Health effects and cost-effectiveness of a multilevel physical activity intervention in low-income older adults; results from the PEP4PA cluster randomized controlled trial

Abstract

Background Older adults are the least active population in the U.S. Low-income communities have fewer physical activity (PA) resources, contributing to less PA and increased chronic disease risk. This study assessed the effect of the multilevel, peer-led, Peer Empowerment Program 4 Physical Activity (PEP4PA) on moderate-to-vigorous PA (MVPA) and health outcomes, over 2 years of follow up. Methods In a cluster-randomized controlled trial, 12 senior or community centers serving low-income older adults were assigned to a PA intervention (n = 6) or usual programming (n = 6) condition. PEP4PA included self-monitoring, health coaching, group walks, social support, and community advocacy to improve walking conditions. The primary outcome was daily minutes of MVPA (7-day accelerometer). Secondary outcomes included Perceived Quality of Life (PQoL), 6-Minute Walk Test (6-MWT), blood pressure (BP), and depressive symptoms at baseline, 6, 12, 18 and 24 months. Mixed effects regression models estimated the effects on outcomes between groups over time and included random effects for repeated measures and center clustering. Effect modification by sex and income status was assessed. We calculated the incremental cost per daily minute of MVPA gained in the intervention group relative to the control group to assess cost effectiveness. Results We enrolled 476 older adults (50 + years). Participants were on average 71 years old, 76% female, 60% low income, and 38% identified as racial or ethnic minorities. Compared to the control group, intervention participants sustained roughly a 10 min/day increase in MVPA from baseline at all time points and increased mean PQoL scores from unsatisfied at baseline to satisfied at 12, 18 and 24 months. Males and higher-income groups had greater improvements in MVPA. No significant effects were observed for 6-MWT or depressive symptoms, and BP results were mixed. The incremental cost per minute MVPA gained per person was $0.25, $0.09, $0.06, and $0.05 at 6, 12, 18 and 24 months, respectively. Conclusions PEP4PA achieved increases in MVPA and PQoL in low-income older adults, over 2 years of follow up. The peer-led, community-based intervention provides a sustainable and cost-effective model to improve health behaviors in underserved, aging populations. Trial registration ClinicalTrials.gov (NCT02405325) March 20, 2015.

Physical activity and functional social support in community-dwelling older adults: a scoping review

“…Crist et al examined the relationship between a peer-led group PA intervention and objective PA in older US-Americans. They found a significant increase in PA in the intervention group at 12 months, and participants maintained the increase over 2 years [ 112 ]. Chia et al found a significant positive association between companionship SOSU and objective PA in Taiwanese men and women, but the association was stronger in women [ 113 ].…”

Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults

“…The findings also replicated a prior study, RS 2.0, by some of us, in a larger sample and longer follow-up. Other intervention studies with interpersonal BCSs plus intrapersonal BCSs have also shown increases in PA of older adults, African American adult women, and adolescents . However, more specific evidence about the unique effects of intrapersonally vs interpersonally oriented BCSs is sparse and inconclusive .…”

Factors influencing technology use among low-income older adults: A systematic review

“…The United Nations defines older adult as individuals age sixty and above [ 1 ]. Nevertheless, because this study's ultimate goal is to inform technological interventions designed for the low-income older adult group, this review considers older adults as individuals starting from the age of fifty years and older based on two contextual propositions: (i) the gap in life expectancy between the richest one percent and poorest one percent of individuals was 14.6 years for men and 10.1 years for women in the United States between 2001 and 2014 [ 29 ], and low-income older adults may need technological interventions related to these aging and health issues earlier in the aging process than the general population of older adults; (ii) the ‘older adults’ age classification of fifty years and above is commonly observed in large longitudinal studies on aging, such as the Health and Retirement Study in the United States 2017 [ 30 ] and the English Longitudinal Study of Ageing (ELSA) 2020 [ 31 ]; and (iii) consistent with the ‘older adults’ age range adopted in existing systematic literature reviews on factors influencing technology use by older adults [ 23 , 32 , 33 ] and empirical studies concerning low-income older adults, such as healthcare access and food insecurity [ 34 ], interventions [ 35 , 36 ], and Internet use [ 37 ].…”