For information about this program please contact Bertha Sandoval, Project Coordinator at: firstname.lastname@example.org
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).
Improves functional ability and independence
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 Wheels 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.
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:
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.
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.
Healthy Moves is officially designated as an evidence-based health promotion program by the federal Administration on Aging.
Reference: National leadership and oversight was provided by the Center for Healthy Aging at the National Council on Aging. Evaluation was led by the University of Southern California Andrus Gerontology Center and the Institute for Change Research Center at Partners in Care Foundation.
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.
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:
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.
Frail Elders Get Physical: Healthy Moves for Aging Well, June Simmons, CEO, Partners in Care Foundation & Kristie Patton, MSW, March 18, 2009, Presented To: ASA/NCOA Joint Conference, Las Vegas, Nevada
(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.
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.
NCOA Toolkit, 2004