- Click here for explanation of classification scheme.

To determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site manager interviews and site visits to determine organizational feasibility. Study 3 was a controlled pilot study that randomized meal sites to a 12-week group based social-cognitive (GBSC) intervention or a standard-care control.

Congregate meal site users from a single Administration on Aging (AOA) in a large Midwestern state.

Not provided for any of the three studies.

Recruitment

• Study 1: Volunteers were recruited from six randomly selected congregate-meal sites in the 18-county region that received services from the AOA in north central Kansas
• Study 2: Volunteer meal-site managers were recruited from 15 randomly selected congregate meal sites in the 18 county region that received services from AOA
• Study 3: The AOA had 43 active congregate meal sites. 15 sites were randomly selected with a goal of four sites to be included in the study. The first four sites that were contacted agreed to participate in the study. 60 individuals were identified as regular meal site users and 40 agreed to participate in the study.

Design

• Study 1: Survey
• Study 2: In-depth face-to-face interview and 10-item physical environment checklist
• Study 3: Group Randomized Trial.

Blinding used

Blinding was not used in the studies.

Intervention

• Study 1 and Study 2: Not Applicable
• Study 3: Participation in PA group program.

Statistical Analysis

• Study 1: Chi-square analyses and Pearson two-tailed bivariate correlations were used to determine relationships within the data 
• Study 2: Percentages of responses were calculated
• Study 3: Descriptive statistics and change scores were provided. Cronbach's alpha scores were used to demonstrate that each psychosocial measure was internally consistent. ANOVA's were used to determine differences between the intervention group and the control group. Condition by time interaction was found for weekly caloric expenditure and standardized effect sizes were computed to identify the magnitude of the effect of the effect of the intervention.

Timing of Measurements

• Study 1: One time survey
• Study 2: One time interview and physical environment checklist
• Study 3: Measures of PA, group cohesion and self-efficacy were collected before and at the completion of the 12-week study.

Dependent Variables

Study 1: Agree, disagree or neither agree nor disagree to the following three statements "I would join a PA program at my congregate meal site if it was offered": One day a week, two days a week, and three days a week.

Using a scale with descriptive anchors that ranged from strongly disagree to strongly agree, participants responded to "I am confident in my ability to do moderate PA one, three, or most days each week.

Study 2: Interview questions included: What programs are being offered at your congregate meal site?, Is there a PA program offered in conjunction with the meal?, If there is an existing class, describe the leader with respect to credentials and demographic characteristics., How often does the class meet?, How many people attend?, How would you describe the population of people attending the meals including their physical functioning and mode of transportation to and from the site, How feasible would a regular PA program at your meal site be?, What methods would be effective in marketing such a class to the individuals going to the three to five days per week?

Physical environment checklist included: Is there a multipurpose room large enough to allow for a physical activity program?, Does the area have windows?, Is the room temperature comfortable?, What type of flooring?, Is there adequate ventilation?, How is the lighting?, Are there adequate number of sturdy chairs to use for the physical activity program?, Is there operational sound equipment?, Is there operational video and television equipment (for possible video led activity session?, What is the global usability of the facility for regular physical activity programming?

Study 3: Mean caloric expenditure (CE), Mean CE moderate activities, Individual attractions to group tasks (ATGT), Individual attractions to the group social (ATGS), Group integration task (GIT), Group integration social (GIS), self-efficacy.

Independent Variables

• Study 1: Age, gender, ethnicity and household income
• Study 2: None
• Study 3: None.

Control Variables

• Study 1: None
• Study 2: None
• Study 3: None.

• Initial N:
  • Study 1: N=152
  • Study 2: N=15
  • Study 3: N=40
• Attrition (final N):
  • Study 1: N=138
  • Study 2: N=15
  • Study 3: N=40
• Age:
  • Study 1: Average age was 77.6 years
  • Study 2: Average age was 47 years
  • Study 3: Average age was 77 years
• Ethnicity:
  • Study 1: 95% White
  • Study 2: 100% White
  • Study 3: 100% White
• Other relevant demographics:
  • Study 1: 69% women
  • Study 2: 100% women
  • Study 3: 78% women, low-income
• Anthropometrics: None
• Location: North central Kansas. 

 Results from Study 1:

	One Day	Two Days	Three Days
Would join	58%	52%	45%
Would not join	31%	30%	33%
Undecided	11%	18%	22%

• Chi-squared analysis revealed that the proportion of participants who indicated that they would join a PA program significantly decreased and the proportion that indicated they were undecided increased when the program days increased above one day of PA each week (P<0.01)
• Bivariate correlations showed that self-efficacy was significantly and positively related to each measure of likelihood. The composite measure of likelihood of attendance at a PA program had the strongest relationship with self-efficacy (P=0.3). As perceptions of PA self-efficacy increased, so did the likelihood participants would participate in a PA program offered with their congregate meal. 

Results from Study 2:

Summary on interview results

• 73% of the meal site managers interviewed indicated that starting a PA program in conjunction with congregate meals was a feasible idea
• Feasibility hinges on having a volunteer to help deliver the program, making the program interesting and not offering it too often
• The remaining quarter of the sample thought that they did not have the time to offer a PA program, they did not have the resources or volunteer base to support such a program or the participants would not be interested.

Summary of physical environment checklist

• With only two exceptions, all sites had a large room available for participation, sturdy chairs and video equipment available
• One site did not have a large multipurpose room, but the tables used for mealtime could be moved easily to free up space for a PA group
• One site did not have sturdy plastic chairs and was rated unsuitable to host a AP program
• Overall, the results provided evidence that vast majority of the sites could support a PA program.

Results from Study 3:

Variable	Change after the group based intervention	Change in the standard-care control group
Mean CE all activities (kcal)	1,065.4	-280.6
Mean CE moderate activities (kcal)	685.6	-268.4
Individual attractions to the group task (ATGT)	-0.1	-0.9
Individual attractions to the group social (ATGS)	-0.2	0.2
Group integration task (GIT)	0.2	-0.6
Group integration social (GIS)	-0.2	-0.2
Self-efficacy	-0.4	-0.4

• Because of the small sample size and pilot nature of the study, a probability value of 0.10 was set a priori as an indicator of statistical significance
• Group-based intervention participants increased caloric expenditure in all PA, whereas control participants did not 
• Weekly caloric expenditure in moderate intensity PA was higher for the group-based intervention participants than in the control group
• Participants in the group based PA intervention maintained consistent levels of task cohesion, whereas those in the standard-care control condition decreased in these perceptions. 

• Study 1: The results show that a substantial portion of attendees would participate in a regular PA program that was offered with congregate meals. The largest proportion of participants would attend a program offered one time per week. Self-efficacy enhancement strategies could motivate participants who were undecided to join a program.
• Study 2: In general, the results provide evidence that a vast majority of sites could support a PA program
• Study 3: The results show that a group-based social-cognitive intervention was successful in increasing AP over a three-month period.

 

 

Government:

Kansas Department of Social and Rehabilitative Services FNP

The author noted the following limitation for Study 3:

• The sample size for this first-generation study was small which limited the power to identify small to moderate magnitudes of effects
• The sample size of four congregate meal sites did not allow for multi-leveled analysis to address issues of participant clustering
• The primary outcome measure was self-reported; however, the CHAMPS measure reflects the state of the art for assessment of PA in older adults 
• The duration of the study only allowed for an examination of the short-term effectiveness of the program
• Future research should expand the magnitude of Study 3 to include multiple groups, a larger sample size and a six-month follow-up to determine issues of organization and individual level maintenance of the program.