Journal of Aging and Physical Activity, 2016, 24, 39  -44 http://dx.doi.org/10.1123/japa.2014-0016 © 2016 Human Kinetics, Inc.

ORIGINAL RESEARCH

Increasing the Availability of Physical Activity Programs for Older Adults: Lessons Learned From Texercise Stakeholders Alan B. Stevens, Shannon B. Thiel, Jennifer L. Thorud, Matthew Lee Smith, Doris Howell, Jessica Cargill, Suzanne M. Swierc, and Marcia G. Ory Many initiatives have been developed to facilitate older adults’ engagement in physical activity (PA) and document its benefits. One example is Texercise, a 12-week program with a focus on increasing participants’ self-efficacy. The goal of this paper is to augment the knowledgebase of PA program implementation and dissemination by elucidating the experience of Texercise implementation as perceived by multiple stakeholders. We conducted 28 semistructured stakeholder interviews and categorized the responses into four preset themes: (1) program delivery and advocacy; (2) value/merit of the program; (3) successes/challenges of offering and sustaining the program; and (4) recommendations for enhancing implementation and delivery. We identified emergent subthemes through further analysis. Many perceptions that are broadly applicable to community organizations emerged. Our findings highlight the importance of stakeholder support when embedding PA programs in communities. Furthermore, the findings are crucial to understanding underlying processes that support widespread program dissemination and sustainability. Keywords: stakeholders, program sustainability, health promotion

Participation in physical activity (PA) is positively associated with numerous favorable health outcomes for all age groups (U.S. Department of Health and Human Services, 2008a). There is increasing recognition of the value of physical activity for older adults in particular. This is demonstrated by national initiatives to facilitate engagement in PA and to document its physical, emotional, and social benefits to older adults. These national initiatives, which include The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older, the National Institute on Aging’s Go 4 Life, and the U.S. Department of Health and Human Services’ Be Active Your Way (National Institute on Aging, 2013; Robert Wood Johnson Foundation, 2001; U.S. Department of Health and Human Services, 2008b), support the translation of evidence from clinical trials into PA programs that are suitable for community settings. The availability of evidence-based programs (EBPs) for translation has increased due to important dissemination efforts by groups such as the National Council on Aging, which endorses 18 EBPs for older adults, and the Administration for Community Living (Administration on Aging, 2013). Despite the national focus on evidence-based PA programs for older adults, the provision of PA programs in local settings has largely remained a state and local effort. At the local levels, agencies providing senior services have begun offering PA programs designed to meet the varied physical abilities and interests of older adults. These local programs are often not evidence-based. Unlike EBPs, these programs have not been subjected to scientifically-rigorous tests of their efficacy. Nevertheless, older adults routinely report benefits from participating in these PA programs and community-based Stevens is with Baylor Scott & White Health, Temple, TX; and Texas A&M Health Science Center, Temple, TX. Thiel and Thorud are with Baylor Scott & White Health, Temple, TX. Smith is with the University of Georgia, Athens, GA; and Texas A&M Health Science Center, College Station, TX. Howell, Cargill, Swierc, and Ory are with Texas A&M Health Science Center, College Station, TX. Address author correspondence to Alan B. Stevens at [email protected].

organizations demonstrate a strong commitment to providing PA programming as a community service.

Background Texercise, a program delivered statewide in Texas, is a PA program that is deeply rooted in the community. It is supported by the Texas Department of Aging and Disability Services (DADS) and has had a large volume of participants complete the program, as it has existed for more than 10 years (Texas Department of Aging and Disability Services, 2013). Only recently has Texercise been subjected to an independent evaluation. The experience of developing and implementing Texercise is not entirely unique. Rather, it is an example of practice-based evidence (Green, 2006). That is, a program developed in a community or clinical setting in response to a well-documented need. The differences between practice-based and evidence-based programs are often not noticeable. This is especially true of PA programs because practice-based and evidence-based PA programs typically share many components (e.g., stretching, range of motion exercises). Practice-based programs may, in fact, have distinct advantages over EBPs in some aspects of implementation and sustainability (e.g., community support, adaptability). With the goal of augmenting the knowledgebase of PA program implementation and dissemination among older adults, we explored stakeholders’ experiences with Texercise implementation. We will discuss how stakeholder feedback can inform the implementation of other PA programs. We will also discuss how the study of practicebased programs can inform the implementation and sustainability of EBPs.

Methods To facilitate the collection of feedback from key stakeholders, the Texas DADS Texercise staff provided the research team with a list of approximately 30 individuals selected because of their familiarity 39

40  Stevens et al.

with Texercise and its evolution. The list included Texercise class facilitators, site providers, partners, state-level program administrators, and participants. Texercise class facilitators identified additional participants who could provide feedback. An explanation of the roles of the stakeholders and the topics addressed during their interviews are provided in Table 1. The research team contacted the potential interviewees via phone to confirm their interest in participating in interviews for the study and to schedule interview times. The stakeholders primarily represented Texercise Classic, a relatively unstructured 12-week program designed to encourage

individuals to adopt healthy lifestyle habits, such as PA and good nutrition. Texercise Classic has a set of resource materials including a handbook that provides: (1) motivational information about why exercise is important; (2) educational information about recommended dietary and physical activity practices; (3) examples of practical exercises for improving strength, endurance, balance, and flexibility; and (4) strategies for setting, tracking, and maintaining goals. The DVD demonstrates the performance of the various recommended exercises. These materials are seen as essential elements of the program because they help reinforce activities learned

Downloaded by George Mason Univ on 09/23/16, Volume 24, Article Number 1

Table 1  Texercise Key Stakeholders, Roles, and Interview Topics

Stakeholder Type

Role Definition

Interview Focus Areas

Class facilitators

Individuals who had led a Texercise class. Both facilitators from Texercise Classic and Texercise Select classes were interviewed.

–Facilitator experiences as program leaders including interaction with Texas DADS staff –The structure of their classes

Number from Texercise Classic

Number from Texercise Select

Total Number

9

2

11

4

1

5

N/A

N/A

4

N/A

N/A

4

1

3

4

14

6

28

–Leader training –Program recruitment, implementation, and evaluation Site providers

An individual from an organization that provided a physical location for the Texercise classes.

–The mission of their organization/ program and their partnership with Texercise –Facilitator experiences as program leaders –The structure of their classes –Program recruitment, implementation, and evaluation

Partners

Larger organizations and companies that provided monetary contributions for the continuation of Texercise.

–The mission of their organization/ program and their partnership with Texercise –The development of their relationship with Texercise –Partner evaluations of the program –Continuity of their partnership with Texercise

State-level program administrators

Participants

Employees with the Texas DADS who are directly involved with the Texercise program. All staff interviewed were very familiar with Texercise Classic. Familiarity with Texercise Select varied among staff members. The Texas DADS employee responsible for marketing the Texercise program throughout the state had a specific set of questions.

–Program marketing

Older adult individuals who had taken a Texercise class. Individuals from both Texercise Classic and Texercise Select were interviewed.

–General physical activity programming questions

–Program components –Long-term vision of the program

–Implementation of the class they participated in (i.e., length, activities, etc.) –Participant evaluations of the program

Total key stakeholder interviews Abbreviation: DADS = Department of Aging and Disability Services. JAPA Vol. 24, No. 1, 2016

Downloaded by George Mason Univ on 09/23/16, Volume 24, Article Number 1

Increasing the Availability of Physical Activity   41

in Texercise Classic (http://www.dads.state.tx.us/texercise/). While program materials and facilitator training were provided in a standardized format by the Texas DADS, variations in how communities implemented the program were permitted (e.g., types of PA, number of classes provided each week). No significant changes to this version of Texercise have been made since its initial implementation. A small number of stakeholders represented Texercise Select, a more structured version of the Texercise program. This variation was developed by expert consultants and is based on known best practices and behavior change principles, with a focus on increasing participants’ self-efficacy (Texas A&M Health Science Center & Scott & White Healthcare, 2013). Two weeks of the 12-week Texercise Select are dedicated to participant recruitment activities; the remaining 10 weeks are comprised of 1.5-hr sessions held twice weekly. Each session incorporates an educational component (interactive discussions and activities about exercise and nutrition) and 30–45 min of active participation in PA. Deviation from this schedule is discouraged. Initial development and testing of the Texercise Select program was conducted in 2013. Several manuscripts have been prepared describing the formation and evolution of Texercise (Ory et al., 2015) and documenting impacts on lifestyle behaviors (Smith et al., 2015) and on physical functioning and quality of life (Ory et al., 2015). The interview questions/guides were developed by behavioral scientists familiar with evidence-based programs for seniors and who have expertise in program dissemination and implementation research. The questions were designed to understand the particular role of the respondent in promoting community-based physical activity programs, their perspectives about the value of the program, successes and challenges in program delivery, and recommendations for implementation and dissemination enhancement. Each stakeholder group received a slightly different set of questions; however, there was an estimated 70% of question overlap across the guides. Over a period of one month, members of the research team conducted 28 key stakeholder interviews via telephone. Completed interviews (27) varied from 11 min to 1 hr in duration. One of the 28 interviews was not completed due to an emergency and was not able to be rescheduled. Completed interviews averaged 19 min for participants, 27 min for site providers, 31 min for Texas DADS staff, 32 min for partners, and 34 min for facilitators. The interviews were audio recorded for later transcription. In accordance with the Texas A&M institutional review board guidelines, consent was obtained from participants and acknowledgment of consent was included in the interview recordings. The interview transcripts were assigned unique identifiers to maintain interviewee confidentiality. Following the collection of interview data, the research team used a combination of preset (or deductive) and emergent (or inductive) themes to analyze the data. This approach allows researchers to inductively derive themes while answering a priori questions drawn from the study objectives (Pope, Ziebland, & Mays, 2000). Two members of the research team read through all of the data and attempted to categorize the stakeholders’ feedback into four preset themes: (1) role in delivering and supporting the program, (2) value and merit of the program, (3) successes and challenges of offering and sustaining the program, and (4) recommendations for implementation and delivery enhancement. These themes defined the four categories and accommodated all interview data. Two additional team members, blinded to the initial “working labels”, examined the review data by the established categories. This was done to establish the reliability of the categories. In addition, the team members identified emergent subthemes from which we pinpointed factors that support the widespread dissemination and sustainability of PA programs. Formal interrater reliability was not calculated.

Findings The stakeholders’ feedback is presented below by theme and subtheme. Where applicable, the stakeholders’ program type is listed (Texercise Classic or Texercise Select). Any names used in quotes have been changed to protect privacy. Themes were discussed by most stakeholders. Roles, values, and successes and challenges were discussed by 25/27 stakeholders with completed interviews, and recommendations were discussed by 23/27 stakeholders with completed interviews.

Roles in Texercise The stakeholders emphasized the value of having multiple individuals and agencies responsible for developing, disseminating, and advocating for the future of Texercise. Each stakeholder group expressed “ownership” of the program. Interview data suggest that all stakeholder groups played roles in developing and/or implementing the program (e.g., providing funding, marketing the program to partners and communities, building support at implementation sites, serving as program champions, participating in workshops).

Value of Texercise Stakeholders identified numerous reasons why Texercise is valuable. These reasons relate to the benefits experienced by individual participants in the program. Social Interaction and Camaraderie.  The stakeholders described

how the group format of Texercise provided opportunities for participants to socialize with friends and meet new people. They indicated that this social interaction alleviated the boredom of exercising alone. Moreover, participants felt camaraderie and were able to hold one another accountable. The thing about having several people there, you get different ideas from different people…it’s pretty unique to have a support group like that. That was the best part…it was supportive. (Participant FP, Texercise Select) I think camaraderie of gathering, you know…it’s getting together and I still have them come back and ask me—it may be in the winter months—and they go, ‘Let’s do another Texercise class.’ They actually like having to get out and be somewhere and do something and feel good about themselves. (Facilitator LR, Texercise Classic)

Suitability for Participants at All Fitness Levels.  According to the stakeholders, the flexibility of Texercise made it suitable for individuals of all ages and fitness levels. They described it as being “accessible” to all participants, regardless of their abilities, and they explained that participants could begin with simple, nonstrenuous exercises and progress to the next level when ready.

I think it’s a perfect program for older adults—not too strenuous but yet some of it was challenging. (Participant ME, Texercise Classic) Well, I think the materials are well done; I think that they’re accessible and work well with people at different levels of fitness. (Facilitator DG, Texercise Classic) Improved Health of Participants.  The stakeholders emphasized that the health of participants improved after taking part in the program. They cited improvements in the physical, mental, and social dimensions of health.

JAPA Vol. 24, No. 1, 2016

42  Stevens et al.

And I’m starting to catch my balance. Now I walk between the furniture or these doors, I don’t even touch them. I don’t need a brace anymore. (Participant GH, Texercise Select) I look back and realize I think I was asleep the last 6 months before I started the program, but my mind was asleep, so it could have been a little on the depressed side, but that will definitely get you out of depression if you exercise like that. (Participant FP, Texercise Select)

Successes and Challenges of Texercise Stakeholders reported many successes and challenges in the delivery and maintenance of Texercise. These successes and challenges were diverse and relate to multiple aspects of program implementation and sustainability.

Downloaded by George Mason Univ on 09/23/16, Volume 24, Article Number 1

Support from the Texas DADS.  The stakeholders viewed the

ability of the Texas DADS to reach residents across the state as a success. They also reported that the Texas DADS was efficient at providing materials and supportive of implementation efforts without micromanaging every site.

Oh, we’re in constant communication. I can’t tell you enough stuff about Sarah and Bill…when I was looking to do the event, Bill would…make sure everything was going well...he and Sarah were there to say, ‘Hey we’re here for you, if you can’t work it out we’re going to make sure it’s there.’ They are instrumental for keeping a lot of the programs that we kind of started running. (Facilitator NV, Texercise Classic) I do a great deal of public speaking and have done that on behalf of Texercise and again it’s primarily through Bill’s efforts. Bill is the guy, from my perspective…that’s really helping to drive this effort statewide. (Partner TW) Expanded Reach.  According to the stakeholders, another success was that implementation sites expanded their reach. When implemented locally, residents in communities become more aware of both Texercise and of the organizations that implemented it. In addition, many participants expressed interest in returning to the sites for future classes.

I think it’s been very successful. We got a lot that want us to continue. We found a lot that want to come back here in the next few months and reengage… (Site Provider LG, Texercise Select) I think the ability of the Texercise program to reach out…to the baby boomers… through the aging network of Texas, to me, is their success. (Partner SM) Recruiting and Retaining Participants.  Stakeholders cited participant recruitment and retention as challenges. Some participants were hesitant to begin the program and others attended sporadically or dropped out midway through the program. Two specific barriers to program participation were lack of transportation to implementation sites and uncertainty regarding the purpose of the program.

Some of the individuals did not have transportation or some would be interested but wouldn’t be committed to that long. The other thing was that it was during the time that people had already scheduled vacations so they couldn’t commit to that time. (Facilitator RF, Texercise Select)

At first, it was just recruitment. Getting people involved…it was like they were scared of it. …I feel like there’s a generation that just, anytime you come into their place and they see new people coming in, and they’re worried about, that they’re going to get taken advantage of. (Facilitator AB, Texercise Classic) Lack of Evidence of Benefit.  An additional challenge identified by the stakeholders was the lack of formal evidence supporting the benefit of Texercise. They indicated that this prevented Texercise from being taken seriously as a health promotion program, but felt that a formal evaluation would help improve the program, thereby benefitting participants.

I would love to see an objective study to see whether or not Texercise is moving the needle or not. It’s like a lot of programs that, they feel good, they look good, your gut tells you that they’re making a difference, but without data it’s hard to determine. (Partner TW) If we can show or prove that Texercise is making a difference, it would then allow the program to receive more funding and obviously expand its reach. (Partner TW)

Improving Texercise Although stakeholders had very positive opinions of Texercise, they identified a number of potential improvements. These suggestions relate to the effective use of resources to best reach and engage participants. Increased Marketing and Use of Diverse Media.  A number of stakeholders indicated that multiple approaches should be used to market the program. Suggested approaches include newspaper, word-of-mouth, and printed flyers. Stakeholders stated that the news media should be provided with more information to reach potential participants. They also suggested that it would be helpful to have data on the program’s success.

Maybe advertising the Texercise fitness and nutrition workshop like… putting it in the newspaper and putting out the flyers… (Site Provider BC, Texercise Select) I’m a true believer in the media, so maybe if you could get TV programs, radio programs. Word-of-mouth is a great marketing tool. But the best we have is these forty-four rec centers, each one of them has to create a brochure…so it’s kind of built-in marketing. (Facilitator JB, Texercise Classic) Targeting a Broader Audience.  Another suggestion provided

by the stakeholders was to have more widespread implementation across the state. They indicated that this could be done through partnerships with local groups, including nursing homes, assisted living facilities, churches, and worksites. In addition, the program needs to evolve with the changing demographics and ability levels of potential participants. Finally, they suggested that Texercise be marketed to additional age groups, such as college students. It’d be great to see two different models of Texercise: one for people in wheelchairs and my walkie-talkies, as I call them. (Facilitator NV, Texercise Classic) I like to do things for other people—you know if there’s like a rest home or something like that where we can go in and actually do something—maybe intermingle and do an exercise program there…they may already have that…but if we could, if

JAPA Vol. 24, No. 1, 2016

Increasing the Availability of Physical Activity   43

we could be trained enough so that we could lead exercise and get other people more active. (Participant FP, Texercise Select) Well, you know, one of the things we believe is that, although it benefits older adults, it’s not necessarily an older adults program, that fitness is a life-long activity. So our hope is to more broadly disseminate through the school system to get Texercise or related activities going on college campuses, but again our initial efforts have been with senior centers just because we do have ready access to that network and it seems to resonate best there. (Facilitator DG, Texercise Classic)

Downloaded by George Mason Univ on 09/23/16, Volume 24, Article Number 1

Accommodating the Technology Preferences of Participants.  The stakeholders differed in their suggestions regarding the

format of program materials (some preferred printed handouts while others preferred DVD). Providing both formats would accommodate participants regardless of their comfort level with technology. The stakeholders recommended that materials be kept current and that the DVD be revised to be more engaging. They also suggested that social media be used to engage younger participants and increase awareness that program materials are available online (in addition to hard copy). I found the handbook more useful than the DVD simply because I just rather look at a book than put on a DVD and I’d rather turn pages then do a DVD. (Participant RS, Texercise Select) The face of fitness isn’t just changing for the younger generation, it is also changing for our aging population and making sure that we keep it fun and invigorating...you’re going from a population that primarily maybe didn’t know a lot about computers…[but] now, you know, with the baby boomers they’re used to having those computers so we’re seeing this population really being more tech savvy so we want to contain that level of excitement and use that on our population…it’s kind of fun getting to see the program changing with this changing population. (State-level Program Administrator CC)

Discussion As indicated in similar community participation research studies (Ory et al., 2013), the inclusion of multiple stakeholder perspectives provides critical value when attempting to understand and make meaning of the implementation and dissemination of health promotion programs. Participants representing a variety of stakeholder groups provided comments that supported the importance of the four themes. Due to our method of tailoring interviews to stakeholder group, a diversity of comments regarding Texercise across stakeholder groups is also represented in our data. However, the overall dataset suggest more continuity than discontinuity between stakeholders. Stakeholders uniformly expressed their advocacy for Texercise. While this is not surprising, it illustrates the significant sense of “ownership” felt by stakeholders at the state and local levels. Stakeholders expressed a clear desire for the program and a willingness to advocate for it. This grassroots support appears to be an important contributor to the program’s widespread dissemination as well as an important indicator of the potential for its sustainability. Conversely, a lack of key stakeholder support in research-generated health promotion programs may be a critical reason why such programs fail to be embedded into communities after the end of research trials (Scheirer, 2005). Participants and facilitators expressed multiple benefits of Texercise. Facilitators especially appreciated the adaptability of the program, which allowed participation by individuals with a wide

range of functional abilities and personalization by different class facilitators. While adaptability can foster program acceptance and dissemination (Scheirer & Dearing, 2011; Schulz, Czaja, McKay, Ory, & Belle, 2010), adherence to essential intervention components is critical for maintaining treatment fidelity and maximizing demonstrated intervention effects (Bellg et al., 2004; Griffin et al., 2010). Participants identified the physical outcomes and the social interaction that accompanied Texercise classes as benefits. Stakeholders expressed a desire for additional evidence of the value of Texercise. Being able to demonstrate positive outcomes is a key factor in developing evidence-based health promotion (Altpeter, Bryant, Schneider, & Whitelaw, 2006). Those responsible for the funding of Texercise (i.e., partners) specifically expressed the need for a more robust evaluation of Texercise, similar to those used to qualify PA programs as evidence-based. This is congruent with the national agenda, which is directing federal funding to EBPs (Administration on Aging, 2013). The challenges of providing PA programs in the community are well documented (Brawley, Rejeski, & King, 2003; Dubbert, 2002). The feedback from these stakeholders reiterates these challenges. For example, participants must have transportation to attend classes held at a common location. In addition, participant attendance is mediated by the other activities in the lives of the participants. Scheduling conflicts were not uncommon and appeared to negatively impact the attendance of Texercise participants. Conversely, social interactions provided by group events are consistently viewed as an added value. Thus, programs that provide social interaction while remaining flexible to the scheduling demands of participants appear to provide the most value (Kendall, Foster, Ehrlich, & Chaboyer, 2012). Stakeholders suggested that concerted efforts be made to market Texercise in the communities where it is implemented. The stakeholders offered multiple marketing suggestions. Some of these marketing or outreach strategies have been implemented by state and local stakeholders, but the need for increased outreach remains, as does the need for innovative strategies to increase participation in PA programs (Shumaker, Ockene, & Riekert, 2008). Additional studies on this topic are needed. Likewise, additional studies are needed to identify participants’ and facilitators’ preferences regarding program materials. While technology offers new opportunities for the dissemination of program materials, traditional printed materials may still be needed to promote engagement in PA programs. Little is known about the relative value of presenting program materials in multiple formats to older adults (e.g., print, video, webpage, social media). Several limitations of this study are important to consider. The Texas DADS staff identified potential stakeholders reflecting various roles who were approached to participate. The lack of specific inclusion/exclusion criteria for potential participants introduces the possibility of selection bias in the sample. However, Texas DADS staff did not conduct the interviews or qualitative analysis and confidentiality was ensured for all participants as a means to reduce this possibility. The semistructured interview instruments were tailored for each stakeholder group because we believed each had unique insights to share. As such, length of the interviews varied due to the number of questions being asked as well as the expected variations in the degree of the thoroughness from each stakeholder. Although no interrater reliability was assessed in this study, this analysis was designed in a manner that allowed for review by multiple members of the research team to ensure appropriate analysis. Importantly, themes established by initial data review staff were independently confirmed by two staff members who determined the subthemes. The study provides no information on the efficacy of its focus, Texercise Classic and Texercise Select, and provides only limited

JAPA Vol. 24, No. 1, 2016

44  Stevens et al.

information on the two major barriers to program participation. Additional information on all of these topics is provided in other sources. More specifically, the formation and evolution of Texercise is provided in Ory et al. (2015). The impact of Texercise Select on well-established physical activity intervention outcomes in lifestyle behaviors is documented by Smith et al. (2015), while outcomes on physical functioning and quality of life has been documented by Ory et al. (2015).

Downloaded by George Mason Univ on 09/23/16, Volume 24, Article Number 1

Conclusions The experience of providing Texercise across the state of Texas for more than 10 years provides a wealth of practical knowledge that can be added to the existing knowledgebase of PA program implementation and dissemination by community-based organizations. Advocacy at the state and local levels appeared to be an effective strategy to promote adoption of Texercise by community-based agencies. While Texercise has reached thousands of people over the past 10 years, there are still millions of older Texans that can potentially benefit from such lifestyle programs. This is the challenge of scaling evidence-based health promotion programs on a state-wide basis. Innovative outreach strategies based on behavior change and motivational techniques are recommended to more fully engage all Texans who would benefit from class-based PA programs. Social media can also be used more effectively. The log-in section of the Texercise website (http://www. dads.state.tx.us/texercise/) has a very appealing YouTube feature with a well-recognized Texas comedy actor promoting Texercise. Another practical suggestion is the use of flexible class scheduling (e.g., offering classes at multiple times and at multiple locations in the community) to accommodate potential participants. This article provides a stakeholder’s perspective of the implementation and dissemination of Texercise and strategies for improvement. A companion quantitative evaluation of Texercise is important for understanding underlying processes that can support widespread program dissemination and sustainability as well as identifying how such programming can benefit the health and functioning of older adults. Acknowledgments The research presented was supported by a grant from the Texas Department of Aging and Disability Services and through the Community Research Center for Senior Health, a joint partnership between Baylor Scott & White Health, Texas A&M Health Science Center, and the Central Texas Aging & Disability Resource Center. The Community Research Center for Senior Health was funded through a grant from the National Institute on Aging (Award Number RC4AG038183-01).

References Administration on Aging. (2013). Disease prevention and health promotion services (OAA Title IIID). Retrieved from http://www.aoa.gov/ AoA_Programs/HPW/Title_IIID/index.aspx Altpeter, M., Bryant, L., Schneider, E., & Whitelaw, N. (2006). Evidencebased health practice: Knowing and using what works for older adults. Home Health Care Services Quarterly, 25(1-2), 1–11. PubMed doi:10.1300/J027v25n01_01 Bellg, A.J., Borrelli, B., Resnick, B., Hecht, J., Minicucci, D.S., Ory, M. … Treatment Fidelity Workgroup of the NIH Behavior Change Consortium. (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology, 23(5), 443–451. PubMed doi:10.1037/0278-6133.23.5.443 Brawley, L.R., Rejeski, W.J., & King, A.C. (2003). Promoting physical activity for older adults: The challenges for changing behavior.

American Journal of Preventive Medicine, 25(3), 172–183. PubMed doi:10.1016/S0749-3797(03)00182-X Dubbert, P.M. (2002). Physical activity and exercise: Recent advances and current challenges. Journal of Consulting and Clinical Psychology, 70(3), 526–536. PubMed doi:10.1037/0022-006X.70.3.526 Green, L.W. (2006). Public health asks of systems science: To advance our evidence-based practice, can you help us get more practice-based evidence? American Journal of Public Health, 96(3), 406–409. PubMed doi:10.2105/AJPH.2005.066035 Griffin, S.F., Wilcox, S., Ory, M.G., Lattimore, D., Leviton, L., Castro, C., . . . Rheaume, C. (2010). Results from the Active for Life process evaluation: Program delivery fidelity and adaptations. Health Education Research, 25(2), 325–342. PubMed doi:10.1093/her/cyp017 Kendall, E., Foster, M.M., Ehrlich, C., & Chaboyer, W. (2012). Social processes that can facilitate and sustain individual self-management for people with chronic conditions. Nursing Research and Practice, 2012, 282671. PubMed National Institute on Aging. (2013). Go4Life. Retrieved from https:// go4life.nia.nih.gov/ Ory, M.G., Nichols, D., Dickerson, J.B., Madsen, K.K., Dowdy, D.M., Menendez, T., . . . Hoelscher, D.M. (2013). Creating a tipping point: Texas obesity policy actions in review, 2000-2010. Progress in Community Health Partnerships, 7(4), 419–427. PubMed doi:10.1353/ cpr.2013.0044 Ory, M.G., Smith, M.L., Howell, D., Zollinger, A., Quinn, C., Swierc, S.M., & Stevens, A.B. (2015). The conversion of a practice-based lifestyle enhancement program into a formalized, testable program: from Texercise Classic to Texercise Select. Frontiers in Public Health Education and Promotion, 2, 291. Ory, M.G., Smith, M.L., Jiang, L., Howell, D., Chen, S., Pulczinski, & Stevens, A.B. (2015). Texercise effectiveness: Impacts on physical functioning and quality of life. Journal of Aging and Physical Activity, 23(4), 622–629. doi: 10.1123/japa.2014-0072. Pope, C., Ziebland, S., & Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. BMJ (Clinical Research Ed.), 320(7227), 114–116. PubMed doi:10.1136/bmj.320.7227.114 Robert Wood Johnson Foundation. (2001, March). National blueprint: Increasing physical activity among adults age 50 and older. Retrieved from http://www.ncoa.org/improve-health/center-for-healthy-aging/ content-library/national-blueprint.html Scheirer, M.A. (2005). Is sustainability possible? A review and commentary on empirical studies of program sustainability. The American Journal of Evaluation, 26(3), 320–347. doi:10.1177/1098214005278752 Scheirer, M.A., & Dearing, J.W. (2011). An agenda for research on the sustainability of public health programs. American Journal of Public Health, 101(11), 2059–2067. PubMed doi:10.2105/ AJPH.2011.300193 Schulz, R., Czaja, S.J., McKay, J.R., Ory, M.G., & Belle, S.H. (2010). Intervention taxonomy (ITAX): Describing essential features of interventions. American Journal of Health Behavior, 34(6), 811–821. PubMed doi:10.5993/AJHB.34.6.15 Shumaker, S.A., Ockene, J.K., & Riekert, K.A. (2008). The handbook of health behavior change (3rd ed.). New York, NY: Springer Publishing Company. Smith, M.L., Ory, M.G., Jiang, L., Howell, D., Chen, S., Pulczinski, J.C., Swierc, S.M., & Stevens, A.B. (2015). Texercise select effectiveness: An examination of physical activity and nutrition outcomes. Translational Behavioral Medicine, 5(4), 433–442. Texas A&M Health Science Center & Scott & White Healthcare. (2013). Texercise: Evaluating its reach and effectiveness final report. Unpublished report. Texas Department of Aging and Disability Services. (2013). Texercise. Retrieved from http://www.dads.state.tx.us/texercise/ U.S. Department of Health and Human Services. (2008a, October). 2008 Physical activity guidelines for Americans. Retrieved from http:// www.health.gov/paguidelines/ U.S. Department of Health and Human Services. (2008b, October). Be active your way: A guide for adults. Retrieved from http://www.health. gov/paguidelines/adultguide/default.aspx#toc

JAPA Vol. 24, No. 1, 2016

Increasing the Availability of Physical Activity Programs for Older Adults: Lessons Learned From Texercise Stakeholders.

Many initiatives have been developed to facilitate older adults' engagement in physical activity (PA) and document its benefits. One example is Texerc...
324KB Sizes 0 Downloads 5 Views