Physical Literacy-based Intervention for Older Adults

Official title

Physical Literacy-based Intervention (PLBI) for Older Adults: A Cluster Randomized Controlled Trial Study Protocol

Overview

The ageing population creates concerns and challenges worldwide. The large number of older adults (aged over 65) in Hong Kong continues to rise as people live longer. This may result in heavy burdens on public services and problems such as a shortage of medical resources. The purpose of this study is to implement a physical literacy-based intervention (PLBI) among older adults in Hong Kong in order to achieve the goal of health promotion. A two-arm cluster randomized controlled trial will be employed in this proposed study. Ten daycare centers for the elderly in Hong Kong will be invited to participate in this study. The intervention group will receive functional fitness training and mastering physical literacy class twice a week with buddy peer support, and they will be asked to keep a reflective writing journal on a daily basis for 12 weeks in total. Participants will be evaluated at baseline (week 0), post-intervention (week 12), and at 6-week follow-up (week 18). This will consist of objective and self-reported measures covering elements within physical literacy (i.e. physical competence, motivation and confidence, knowledge and understanding) and also physical activity levels on an individual basis. The study intends to introduce a conceptual framework of physical literacy for the elderly through an intervention that allows older people to develop daily behaviour habits, which should promote active ageing for the elderly and greater self-esteem in later life. After this study, participants may share their positive experiences, and encourage their peers in the community to become physically literate in the future. In the long run, due to the feasibility and sustainability of these potential programs, this proposed study has the potential to connect seniors through social engagement and contribute to healthy living.

Detailed description

Older adults who are physically literate can effectively adapt to physical challenges associated with injury, chronic disease, and aging, demonstrating a characteristic ability to maintain their independence for an extended period compared to those who engage in less physical activity. Older adults who are physically literate can adapt to challenges associated with injury, chronic disease, and aging, thereby maintaining their independence for a more extended period compared to those who engage in less physical activity. Viewed through the lens of physical literacy, successful agers adeptly adjust and modify their activities, employing age adaptation and physical competence. They achieve this by optimizing their choices in terms of motivation and enjoyment of movement, ultimately maximizing their success, boosting confidence, and sustaining higher levels of functioning across all dimensions. Thus, developing physical literacy aligns with the goal of promoting healthy ageing, enhancing the prospects for overall well-being across the lifespan. This is grounded in the understanding that initiating an active lifestyle from the outset contributes to preserving independence and positively impacting population health.

This study attempts to introduce a conceptual framework of physical literacy through a Physical Literacy Based Intervention (PLBI) that allows older adults to develop good exercise habits with the development of daily behavioral habits. Based on the unique physical literacy journey and lifestyle of each individual, the proposed study would offer the elderly a meaningful way to achieve active ageing and encourage them to realize their physical literacy journey in later life. Evidence has shown that exercise is associated with better physical and mental health in older adults, and exercising with others is more likely to lead to a sufficient amount of physical activity. After this study, it is expected that older people will also encourage their peers in the community to engage in physical activity.

The benefits of physical activity to health are widely acknowledged. The concept of physical literacy has been vaunted as a key component in the establishment of lifelong adherence to physical activity. McLennan and Thompson espouse that physical literacy is the foundation of quality physical education. The development of physical literacy is the most influential variable with respect to physical health improvement. The proposed research, therefore, aims to implement a PLBI including functional fitness training and mastering physical literacy class, buddy peer support, and reflective writing for the development of motivation, confidence, physical competence, knowledge and understanding under the concept of physical literacy to achieve the goal of health promotion. This will add an effective comprehensive assessment and charting of physical literacy for older adults. In the short term, this study will lead to a convenient and powerful program and assessment tool that can be used by elderly centers and elderly fitness trainers and assessors. In the long term, this research will benefit the general public, in particular, communities of older people by encouraging participation in physical activity. When framing the proposed model to chart physical literacy for older adults, the program and measurement system may be adopted in elderly and ageing studies.

The aims of this study are 1) to develop and implement a PLBI including functional fitness training, mastering physical literacy class, buddy peers support, and reflective writing for older adults in Hong Kong; 2) to explore physical literacy (physical competency, daily behavior, knowledge and understanding, and motivation and confidence) of the older adults in Hong Kong; 3) to examine the effectiveness of a PLBI in terms of changes in physical literacy development among older adults in Hong Kong; and 4) to add information to the literature of physical literacy, gerontology, and public health in the Asian context of Hong Kong.

Interventions

• Behavioral Weekly-based functional fitness training
  Participants will receive a 12-week duration of functional fitness training in daycare centers, which will be implemented twice a week. The 60-minute per session training series will be delivered and guided by qualified elderly health and fitness instructors, who will be provided with a workshop before this intervention. The workshop will be designed and delivered by the research team. The first session will focus on the physical literacy of older adults and the second session will focus on how
• Behavioral Mastering Physical Literacy Class
  A 30-minute MPLC program will be conducted by experienced elderly health and fitness instructors after WBFFT. This MPLC program aims to enhance the knowledge and understanding of physical literacy. Referring to the newly developed consensus statement, the MPLC includes the following five domains related to the relationship with movement and physical activity throughout life: i) Why physical literacy matters - improves health, well-being and quality of life. ii) Understanding physical literacy
• Behavioral Daily based reflective writing
  At the end of the baseline stage of this study, each participant of the intervention group will receive a template notebook for daily-based reflective writing. The required columns consist of the daily diet, physical activity, mood and sleep quality. Participants will be required to write down their behavior in this notebook daily. In each week's functional training course, there will be a life-sharing session, where the participants will be reminded to bring their notebooks and share their dail
• Behavioral Buddy Peers Support Group
  Peer-support groups with buddy members will be arranged in each daycare center. Three pairs of buddies and hence about 6 participants will be formed per group. A total of 6 buddy pairs and 2 groups will be formed per daycare center. Buddy peers will encourage each other to do functional exercises regularly or to perform functional exercises together. The time and place for the practice will be decided among buddy members. A member in each group will be nominated as the leader to assist in the li

Primary outcome measures

• Physical Competence [Time frame: Week 0; Week 12; Week 18]
• Objective Physical activity levels [Time frame: Week 0; Week 12; Week 18]

Secondary outcome measures (6)

• Demographic information [Time frame: Week 0; Week 12; Week 18]
• Self-report physical activity levels [Time frame: Week 0; Week 12; Week 18]
• Knowledge and understanding [Time frame: Week 0; Week 12; Week 18]
• Physical literacy [Time frame: Week 0; Week 12; Week 18]
• Motivation and confidence [Time frame: Week 0; Week 12; Week 18]
• Buddy Peers Support [Time frame: Week 0; Week 12; Week 18]

Eligibility criteria

Inclusion criteria

• those aged 65 to 74 years old who are registered in a daycare center/unit for the elderly in Hong Kong.
• the ability to walk eight meters without assistance.
• able to read and write.

Exclusion criteria

• neurological disease which impairs mobility, cardiovascular disease which results in shortness of breath or angina on walking up one flight of stairs.
• cognitive impairment. Participants' cognitive function will be screened by the Chinese Mini-Mental State Examination and those who score below 24 will be excluded.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Other

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Sum RKW, Yang Y, Choi SM, Duncan MJ, Li M. Physical literacy-based intervention for older adults: a cluster randomized controlled trial study protocol. Front Sports Act Living. 2024 Jul 17;6:1392270. doi: 10.3389/fspor.2024.1392270. eCollection 2024. PMID 39086857

Identifiers

NCT: NCT06137859 · SBRE-21-0353

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗