Findings from a Randomized Controlled Trial of an Ecologically-Sensitive Intervention to Enhance the Health-Promoting Effects of Older Adults' Activity Portfolios

Purpose: While observational studies suggest that promoting socially-productive activities such as work, volunteering, and informal helping could potentially be a low-cost public health intervention for older adults that is also good for families, communities and society, there is a lack of experimental evidence suggesting that promoting such activities is effective in improving health and well-being outcomes. Engaged4Life is an innovative ecologically-sensitive intervention designed to help community-dwelling older adults explore new activities that are personally meaningful and that also provide opportunities for physical activity. Twenty-six low-engaged community-dwelling adults age 65 or older were recruited from community-based organizations in the greater Boston area. 13 were randomly assigned to the intervention group, and 13 to the control group. The intervention group received the Engaged4Life intervention, consisting of a 3 hour workshop and individualized mentoring via phone for two weeks (2X/week for 3 weeks).

Method: Given the repeated measures design of the study where daily observations (Level-1, 336 observations: 1 observation per day for 7-days pre-intervention and another 7-days post-intervention) were nested within participants (Level-2, 26 participants), the multilevel mixed-effects linear regression procedure (xtmixed) available in Stata IC 13.1 was used to specify two-level linear mixed effects models. Models to estimate the effect of the intervention on daily study outcomes included a dummy variable indicating whether the observation was during the pre- or post-intervention phase and another indicating whether the participant was in the treatment or control group. Final models were cross-level interaction effects models with a random intercept and random slopes.

Results: Findings reveal that daily steps increased by an average of 551 (15% increase) from the pre-to-post intervention observation period for the intervention group (p<.05), but not the control (p=.153). End-of-the-day fatigue levels were reduced for the intervention group (p<.05) but not the control. Sedentary activity levels were also reduced for the intervention group in the post-intervention phase compared to the control group in pre-intervention phase (p<.05). For daily steps, daily sedentary activity and end-of-the-day fatigue, the cross-level interaction effect of group by phase was significant for daily steps, daily sedentary activity and end-of-the-day fatigue, indicating that the intervention group improved from pre- to post- compared to the control group for all three outcomes.  

Implications: Results indicate that the Engaged4Life intervention shows initial promise in reducing increasing physical activity levels and reducing daily sedentary behaviors and end-of-the-day fatigue levels through enhanced engagement in personally meaningful activity and peer mentoring. Discussion of implications will focus on social workers as administers of the Engaged4Life program in community-based settings.