential to prevent decline in physical function at relatively low cost. However, such programmes have not been robustly evaluated._x000D_ _x000D_ Aims /objectives: This study will evaluate the effectiveness and cost-effectiveness of the Active Connected Engaged (ACE) intervention, a 6-month peer-volunteer led active ageing programme designed to engage older people at risk of mobility disability in physical activities that will maintain or improve their lower limb physical function. ACE will be delivered by the Royal Voluntary Service (RVS)._x000D_ _x000D_ Methods: We will conduct a 2-arm individually randomised controlled trial with an internal pilot study. Participants will be 515 community-dwelling adults aged 65 years or more, at risk of mobility disability (Short Physical Performance Battery (SPPB) score 4-9) and 150 peer volunteers. Intervention arm: A series of peer volunteer meetings with participants and telephone support to take part in local activities of interest that may involve a physical activity or muscle-strengthening component. Control arm: The control group will receive written information on healthy ageing and attend one meeting at 12 months to promote ongoing engagement with the study. Assessments: Baseline, 6, and 18 months. Primary outcome: SPPB score (lower limb functional ability) 18 months post-randomisation. A mixed-methods process evaluation will include a whole systems approach to identify the wider impacts of the ACE intervention and the best ways to implement it. It will also assess intervention fidelity and explore how effectiveness and uptake vary with a range of socio-demographic factors._x000D_ _x000D_ Public Involvement: The ACE intervention was co-created with service users and service providers. Service user representatives will sit on our Trial Management and Trial Steering Committees. Participant Advisory Groups at each site will help to design patient-facing materials, interpret data and disseminate the findings. We will train 30 volunteer Citizen Scientists to support data collection._x000D_ _x000D_ Impact / dissemination: If the findings are positive, we will seek to roll out the intervention nationally and impact public health policy on active ageing. We will co-develop a dissemination strategy with our Participant Advisory Groups, the RVS, Age UK, Sport England and Public Health England. A key output will be the ACE delivery toolkit. This will be promoted to health, public health and social care policy makers and practitioners and voluntary sector organisations. Dissemination will include events with participants and volunteers, academic publications and conferences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MUSCULOSKELETAL