Title: A feasibility study and pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults: “Walk With Me Study”
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: In light of the impending rapid ageing of the UK population and associated declines in health and physical activity, action to promote active healthy ageing is a major public health priority, particularly in socio-economically disadvantaged older adults. Research has demonstrated the short term effectiveness of previous interventions, but further research is required to promote sustained changes. Interventions based on the socio-ecological model of health, that tackle multiple levels of influence (individual, social and environmental factors) on physical activity may be more effective at producing sustained changes. We will develop and test the feasibility of a multilevel peer-led intervention using the MRC framework for developing complex interventions. The intervention package will be developed after defining appropriate behaviour change techniques (BCTs) by: (i) identifying BCTs used in previous peer-led interventions and (ii) conducting qualitative interviews with members of the target population to explore their preferences for particular BCTs. Based on the outcome of these stages, we will then (iii) conduct a pilot randomised controlled trial (RCT). The intervention will be delivered by trained peer mentors, under the governance of the existing PHA Walk Leaders Network. The PHA will fund all intervention costs, including the recruitment, training and management of the peer mentors and the costs of delivering the peer-led walking programme. The main research objective is to test the feasibility of a peer-led walking programme in promoting sustained increases in objectively measured physical activity in sixty community dwelling 60-70 year old adults, residing in socio-economically disadvantaged communities, recruited through a range of strategies. Following the completion of baseline measures, all participants will be randomised to a control or intervention group by an independent statistician. Those allocated to the control group will receive a standardised information leaflet and referral to local physical activity opportunities. Those allocated to the intervention group will be paired with a peer mentor, and participate in a 12-week intervention, aimed at increasing their time spent in moderate intensity activity, through a range of BCTs, including goal setting and encouragement to make greater use of their neighbourhood environment. The feasibility of conducting a definitive study will be assessed by collecting recruitment and attrition rates in the pilot RCT. The primary outcome measure will be minutes of moderate and vigorous physical activity objectively measured using an Actigraph GT3X accelerometer at baseline, post-intervention (12 weeks) and 6 months after baseline. The impact of a meaningful change in physical activity in the target population would be the development of a definite trial with the potential to offer greater equity of opportunity for physical activity for socio-economically disadvantaged communities. This will lead to more effective strategies for promoting community engagement to tackle levels of inactivity, integrated into current service provision and the findings will be used by project partners to inform the development of future initiatives. The impacts will be maximised through the engagement of the project partners in the research process through the NI Public Health Research Network, thus creating the opportunity for a virtuous cycle of research, implementation and feedback.

Lay abstract: It is well known that being physically active provides numerous benefits for older adults. Evidence shows that regular exercise can improve physical and mental health, as well as providing opportunities to engage with neighbours and friends. Despite these benefits, as people age, their activity levels decline rapidly. This is especially true of people living in deprived communities, who develop health problems at an early age and are generally less active. The need to develop effective physical activity programmes for older adults living in socio-economically disadvantaged communities has been identified. Previous research suggests that interventions that are likely to produce sustainable changes in activity levels would address the individual barriers to participation (like motivation), as well as tailoring the approach to their social (e.g. support from friends or family) and environmental (e.g. promoting use of parks) circumstances. The aim of this study is to develop a peer-led walking programme for 60-70 year old adults from socio-economically disadvantaged communities and then test the feasibility of conducting a trial to study its effects. To do this we will review previous peer-led programmes and summarise the approaches they have taken. We will discuss these with older adults, to understand which they think are attractive and helpful. This will help us to develop a pilot intervention. In partnership with local community organisations, we will invite 60 residents from socio-economically disadvantaged communities aged 60-70 years to participate. Those who agree, will be allocated to one of two groups by chance (randomly). Half will be offered a 12-week programme with a peer mentor, to discuss options for increasing their physical activity and guide them through a programme. We plan to recruit six peer mentors from among participants of previous initiatives run by the Public Health Agency and community organisations. Peer mentors are individuals of a similar age and who reside within the target communities. They will be offered a comprehensive training programme, which will include emergency life support, training in communication skills and the delivery of the walking programme. To show that any changes in activity were due to the peer-led programme, we will assign the other 30 individuals to a control group who will receive a standardised information leaflet on physical activity and will be referred to local physical activity opportunities. As the aim of this pilot study is to test the feasibility of conducting an intervention, we will assess the delivery of intervention by recording the rate of recruitment achieved and level of drop out from the intervention. This data indicates the acceptability of the proposed approach. In addition we will estimate changes of physical activity, health and mental wellbeing before the intervention, at the end of the intervention (12 weeks) and six months after participants commence the intervention. To measure physical activity, participants will be asked to wear a device called an accelerometer for 7 days. Accelerometers provide a comprehensive assessment of physical activity that are more accurate that questionnaires. At the end of the intervention, we will invite participants and peer mentors to attend discussion groups. During these sessions we will invite feedback on the intervention and suggestions of how it could be improved, to inform the development of a larger, future study.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE