Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community-dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial

Abstract

IntroductionSITLESS is a randomised controlled trial determining whether exercise referral schemes can be enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity in the long term, in community-dwelling older citizens. The intervention is complex and requires a process evaluation to understand how implementation, causal mechanisms and context shape outcomes. The specific aims are to assess fidelity and reach of the implementation, understand the contextual aspects of each intervention site, evaluate the mechanisms of impact, and explore perceived effects.Methods and analysisFollowing the Medical Research Council guidance on complex interventions, a combination of qualitative and quantitative procedures is applied, including observational checklists and attendance registries, standardised scales (ie, Marcus’s Self-Efficacy Questionnaire, Physical Activity Self-Regulation Scale and the Lubben Social Network Scale) at baseline, postintervention and follow-up assessments, semistructured questionnaires gathering contextual characteristics, and participant observations of the sessions. Semistructured interviews and focus groups with the participants and trainers are conducted at postintervention and during the follow-up to explore their experiences. Outcomes from the standardised scales are analysed as moderators within the impact evaluation. Descriptive results on context and perceived effects complement results on impact. The qualitative and quantitative findings will help to refine the logic model to finally support the interpretation of the results on the effectiveness of the intervention.Ethics and disseminationThe study design was approved by the respective Ethical Committee of Ramon Llull University, Southern Denmark, Northern Ireland and Ulm University. Participation is voluntary, and all participants are asked to sign informed consent before starting the study. A dissemination plan operationalises how to achieve a social impact by reaching academic and non-academic stakeholders. A data management plan describes the specific data sets and regulates its deposition and curation. All publications will be open access.Trial registration numberNCT02629666; Pre-results.

Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review

“…The research described in this review covers the theoretical basis and empirical evidence for establishing a green-outdoors bent to social prescribing, which includes reviews of park prescription programs [46], group hiking prescriptions [47], farmers' market prescriptions [48], "Walk with a Doc" programs (https://walkwithadoc.org/), and exercise referral programs [49][50][51]. These social prescriptions take various forms, such as referrals for high-risk patients to weekly, biweekly, or monthly guided outdoor activities with provided transportation [44••, 47], or open-ended, digitally supported prescriptions outlining expected duration, intensity, and frequency of outdoor physical activity [24•].…”

“…The effects are often short-lived [51]. However, the use of social prescribing with enhanced selfmanagement strategies (e.g., individual goal setting, self-monitoring, prompts and cues) have the potential to strengthen the impact of such measures in fostering physical activity behavior change, and in turn, affect mood and feelings of connection if the activities are done within a group context [49,50]. Moreover, these strategies can be linked with nature-based solutions, promoting access to social and natural settings and open spaces [83].…”

A Prescription for Wellness: Exercise Referrals at a Federally Qualified Health Center

“…The past 2 decades have seen a rapid expansion of exercise referral programs across the United Kingdom, 11 and in 2019, a multicountry European randomized controlled trial was designed to enhance exercise referral schemes with PA-related behavior change theory. 12 A large body of empirical and theoretical evidence supports the important role of theory and personal PA-related psychosocial factors. For example, the social cognitive theory (SCT) posits that learning occurs within a dynamic and reciprocal interaction of the individual, environment, and behavior.…”

Older Adults’ Experiences of a Physical Activity and Sedentary Behaviour Intervention: A Nested Qualitative Study in the SITLESS Multi-Country Randomised Clinical Trial

“…The SITLESS project fulfils the definition of a complex intervention, comprising of different active components (i.e., structured exercise programme, one-to-one visit, group-based sessions, telephone follow-up) that allowed for tailoring to improve a range of short-term and long-term physical, social and psychological outcomes [ 8 ]. With this in mind, the need for comprehensive and effective evaluation of interventions targeting older adults is needed in order to understand the components that can influence positive behaviours and result in sustained behaviour changes.…”

“…Accordingly, the SITLESS study comprises a clinical trial focused on assessing effectiveness (i.e., impact evaluation) with quantitative methods and, complementarily, a process evaluation conducted with mixed methods. Process evaluation combines qualitative and quantitative results to help support the interpretation of impact evaluation outcomes [ 8 ].…”