Title: A randomised controlled trial and economic evaluation of a community-based physical activity intervention to prevent mobility-related disability for retired older people. The REACT (REtirement in ACTion) study
Funder: Department of Health and Social Care

Abstract: Research Question: What is the effectiveness and cost-effectiveness, compared with a minimal intervention control condition, of a community-based physical activity intervention (REACT) for reducing the progression of functional limitations in older people who are at high risk of mobility-related disability? Intervention: Modelled on the LIFE physical activity intervention for older people in the US, REACT is a standardised 12-month, primarily group-based physical activity programme with two phases: 1) Adoption (weeks 1–24) provides a 45-minute individual assessment, followed by two 60 minute sessions per week designed to stimulate initial increases in fitness, lower-limb function, confidence and social support and facilitate lifestyle changes; 2) Maintenance (weeks 25-52) provides an optional weekly exercise session. Participants are informed about local activity opportunities, offered ‘taster session’ vouchers for various activities, and invited to become “REACT Ambassadors” to support the ongoing sustainability of REACT. The setting: Leisure/community centres and fitness/health clubs provided by REACT collaborators during low usage hours in economically and ethnically diverse areas. Delivery staff: Qualified exercise specialists will be trained to deliver the intervention. Funding: Intervention costs are covered by BANES City Council, the West Bank Charitable Organisation and AgeUK Birmingham. Evaluation methods: A multi-centre pragmatic two-arm parallel group randomised controlled trial with an internal pilot phase, and a 24 month follow-up, comparing REACT with a minimal intervention control condition. Participants: 768 sedentary men and women aged 65+ who are at risk of major mobility limitations but who are still ambulatory, will be randomised in a 1:1 ratio to either intervention or control group. Controls receive a minimal intervention comprising information about local activity opportunities and two education sessions on healthy ageing. Outcomes: The primary outcome is functional ability (independently assessed performance on a sit-to-stand task, a standing balance test and gait speed), measured using the Short Physical Performance Battery (SPPB) at 24 months. The secondary outcome is minutes of moderate intensity physical activity, assessed by accelerometry. Tertiary outcomes include minutes of sedentary behaviour, health-related quality of life, cognitive function, mental well-being and the Barthel Index (an indicator of ability to live independently). Health economics: A full economic evaluation will estimate the incremental cost-effectiveness of REACT compared to control. Decision-analytic modelling will assess cost-effectiveness over a lifetime perspective. Analysis: Using intention-to-treat analysis of variance, REACT and the control groups will be compared at 24 months presented as between-group mean differences, 95% confidence intervals and p-values. Public health impact: Evidence-based, cost-effective interventions for preventing mobility disability in older people and tackling inactivity are needed to reduce health risks, particularly among people with low socio-economic status. Drawing on the latest, evidence-based intervention technology from the US and translating this for use in the UK has the potential to provide a timely response to this urgent problem.

Lay abstract: The REACT project evaluates the usefulness and value for money of an intervention to promote physical activity in retired people aged 65 and over who have low levels of physical activity and who are already showing some signs of limited mobility. We propose to adapt the successful LIFE intervention programme from the USA, which has been shown to be effective in improving mobility and physical functioning. Our previous development work, which involved extensive consultation with a network of service users and service providers as well as charities, researchers and experts in physical activity promotion, selected the LIFE programme as the “best bet” for use in the UK to promote physical activity with a wide range of older people living in different areas and with different cultural backgrounds. We will adapt the LIFE intervention for use in leisure and community centres in three locations during low cost daytime hours. The programme takes full account of the needs of UK older adults, particularly those in more deprived/less well-off communities. REACT is a 12-month activity programme for inactive people aged 65 and over designed to help them get started with activity, become fitter, and improve their health and well-being. As well as improving heart fitness, strength and balance, it emphasises enjoyment of activities, provides opportunities for rewarding social contact, and helps people develop skills for long term changes in their lifestyle. A novel element is the "ambassadors" programme that provides the opportunity for people who have taken part to get involved as programme recruiters, supporters, or in helping other participants to get involved in activities in the local community. We will conduct a pilot study to confirm that the programme can be delivered as planned and that the trial procedures work well. If we have problems with recruitment, obtaining follow-up measurements, or delivering the intervention we will stop the trial. Otherwise the study will carry on to become a full-scale evaluation study. In total this will involve 768 people. We will ask them to sign up to either join our REACT intervention programme or to receive a less intensive intervention (including information, vouchers for taster sessions at local centres and attendance at two sessions with a healthy living education group). All participants will complete tests at the start of the study and then again at 6 months, 12 months and 24 months. This will include a set of three tests of physical functioning (a balance test, a ‘sit-to-stand’ test and a walking speed test), wearing a small device that assesses their physical activity for a week, and some questionnaires to measure health status and mental health. Participants will be invited to contribute to discussion groups, where we will get feedback about whether the proposed intervention and evaluation methods were acceptable and how they might be improved. The work will be conducted by a team of researchers and practitioners who are experienced in promoting physical activity in older people and in conducting this type of research. The proposed research is important because physical fitness makes a huge difference to older people’s mobility and quality of life. We currently do not have any interventions targeting functional ability in older people that have been shown to be effective and to provide good value for money.

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