Getting Older Adults OUTdoors (GO-OUT)
Condition: Older Adults With Decreased Outdoor Walking Ability
Study type: Interventional

Summary: 
      Community walking is an issue that older adults with chronic conditions have described as
      important to participation in the community. Walking outside the home is a universally
      accessible form of physical activity that has multiple health benefits. Walking for 150
      minutes per week can help reduce the risk of cardiovascular disease, hypertension, stroke,
      diabetes, osteoporosis, and depression, as well as falls. Practice walking across roads,
      slopes and curbs, while talking, and dealing with crowds and traffic, is safe and feasible
      and can improve confidence, balance and walking ability. Being physically active outdoors in
      nature appears to improve mental health more than being active indoors. Despite these health
      benefits, the majority of older Canadians do not walk outside on a regular basis. Barriers to
      walking outside include fear, physical disability due to chronic disease, the appropriateness
      of footwear and walking aids, and the physical environment, such as uneven pavement, weather
      and temperature. To date, the best strategy for getting people to walk outdoors regularly is
      unknown. The investigators propose to evaluate the effectiveness of a dynamic 1-day workshop,
      at which older adults who infrequently walk outdoors learn strategies to facilitate outdoor
      walking, such as appropriate use of footwear, ambulatory aids and equipment, goal setting,
      and practice skills related to increasing outdoor walking. The workshop will be compared to
      the workshop plus involvement in a walking group for 3 months. Outcomes include outdoor
      walking activity, total physical activity, walking ability, participation, and health-related
      quality of life. Each participant will have four evaluations: baseline, 3, 5.5 and 12 months
      later. The investigators will interview select participants at 6 and 12 months to ask them
      about their opinions of what worked and didn't work. Increasing outdoor walking is expected
      to improve health and well-being, and help people live independently in the community for
      longer.
    

Detailed description: 
      Background: Inability to walk outdoors restricts full participation in physical activity and
      community living for older adults that can reduce health-related quality of life (HRQL).
      Older adults report limited outdoor walking with only 8% achieving the Canadian
      recommendation for older adults of 150 minutes of moderate-to-vigorous (MV) intensity
      physical activity per week. Known barriers to walking outside include fear, physical
      disability due to chronic disease, the appropriateness of footwear and walking aids, the
      physical environment, weather and temperature. Group practice walking outdoors in locations
      with variable environmental challenges has the potential to improve physical ability,
      confidence, outdoor and overall physical activity and social participation. The extent to
      which it is safe and feasible to implement this intervention in people with varying degrees
      of physical ability, preferences for where to walk, neighbourhood walkability, and to measure
      outdoor walking activity, is unclear.

      Objectives: In older adults with a limitation in outdoor community mobility:

        1. To estimate the extent to which a 1-day educational workshop and 10-week outdoor
           mobility program (GO-OUT intervention) compared to the workshop and weekly reminders
           improves outdoor walking activity (primary outcome) and secondary outcomes of physical
           activity, lifespace mobility, participation, HRQL, balance, leg strength, walking
           self-efficacy, walking speed, walking distance/endurance, and mood over 12 months.

        2. To explore participants' perceptions of intended and unintended consequences of the
           interventions, potent intervention components, mechanisms of effect, modifying
           influences of disability level, sex,neighborhood walkability, weather, car access, and
           study site, and recommendations for future program delivery models.

      Approaches and Methods:Study Design: A 2-group mixed methods stratified randomized controlled
      trial following CONSORT criteria is proposed. Group allocation will be concealed and outcome
      evaluation blinded. The trial will be run at 4 sites (Edmonton, Winnipeg, Toronto, Montreal)
      to accrue a sufficient sample size, optimize the external validity of the results to urban
      centres variable in population size, weather conditions, and environmental barriers, and
      build capacity across 4 provinces to support potential implementation. Following a baseline
      assessment, eligible participants will be stratified by site, and randomly assigned to
      receive the 1-day educational workshop and 3-month outdoor mobility program (GO-OUT
      intervention) or the 1-day workshop plus weekly reminders. Follow-up evaluations will occur
      at 3, 5.5 and 12 months from baseline. A sub-sample of participants from the GO-OUT and
      workshop groups at each site will participate in face-to-face interviews at 6 and 12 months
      to explore their experiences. Interventions and assessments are designed to be implemented in
      'good weather' months, to avoid the potential negative effect of season on the primary
      outcome of outdoor walking activity.
    

Intervention name(s): GO-OUT Group; Workshop Group
Intervention type(s): Other; Other
Intervention description(s): Following a baseline assessment, eligible participants will be stratified by site, and randomly assigned to receive the 1-day educational workshop and 3-month outdoor mobility program (GO-OUT intervention). Follow-up evaluations will occur at 3, 5.5 and 12 months from baseline.; the 1-day workshop plus reminders. Follow-up evaluations will occur at 3, 5.5 and 12 months from baseline
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Experimental: GO-OUT program An outdoor walking workshop with stations to learn various outdoor walking skills and information, followed by a supervised, group based outdoor walking program, twice a week for 60 minutes, for 10 weeks.
Intervention: Other: GO-OUT program Active Comparator: Task-oriented outdoor walking workshop An outdoor walking workshop with stations to learn various outdoor walking skills and information.
Intervention: Other: Task-oriented outdoor walking workshop
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment