Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65–75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial

Bammann et al. BMC Public Health (2018) 18:1197 https://doi.org/10.1186/s12889-018-6124-z STUDY PROTOCOL Open Access Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65– 75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial Karin Bammann* , Carina Drell, Lena Lotte Lübs and Imke Stalling Abstract Background: Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany. Physical activity promotion programs for older adults are often not successful, one reason is insufficient relevance of intervention measures for the study population. Community-based participatory research (CBPR) is a possible key strategy for tailoring more meaningful intervention programs to a specific community. However, evidence for the effectiveness of CBPR in the general population is scarce. This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults. Methods/design: The OUTDOOR ACTIVE intervention trial is a cluster-randomised intervention study carried out in a random sample of eight subdistricts in the city of Bremen, Germany. The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and land use mix of the subdistrict. Within the pairs, the subdistricts are assigned randomly to the two study arms: participatory development and implementation of a community-based program to promote outdoor physical activity (intervention) versus no intervention (controls). For evaluation, a survey is carried out before (baseline) and after (follow-up) the intervention period. The measurements include 7-day accelerometer measurement, physical fitness test, blood pressure, basic anthropometry, and self-administered questionnaire. Discussion: The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting. Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group, and it will inform policy makers and other stakeholders how to benefit from the results. Trial registration: German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018). Keywords: Physical activity, Older adults, Health promotion, Community-based intervention, PRECEDE-PROCEED model * Correspondence: Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Bammann et al. BMC Public Health (2018) 18:1197 Background The current demographic change in Europe is characterized by decreasing birth rates, rising life expectancy and an ageing population. This development is posing challenges on private, social and societal levels, and healthy ageing has become one key strategy to fight the expected added burden of the health system [1]. Physical activity (PA) is declining with age, and it is less prevalent in women compared to men and in lower compared to higher socioeconomic groups [2]. Despite its known benefits for health, more than two-thirds of the age group 65 years and older do not meet minimal PA recommendations in Germany [3] and raising these levels, preferably in community-based or neighborhood-based settings, forms one of the seven national specific health targets in the area of healthy ageing [4]. Cochrane reviews on PA promotion have repeatedly criticized the lack of intervention studies with sound methodology using objective PA measurements for evaluation [5–7]. Various factors of all ecological levels (intrapersonal, interpersonal, and environmental) contribute to the uptake and maintenance of any type of PA [8]. However, due to a lack of longitudinal studies and studies using objective PA measurements, a differentiation between correlates and determinants is barely possible [7, 8]. Factors that could play a causal role for PA in adults in general are perceived fitness, intention to exercise, self-efficacy, social support, PA history, and other psychosocial variables [8–11]. Apart from these intra- and interpersonal characteristics, the engagement in PA is strongly dependent on environmental factors [8, 12–14] and environmental intervention has been shown to be potentially successful previously [15]. Research in older adults is still scarce; a review from 2004 implies that among environmental factors, safety and aesthetics could play the most important roles in older age groups [16]. A review by van Cauwenberg and colleagues on determinants for PA [17] found inconsistent results for the age group 65+, which the authors attribute to “methodological issues within this developing research field”. Only two of the 29 included studies were using objective PA measurements, and most studies failed to differentiate between types of activity. The latter would be important for detecting associations between PA and environmental factors [17]. As any engagement in PA, outdoor PA has direct beneficial health effects on muscle strength, motor skills and cardiorespiratory fitness. Outdoor PA also has indirect effects that are not attributed to the physical movement alone, including higher Vitamin D levels, mental wellbeing and raised emotional scores through exposure to sensory engagement [18]. EEC readings show the direct impact of the PA environment [19]. In a recent study, older adults who were physically active outdoors at least once a week showed higher Page 2 of 6 levels of PA compared with those who were physically active indoors only [20]. Moreover, outdoor PA gives the opportunity for social interaction and does not require sports facilities. The success of PA promotion programs is heterogeneous [21, 22] and depends amongst others on the type of intervention and presence of a methodological framework for the development of the intervention [23]. Community-based participatory research (CBPR) frameworks show great potential for PA intervention as they involve the community, especially if they follow an ecological model [10]. CBPR have been shown to be effective for work-related health promotion [24], and they are useful to reduce health disparities [25]. Experience with CBPR in the development of PA promotion programs in older adults is limited. Despite the poor evidence bas (...truncated)