The intervention group received a standardised 12-month programme designed for delivery in leisure/community centres and fitness/health clubs where low-cost late morning capacity is available (which coincides with the periods where older adults are most likely to be out and about) and where suitable space for social activities is available. REACT was by qualified exercise professionals with experience in delivery of exercise classes in the community. We collaborated with existing community based organisations who had access to appropriate venues and delivery staff. These organisations offered a range of facilities suitable for delivery of the intervention.
Sessions were organised as group activities with up to 15 participants per group, but there were individually tailored elements for both aerobic exercise (where intensity was tailored to existing aerobic capacity/fitness) and strength work (where exercises were tailored to existing muscle strength). Activities included cardiovascular, strength, balance and flexibility exercises and daily lifestyle-based activity in the form of neighbourhood walking and active travel. Breaks in sedentary time were also promoted. Social activities such as post-exercise coffee meetings and community-based activities were organised to encourage a ‘social club’ atmosphere and promote long-term compliance.
The REACT intervention was designed to develop physical confidence, build skills for long term behaviour change, including a focus on neighbourhood activity, and providing opportunities for enjoyable social engagement. A novel element was the accompanying ‘REACT ambassadors’ scheme that provided the opportunity for participants to develop expertise and contribute as: a) a programme recruiter, or b) a local neighbourhood coordinator.
Our aim was to produce a pragmatic model of delivery that is rooted in the needs of the local community, that attracts a diverse population of older adults largely through its social and developmental appeal, is increasingly self-sustaining, and that has potential for application across the UK.
The programme was designed to address each element of health-related fitness recommended in the UK Chief Medical Officers' guidelines for activity for older adults. This includes warming up, strengthening and flexibility exercises, aerobic exercise building to moderate intensity levels, and exercises designed to improve balance and coordination. The intervention included a long-term target of 150 minutes of moderate intensity activity per week, which was approached progressively and took place in part beyond the structured sessions. Participants were encouraged to seek opportunities for physical activity throughout the day, through active hobbies such as gardening, and use of stairs, leisurely walks with friends and active travel. Supplementary instructions, ‘home-friendly’ exercises and written materials were supplied to encourage generalisation of exercise performance to the home environment.
Principles of progression and adaptation were applied in order to build exercise training demand at a rate that was appropriate for current levels of function and activity. Participants were trained to use ratings of perceived exertion and self-assessment of breathing as a method of regulating physical activity to moderate intensity levels. The initial focus was to orient participants to the concept of strength training, to build confidence in performing and completing the exercises, and to introduce the concept of training progression.
The supervised setting allowed instructors to tailor the programme to individual needs and abilities early on, so as to prevent early dropout and through in-session interactions and discussion to facilitate the building of self-efficacy and support. If participants missed two consecutive sessions, REACT leaders called the participant to problem solve ways for the participant to re-engage with the programme.
REACT was delivered in three progressive phases (Start up, Build up and Take charge) and established behaviour change techniques were used to enhance motivation, to make realistic plans for sustainable activity, to pre-empt and overcome barriers, to engage social support and to use self-monitoring and self-regulatory techniques to support the maintenance of behaviour change. REACT was delivered by qualified exercise professionals with experience in delivery of exercise classes in the community. The REACT co-applicants provided training in intervention delivery methods, including detailed session plans to ensure consistency and fidelity in programme delivery.
Start up (weeks 1 to 8)
The purpose of this phase was to stimulate initial increases in physical activity and fitness, to reduce any anxieties or concerns about exercise, and to build confidence and a sense of attachment to the programme. Each participant received a 45-minute individualised, face-to-face introductory session, during which time the programme was described, benefits and personal relevance of activity discussed, questions answered, and baseline assessment used to tailor the programme for starting levels and progression.
Two 60-minute physical activity sessions per week, plus a 20 minutes social and educational session, were then delivered by the REACT trainer.
Twice/week 60-min. physical activity sessions followed by a 20-min. social and education session
45-min. individualised introductory session with activity session leader
Build-up (weeks 9 to 24)
A 45-minute interactive educational/social session run by the REACT trainers was added at the end of one of the two weekly sessions. These sessions used evidence-based, person-centred behaviour change strategies to build intrinsic motivation and self-efficacy. They were designed to maximise enjoyment, social interaction, and group identity.
Behavioural management focused on self-regulation using goal setting, self-monitoring, reviewing of goals and problem-solving. A key focus was on exploring and planning the transition to more lifestyle-based activities. Pedometers were introduced during these sessions to support the participants in the transition to the maintenance phase.
45-min. interactive social and education session added at the end of one physical activity session
Twice/week 60-min. physical activity sessions + 20-min. social and education session
After week 12, the exercise session frequency was reduced to one per week but with an expectation that participants found an hour per week to exercise at home, in the neighbourhood or at a local physical activity session. Performance of this transitional behaviour was encouraged and monitored in the interactive sessions.
Participants were also introduced to the REACT Ambassador training programme. REACT Ambassadors had a choice of specialising in programme administration, or becoming local community activators (facilitators of local physical activity opportunities). For a leaflet with more information about the Ambassador's programme, click here.
Frequency of 60-min. physical activity sessions + 20 min. social and education session reduces to once/week after week 12
Ambassador training programme is introduced after week 12
Take charge (weeks 25 to 52)
The third stage focussed further on home and neighbourhood-based activities while continuing with a weekly centre-based physical activity session followed by a social and education session. Participants enacted action plans that were made during the transition phase and were supported through group social/education meetings once a month.
At this stage the groups were encouraged to organise their own social interaction beyond the scope of the study and to consider doing activities together as part of their ongoing physical activity regime. Participants were informed about local opportunities for physical activity in the community via our partners at each site and were offered vouchers for taster activity sessions (supplied by our collaborators and partners, other local service providers /companies, including health walks, bowling clubs, dance classes, and Tai Chi). This introduced people to a range of both free and pay-for activities that are available in the local community.
60-min. physical activity sessions + 20 min. social and educatin session continues once/week
Additional social and education meetings once a month to support the enactment of
Participants are actively engaged in other physical activity opportunities in the community
REACT Ambassadors helped to sustain activities after the initial 12 months by organising group meetings and activities. Further ‘taster session’ vouchers for community based activities were also provided, and participants were offered the weekly REACT sessions at a subsidised rate (subject to agreement with providers).
This menu of strategies was designed to build and establish a ‘brand’ that has wide appeal, attract media attention and become increasingly known through recommendation and word-of-mouth, which is the most successful mechanism of recruitment to community-based health promotion programmes. The Ambassador programme promoted growth and increasing sustainability. The pilot study helped to embed the intervention in the local community and (through word-of-mouth) facilitate recruitment for the main trial.
REACT aims to be scaled up nationally and implemented in a range of settings ensuring its successful translation to community programmes. During this study, REACT was delivered in a wide range of community settings to which we had access via our extensive network of collaborators and partners. These included sports centres as well as church halls and other community centres, as both the space and the equipment requirements for delivering REACT made the delivery of the intervention feasible in any community facility. Non-fitness centred community spaces may be more appealing to older people than sports centres which usually promote a young, elite sport and performance focused image more appealing to younger populations.
After completion of baseline assessments, participants allocated to the control group were invited to three 60-minute group sessions, spaced around four months apart, where they received information on a variety of healthy ageing topics including nutrition, Dementia awareness and the benefits of volunteering.