Healthy Moves for Aging Well

Table of Contents

  • The Intervention
  • Target Population
  • The Evidence
  • Funders/History
  • Testimonials
  • Volunteer Coaches
  • Benefits of Exercise
  • Evaluating Program Outcomes
  • Other Tools/Exercises
  • Publications/Presentations

The Intervention

Healthy Moves for Aging Well is a simple and safe in-home physical activity intervention developed and tested by Partners in Care to enhance the activity level of frail high-risk sedentary seniors living at home. The model was developed for community-based care management programs arranging and delivering services to seniors in the home. Healthy Moves is an additional service that can be added to the care manager's scope of work without significant additional time or expenses.

The Healthy Moves program has the potential to be effectively adapted by any agency that serves the senior population in the home, as long as the agency is ready and willing to implement the innovation, has the capacity and resources to support change, and has compatible goals with the mission of Healthy Moves. In addition to care management, Healthy Moves can also be used in Adult Day Health Care Centers, Senior Housing sites, Meals on Wheel programs and health plans. This program serves high-risk seniors throughout the nation and is focused on maintaining health status and quality of life.

Two levels of exercises are offered through this program: chairbound and advanced exercises. The materials are available in multiple languages.

Chairbound Exercises

Advanced Exercises
English
Spanish
Russian
Armenian
Korean
Chinese
Farsi

Target Population

Healthy Moves for Aging Well is designed for older adults who are currently enrolled in a care management program involving an ongoing, problem-solving relationship with a care manager. Specific recommended participant recruitment criteria include:

  • Age 65 years and older
  • Participation in a care management program
  • Need for assistance with 2 to 4 activities of daily living (ADLs)
  • Willingness to participate (motivation)
  • Caregiver in the home not required but permissible
  • If client lives alone or has no caregiver available, s/he must have ability to stand unassisted in order to exercise alone safely
  • Cognitive status sufficient to follow directions

The Evidence

Healthy Moves integrates best practice information from two evidence-based components: physical activity and behavior change.

The physical activity component of Healthy Moves is drawn from the evidence-based work of fitness experts Dr. Jessie Jones and Dr. Roberta Rikli of California State University in Fullerton, California. They conducted a nationwide research study testing six exercises linked to activities of daily living on 7,183 older adults ages 60 to 94 representing 267 various sites in 21 different states. The study developed a standardized test, known nationally as The Senior Fitness Test, for assessing the fitness levels of older adults. They reported that increased physical activity reduces the loss of function over the years, 10% each decade after the age of 60. Physically active individuals drop their rate of decline in half.

Changing Behavior Through Brief Negotiation--An Innovative, Research Based Approach

The evidence for changing behavior is from the research of Prochaska and DiClemente. These two accomplished researchers developed and tested the Stages of Change model, also known as Motivational Interviewing and Brief Negotiation. The Brief Negotiation method is an innovative approach for increasing older adults’ intrinsic motivation for making and sustaining changes in physical activity in brief clinical encounters.

The Brief Negotiation Roadmap is a research-based comprehensive tool that care managers use when introducing clients to the Healthy Moves program. This roadmap encapsulates the steps involved in the Brief Negotiation method, assesses readiness to change, and explores the client’s ambivalence to participate in the Healthy Moves program. For care managers, only a 10-15 minute session is needed with each client to encourage their identification of personal goals needed to incorporate moderate physical activity.

Providers can assess a client’s readiness for change by using a ruler scaled from 0 to 10 (higher numbers indicate greater readiness to change). The client is asked to select a number that best describes how ready s/he is to consider making a particular change. After understanding the client’s current state of readiness, a variety of follow-up questions taken from the roadmap can be asked to increase and strengthen intrinsic motivation (e.g. What prompted you to pick a 4 and not a 1? What would it take for you to move from a 2 to a 5?).




A second Brief Negotiation strategy is to invite the clients to make the arguments for change and ways of achieving it. In essence, the clients talk themselves into change. Change talk can include a number of different client verbalizations: desire, ability, reasons, need, optimism, intention, and commitment for change. A simple strategy for eliciting “change talk” is to ask for it directly, via strategic open-ended questions (e.g., What worries you about your blood pressure? How might your life be different if you begin exercising? What’s at stake if you don’t get your blood sugars under better control?)

After it is clear that the client is motivated to make changes in his/her physical activity level, the next step is to collaborate with the client to identify barriers and to set or identify an achievable plan of action. They work together to introduce and sustain the Healthy Moves exercises personally tailored to the client’s needs, resources, barriers, and individual lifestyle.

Funders

Partners in Care with funding from the John A. Hartford Foundation and national leadership and oversight from the National Council on the Aging and a Regional Advisory Team in Los Angeles developed and conducted a pilot project of Healthy Moves for Aging Well in four Los Angeles care management sites. The results yielded a high 76.2% client retention rate after six months of participation in the program.

The promising results of the pilot led to the current efforts to mainstream the Healthy Moves program into local care management programs in Los Angeles. These efforts are supported with funding from the Archstone Foundation, The California Endowment and UniHealth Foundation.

Healthy Moves is officially designated as an evidence-based health promotion program by the federal Administration on Aging. National leadership and oversight is provided by the Center for Healthy Aging at the National Council on the Aging, and the evaluation is led by the University of Southern California (USC) Andrus Gerontology Center and the Institute for Change Research Center of Partners in Care.

What Clients are Saying?

“The Healthy Moves program has helped me both mentally and physically, and I’m only getting better every day. I’ve noticed I’m not getting sick as often and I’m more mentally alert.” -80 year old

“I love doing my exercises because I can just sit in my chair and workout! The level is perfect.”-96 year old

“I give myself praise because I'm doing a lot better. I'm not afraid of falling anymore because I am a lot stronger." -94 year old

“The swelling in my ankle is just about all gone. My doctor is pleased that my swelling is down. I think the ankle point and flex reduced the swelling.” -91 years old

“I am very close to achieving my goal to rise from my chair easily and avoid tripping. I do the Healthy Moves exercises every day in addition to an exercise program I watch on TV. I have made progress and feel a sense of accomplishment.” -78 years old

“I will absolutely continue to do my exercises. I’ve improved a great deal since I was enrolled. I started out doing 20 arm curls a day and now I can do 50 a day. I’m also doing the advanced movements with a chair and I hold onto the kitchen sink.” -83 year old

What Care Managers & Coaches are Saying...

“My client told me the arm curl has helped improve her arm movement. She also really likes having the phone coach call her on a weekly basis. It’s so assuring to know that the program has such a positive impact on my clients.” – Care Manager

“My client is 88 years old and is physically ambitious and doing really well with the program.”– Peer Volunteer Coach

“My client started using the weights that I gave her to do the arm curls. Her son is physically active and is really happy that his mother is now concerned about increasing her upper body strength. When I talk to her on the phone, I can tell from her voice a sense of accomplishment both mentally and physically. She’s had an epiphany.”- Peer Volunteer Coach

“My client is really enjoying the exercises. She does them every day, several times a day. She wants to learn more exercises.” –Care Manager

Why Exercise?

Regular physical activity is one of the most powerful health interventions that can improve an older adult’s ability to function and remain independent in their own home. Despite the scientific evidence that exercise has tremendous health benefits, the majority of older adults are sedentary. National data indicate only 31% of individuals aged 65-74 and only 23% of those 75 years and older engage in regular physical activity, defined as 20 minutes of moderate activity 3 or more days per week (AHRQ, 2003).

Maintaining an active lifestyle is associated with the following benefits among older adults:

  • Lowers blood pressure
  • Lowers cholesterol
  • Increases bone density
  • Increases range of motion
  • Reduces symptoms of depression and pain
  • Improves mental alertness and mood
  • Reduces the risk of chronic diseases
  • Improves balance and prevents falls
  • Improves functional ability and independence

Volunteer Coaches

Following enrollment, agencies recruit and train motivational phone coaches from the community and local universities to complement the role of the care managers in reinforcing behavior change through motivational interviewing techniques. Dedicated, flexible and patient coaches with cultural and linguistic competency for the clients in the program call their assigned clients on a weekly or bi-weekly basis to offer a form of social support, motivate the clients to adopt and maintain the recommended exercises, and to monitor each client’s participation in the physical activity program.

The care managers monitor their clients’ participation during their monthly phone calls and at their regularly scheduled appointments. Depending on the structure of the care management agency, care managers formally reassess their clients in the home at 3-month intervals.

Are you interested in being a motivational coach?
Please contact Jennifer at jwieckowski@picf.org

Evaluating Program Outcomes

To measure changes in health outcomes and functional performance, the program incorporates a pre-test and post-test. Sites have the option of evaluating their performance using one of the following tools, depending on the level of evaluation desired:

· Long Enrollment & 3-Month Follow-Up Evaluation Forms

· Brief Enrollment & 3-Month Follow-Up Evaluation Forms

The long enrollment and follow-up evaluation forms offer project sites an opportunity to evaluate key outcome measures including pain and depression, fear of falling and the number of injurious falls, goal setting and goal attainment, and maintenance of or improvement in physical functioning using a modified version of the evidence-based Senior Fitness Test. The brief enrollment and follow-up evaluation forms are intended for project sites that do not have the time to collect evaluation measures during home visits. The longer enrollment forms are more comprehensive when assessing the effectiveness of the program on individual clients, however, the brief forms may be more practical for some sites.

Selected Presentations

(July 2007). "Physical Activity, Exploring this Important Component of Healthy Aging Across the Continuum." 2007 National Association of Area Agencies on Aging (N4A) Annual Conference. San Francisco, CA.

(April 2007). “Fall Prevention Strategies.” 2007 Conference on Aging, Pasadena, CA.

(March 2007). "Get Active at Home: Engaging Frail Elders in Safe Physical Activity." 2007 American Society on Aging and National Council on Aging Joint Conference, Anaheim, CA.

(October 2006). "Evidence-Based Innovations to Reduce Falls in Waiver Clients." 22nd National Home & Community Based Service Conference, Minneapolis, Minnesota.

(September 2006). “Introducing a Simple, Evidence-based Physical Activity Intervention for Community-dwelling Frail Older Adults.” 2006 Centers for Disease Control National Health Promotion Conference, Atlanta, GA.

(March 2006). “Engaging Frail Elders in Evidence-based Home Physical Activity,” “New Care Management Strategies to Improve Health Outcomes,” and “Translating Research into Care Management Practice: Results from the AoA Evidence-based Prevention Initiative.” 2006 American Society on Aging and National Council on Aging Joint Conference, Anaheim, CA.

Publications/Newsletters

Wieckowski, J. and Simmons, W. J. (2006) "Translating Evidence-based Physical Activity Programs into Community-based Programs" [Special Issue]. Home Health Care Services Quarterly, 25 (½), The Haworth Press.

Wieckowski, J. (Spring 2006). “Integrating a Simple In-Home Physical Activity Program for Older Adults.” Healthcare and Aging Newsletter.

NCOA Toolkit, 2004