Older adults' participation in a community-based falls prevention exercise program: relationships between the EASY tool, program attendance, and health outcomes.

PURPOSE OF THE STUDY: The Exercise Assessment Screening for You (EASY) tool was developed to encourage older adults at every functional level to be more physically active. The purposes of this study were to examine characteristics of older adults who participated in an evidence-based falls prevention program by their entry to EASY tool scores, associations between EASY tool responses and class completion, and influences of EASY scores and items on improvements in days limited from usual activity and unhealthy physical health days. METHODS AND DESIGN: The program consisted of eight sessions conducted statewide by trained lay leaders in Texas. Assessments were collected at the beginning of session 1 and conclusion of session 8. Data included responses of 2,235 older adults. Logistic regression analyses were performed to assess the influence of individual EASY items and cumulative scores on health outcomes from baseline to postintervention. RESULTS: Neither the composite EASY scores nor the individual items significantly influenced program attendance. Higher cumulative EASY scores and individual items were associated with improvements in both health outcomes. IMPLICATIONS: The EASY tool enabled seniors with major health problems to enroll in falls prevention classes, without the additional burden of requiring medical consent for participation.

Transformation of a rural community for active living.

The current economic recession is challenging all communities to protect and promote the health and well-being of children and families. Rural communities are often more vulnerable than their more urban counterparts because of limited resources and services. Successful models are needed in rural communities that demonstrate the benefits of linking programs, services, and policies that promote active living to improve population health. This article reports the lessons learned by the Martinsville-Henry County Coalition for Health and Wellness and Activate initiative as a rural model for active living and provides recommendations for other rural communities.

Changes in physical functioning in the Active Living Every Day program of the Active for Life Initiative®.

BACKGROUND: Physical activity can prevent or delay the onset of physical functional limitations in older adults. There are limited data that evidence-based physical activity interventions can be successfully translated into community programs and result in similar benefits for physical functioning. PURPOSE: The purpose of this study is to measure the effects of the Active Living Every Day program on physical functioning and physical functional limitations in a diverse sample of older adults. METHODS: As a part of the Active for Life initiative, the Council on Aging of Southwestern Ohio implemented Active Living Every Day (ALED), a group-based lifestyle behavior change program designed to increase physical activity. Performance-based physical functioning tests (30-s Chair Stand Test, eight Foot Up-and-Go Test, Chair Sit-and-Reach Test, 30-Foot Walk Test) were administered to participants at baseline and posttest. Baseline to post-program changes in physical functioning and impairment status were examined with repeated measures analysis of covariance. Interactions tested whether change over time differed according to race/ethnicity, body mass index (BMI), and baseline impairment status. RESULTS: Participants significantly increased their performance in all four physical functioning tests. The percentage of participants classified as "impaired" according to normative data significantly decreased over time. Physical functioning improved regardless of BMI, race/ethnicity, or baseline impairment status. CONCLUSIONS: ALED is an example of an evidenced-based physical activity program that can be successfully translated into community programs and result in significant and clinically meaningful improvements in performance-based measures of physical functioning.

The impact of a national strategy to increase physical activity among older adults on national organizations.

This study was designed to evaluate the impact of the National Blueprint (NB) on the policies, programs, and organizational culture of selected national organizations. The theoretical model selected to assess the impact of the NB on organizational behavior was Burke's system theory of organizational change. Three organizations, AARP, the American College of Sports Medicine (ACSM), and the Administration on Aging (AoA), were selected for the study. Two individuals in each of these organizations were selected for interview. Semistructured interviews and document reviews were used in the data-collection process. Findings showed that the publication and establishment of the NB resulted in changes in the operating procedures of AARP, ACSM, and AoA. The results were broadly consistent with Burke's system theory of organizational change. The publication of the NB was shown to affect the behavior of organizational leaders, organizational culture, policies, programs, and individual and organizational performance. The new information generated has increased our understanding of the impact of health campaigns on organizational behavior.

A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY).

The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.

The Robert Wood Johnson Foundation Diabetes Initiative: demonstration projects emphasizing self-management.

PURPOSE: The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings. METHODS: The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination. RESULTS: Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care. CONCLUSIONS: The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.

Effect of the Heart At Work program on awareness of risk factors, self-efficacy, and health behaviors.

This study evaluates the effects of the American Heart Association's Heart At Work program on cardiovascular disease risk factor awareness, self-efficacy, and health behaviors. A prospective, quasi-experimental research design was used to assess the impact of the program at two factory sites (one intervention and one control). A total of 633 employees participated. Intervention site respondents significantly improved their knowledge of blood pressure management, the relationship between nutrition and cardiovascular disease, and heart attack risk factors. They also were more likely to begin treatment for hypertension, to report fewer sick days, and to have plans to improve their diet and lose weight. These findings suggest that the Heart At Work program had a favorable overall impact.