A Model for Our Times

In the face of a rapidly growing older adult population, Choose to Move helps seniors become active and socially connected for health.

By Christa Hoy

We live in an unprecedented time in history. Our population is rapidly aging, and we are living longer than ever. In Canada, there are more people over the age of 65 than under the age of 15¹. This shifting demographic presents both tremendous challenges and opportunities for society. Chief among these challenges is the fear and narrative that our health-care system will be taxed beyond the limit. This concern is all the more troubling because a majority of seniors are not getting enough physical activity for health and mobility benefits, and social isolation is widespread². But it’s not all doom and gloom. There lies great opportunity in having a healthy and vibrant population of seniors, and with the correct evidence-based policies and programming in place, we can achieve it.

To impact the health of populations, effective programs or interventions — those that have been tested by science and demonstrate positive results — must be effectively scaled-up and evaluated. However, the vast majority of physical activity research focuses on descriptive studies (e.g., describing the effect of physical activity on health) and one-off trials that never leave the lab setting or make it to the real world. Only three percent of physical activity research is about dissemination — interventions that have been tested and demonstrate positive results that are then delivered in real-world settings at a large scale³. Even fewer physical activity dissemination studies have focused on seniors. We need to decrease the amount of time it takes to get evidence into practice in order to address real-world public health challenges.

What to do about this?

In response to our shifting demographics and rates of physical inactivity among seniors, the British Columbia Ministry of Health developed a physical activity strategy for the province⁴. Older adults are one key focus area. Our team, the Active Aging Research Team at the University of British Columbia, was tasked to develop, implement, and evaluate a physical activity strategy for seniors. With community partners, we co-designed a strategy that is based on evidence, has a broad reach across the province, and targets seniors who are not already active. Active Aging BC emerged from this process, with Choose to Move as a signature initiative.

Watch this video to learn more about Choose to Move

Choose to Move is an evidence-based intervention designed to be delivered at scale — one of the three percent of physical activity dissemination studies. It is delivered at local recreation facilities across BC in partnership with the BC Recreation and Parks Association, YMCA of Greater Vancouver, and United Way of the Lower Mainland. Choose to Move is choice-based. Working with a trained activity coach, inactive senior participants develop a physical activity action plan. In this plan, participants set meaningful and achievable goals, like, “I want to be strong enough to do my own house cleaning so that I can fire my housekeeper and save some money,” and “I want to be able to play with my grandchildren without getting tired as quickly.”

Over the course of six months, activity coaches support participants in different ways. At the beginning of Choose to Move, activity coaches meet with participants one-on-one to set goals and choose activities existing in the community or that they can do on their own (e.g., walking). Choose to Move gets social when groups of up to 15 participants gather to share challenges and successes with their physical activity plans and discuss a health topic (e.g., stress management). Activity coaches also call participants over the course of Choose to Move to see how they are progressing with their plans, provide support and encouragement, and help troubleshoot any roadblocks along the way. Support is greatest in the first three months, then tapers off.

But, how do we know that Choose to Move works? Our team evaluated both how Choose to Move was implemented and the impact on participants’ health behaviours. We recently published findings⁵ from our impact evaluation for the 56 programs that began in 2016. We measured participants’ physical activity, mobility, strength, social connectedness, loneliness, and happiness before, during, and after Choose to Move.

We found that, generally, participants experienced positive behaviour changes.

We found that Choose to Move positively impacted participants’ behaviours, however, we found differences in outcomes in younger (60–74) and older participants (75+). Both age groups increased their physical activity, mobility, and strength after participating in the program. Social connectedness increased in the younger participants only, but the older participants were more connected than the younger participants at the start of Choose to Move. Loneliness decreased and happiness increased in both age groups across the duration of Choose to Move.

We hear stories from participants that echo our findings. Like Laurie, a 90-year old participant from Penticton, who told her activity coach she noticed both mental and physical changes. She didn’t realize how disconnected she had become before joining Choose to Move. Laurie, “felt like participating in life again,” after beginning Choose to Move, and now she, “does what she can and she wants to.”

Choose to Move is one of the first physical activity initiatives for seniors to be delivered at scale anywhere in Canada. Our findings provide evidence that the initiative is effective and scalable. The improvements in physical activity, mobility, and social connectedness are important. Seniors who are socially connected have a better quality of life, and a greater likelihood of survival compared to those who are not⁶. Gains in physical activity and mobility will reduce the risk of chronic conditions and preserve seniors’ independence⁷. Choose to Move is contributing to a healthy and vibrant population of seniors in BC and continues to be delivered across the province.

Since 2015, the Active Aging Research Team, the BC Recreation and Parks Association, YMCA of Greater Vancouver and the United Way of the Lower Mainland have been working in partnership to enhance the health, physical activity and social connectedness of BC seniors through Choose to Move.

References

1. Statistics Canada: Age and sex, and type of dwelling data: key results from the 2016 census. The Daily 2017. https://www150.statcan.gc.ca/n1/daily-quotidien/170503/dq170503a-eng.htm
2. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009Canadian health measures survey. Health Rep. 2011;22(1):1–8
3. Milat AJ, Bauman AE, Redman S, Curac N. Public health research outputs from efficacy to dissemination: a bibliometric analysis. BMC Public Health. 2011;11:934
4. Ministry of Health. Active People, Active Places: British Columbia physical activity strategy. In: Healthy families BC; 2015.
5. *McKay HA, Nettlefold L, Bauman A, Hoy C, Gray SM, Lau E, Sims-Gould J. Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale. BMC Public Health. 2018; 18:1289.
   *Literature from the Active Aging Research Team
6. Poscia A, Stojanovic J, La Milia DI, Duplaga M, Grysztar M, Moscato U, Onder G, Collamati A, Ricciardi W, Magnavita N. Interventions targeting loneliness and social isolation among the older people: an update systematic review. Exp Gerontol. 2018; 102:133–44.
7. Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. Gerontologist. 2016;56(Suppl 2):S268–80.