Project ACE: Active, Connected and Engaged Neighbourhoods

BACKGROUND AND AIMS: Low levels of physical activity in older people are associated with a number of physical and mental health problems. However, older people remain the least active of all age groups. Providing programmes to support increased physical activity can be expensive. However, one lower-cost option is to use volunteers to deliver such programmes. There is some evidence of positive effects in volunteer-based physical activity promotion schemes, but there is a lack of well-developed and evaluated programmes. The Active Connected Engaged Project (Project ACE) aims to develop and evaluate a practical, sustainable and low cost model of using volunteers to promote active ageing. However, before we go to the expense of a large trial (around #2million), it is important to make sure that the methods and procedures for assessing its impact are going to work as intended.
THE ACE PROGRAMME: The ACE programme is based on the latest evidence about what works best in promoting and sustaining physical activity in older people. The programme involves two meetings to engage participants and help them to understand the benefits of increased physical activity. Participants will then choose from a variety of physical activities that are available in their local community. An ACE activator will meet the participant up to 3 further times to review progress and to help to identify and overcome any obstacles they may encounter. Two paid neighbourhood co-ordinators will help to identify and train the twenty ACE volunteers and to identify local opportunites for physical activity.
METHODS: In the first stage of the project, we will develop the ACE programme, the volunteer training course and the role of the neighbourhood co-ordinator. In the second stage, 100 older adults aged 65?85 years with low levels of physical activity will be recruited through advertising campaigns and through promotion at local events. We will use interviews with groups of patients and intervention delivery staff to find out what people thought about the programme, what worked well or badly and how it might be improved. Other information will help us to plan the future trial (e.g. recruitment and attendance rates).
SERVICE USER INVOLVEMENT: Two members of the public will advise on recruitment, measurement and intervention methods, interpreting the findings and explaining the findings to the public.

BACKGROUND/AIMS: Programmes that effectively increase physical activity in older people will yield large improvements in quality of life, independence, social activity and health and care costs related to cardiovascular disease, diabetes, dementia. Unfortunately, little evidence exists for effective interventions and at a national level, resources for prevention are scarce. The Active, Connected and Engaged (ACE) neighbourhoods project will develop and pilot a low cost, pragmatic, and sustainable intervention programme in which retired volunteers promote physical activity. The specific objectives are to: a) refine and manualise the intervention; b) monitor recruitment, retention, attendance and adherence rates; c) determine participant reactions to the intervention; d) estimate the variance in outcome measures to enable calculation of sample size for a future multi-centre RCT and e) estimate resource use/costs and develop methods for economic evaluation.
METHODS: We will conduct a two phase, 24-month pilot study involving two paid neighbourhood coordinators, 20 activity promotion volunteers [ACE activators] and 100 participants. In Phase 1, we will refine the ACE programme, develop the activator training manual and refine the role of the ACE co-ordinators. In Phase 2, 100 sedentary older adults aged 65?85 years will be recruited in two neighbourhoods in Bristol and will be randomised to the intervention and control groups. In the intervention group, the ACE activators will deliver up to five individual sessions over six months to engage and motivate participants and support maintenance, following a theoretically-driven behaviour change model. Controls will receive a booklet with information about local physical activity opportunities and will be offered the ACE programme at the end of the study.
The main outcomes (on which the study is powered) are: Recruitment rate and study completion rate. Intervention concordance (the proportion attending =3 of the 5 individual sessions) and intervention fidelity will also be assessed. To pilot the trial measures, we will assess physical activity (by accelerometry), well-being, neighbourhood quality of life, perceptions of competence, autonomy, relatedness, and resilience, for both intervention participants and volunteers. Focus groups will explore topics related to recruitment, training and delivery of the ACE programme and discuss strategies that facilitate the lifestyle change process and that might improve the programme or the delivery of the research.
OUTPUTS: The main output will be a well-informed and grounded intervention that has potential for generalisation throughout the UK and is ready for evaluation in a definitive effectiveness and cost effectiveness trial.