This week we spotlight Cincinnati Veterans Affairs (VA) Management of Overweight/Obesity for Veterans Everywhere Program (MOVE!), an evidence-based lifestyle program for veterans.

The Program Basics

According to Stephanie Ciccarella, Cincinnati VA utilizes a 2-step process to promote readiness to change.  The first step offers education on nutrition, behavioral habits, and physical activity. The second step emphasizes action, like journaling, physical activity, and problem-solving personal habits. Training is offered twice a week under the supervision of a physical therapist with cardiovascular, strength training, and education during 2-hour classes.  Personal accountability is the cornerstone of the program.

Veterans begin the second step with education on the importance of regular daily activity. Each person is issued a pedometer and instructed to track their daily steps. Veterans are able to see changes in their activity levels reflected in their journals and set goals. By the end of the program, veterans take lead roles by leading exercise and supporting each other through problem solving and motivation. 

Measuring Success

"Emphasis on performance and outcome measures are keys to determining effectiveness of the program,” says Ciccarella. “They help guide program development.” 

The Cincinnati MOVE! Phase II program utilizes additional evidence-based outcome measures to help guide the development of physical activity training and education during meetings.  These outcome measures (listed below) help indicate ability to successfully participate in semi-intensive exercise, degree of health risk, and improvement in function.  By reviewing pre- and post assessment measures, each group member is able to see his or her specific improvement.

Challenges and Program Shortcomings
    
“One of the primary shortcomings of this program is its length,” says Ciccarella. A longer program would ensure a more thorough change in behavior and demonstrate greater physical progress.  Another drawback to the program is geographic availability.  Evidence demonstrates that people are more likely to maintain a physical activity schedule when resources are available within 10 miles of their homes. Some veterans must travel significant distances to participate.  Veterans are also required to commit a significant amount of time over a 6-week period.  This poses a problem for those who work, have children, or go to school. Given the nature of weight loss, the benefits of participation may not be dramatic enough to maintain motivation.  Some of the proposed answers to these problems include lengthening the program to 9 or 12 weeks, expanding Physical Therapy Clinics in all outpatient settings, and introducing more flexible scheduling. 

Outcome Measures

Implementing a Similar Program in Your Community

Cincinatti VA tailored the national MOVE! Program to fit their specific needs. To implement the program in your area, check out the original MOVE! Program at: http://www.move.va.gov/ and see how it can work for you.

How could you tailor the MOVE! program for your area?

Are you interested in having your program spotlighted? Leave a comment below and we will contact you with more information.

This week we would like to spotlight Alive!, an email-delivered intervention to help people increase their physical activity and improve their diets.

 The Program Basics

The core of the Alive! program, is individualized weekly goal-setting, according to Dr. Gladys Block. Alive! is intended for adults with access to email and the web. Currently its focus is on working adults, although it is adaptable to older persons and college students. Alive! was developed by NutritionQuest in collaboration with physical activity, nutrition and behavioral experts Barbara Sternfeld (Kaiser Permanente), Gladys Block (UC Berkeley), Abby King (Stanford), Kim Gans (Brown) and Cliff Block (NutritionQuest).

The first step in the Alive! program is to complete a detailed online physical activity and dietary practices assessment. Results are provided to participants instantly. For physical activity, the participant's minutes of moderate or vigorous activity, as well as strengthening activities, are compared with the Physical Activity Guidelines for Americans.

That feedback serves to motivate individuals to make changes and to participate in Alive!. Feedback is provided to everyone, whether or not they decide to enroll. If they do enroll, they choose a "Path" to work on for the next 12 weeks, either improving physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. At the end of each 12-week intervention period, participants may choose one of the other two Paths or continue further in the same Path.

In weekly emails, the participant is offered a choice among four small-step goals, individually tailored, to work on during the coming week. Each weekly goal is a small achievable step that will move the participant closer to the Path's behavioral target, such as increasing physical activity to national standards.  Goals are tailored to the participants' baseline activity level and to their personal characteristics and preferences. Tips for overcoming barriers and motivational support are also individualized, as is optional automated algorithm-driven phone and print support. In addition to weekly goal-setting, the Alive! program also provides weekly health information and many other resources.

Measuring Success

The developers of Alive! used a randomized controlled trial among almost 800 employees of a large firm to measure their success. Articles reporting the results of these studies can be found here and here. The evaluations showed statistically significant improvements in physical activity and dietary intake during the intervention. However, even more exciting is the fact that that those changes were sustained four months after completion of the intervention.

Challenges

According to Dr. Block, “the computer programming challenges have been enormous, because of the high degree of individual tailoring at the heart of the program. Apart from that, our biggest challenge has been to interest companies or organizations in using a low-cost, successful intervention that only improves physical activity and diet.”

Implementing a Similar Program in Your Community

If you are thinking of creating a computer based intervention for your community, Dr. Block offers the following advice:

• Algorithm-driven individualizing of most elements of such electronically delivered programs is essential.
• Developing such a tailored program is likely to require far more expert input and costly programming than anticipated.
• Be aware that today’s ever-changing web and email standards require the use of high-level programming expertise in presentation methods.
• Contact NutritionQuest to discuss tailoring the Alive! program for your community.

If you don’t feel tech savvy enough to create your own algorithm-driven, individualized e-mail- based physical activity promotion program, what are ways you could individualize programs in your community to increase program success?

Image courtesy of the President’s Challenge

Providing low cost, readily accessible tools that organizations and individuals can use to help children increase their levels of physical activity can be a challenge, but it’s one the President’s Council on Physical Fitness and Sports’ (PCPFS) President’s Challenge program is ready to meet.  Thanks to one of the goals identified in First Lady Michelle Obama’s “Let’s Move” initiative--to increase youth physical activity as measured through participation in the President’s Challenge Presidential Active Lifestyle Award (PALA) , the Council hopes more physical activity practitioners, parents, caregivers, and teachers will know about the tools at their disposal. 

In addition to the PALA, the physical activity and fitness awards programs that make up the President’s Challenge offer a low or no cost and easy way to help children and adults stay on track with their physical activity and fitness.  While tracking physical activity isn’t for everyone, it can help some realize a goal, such as those outlined in the Physical Activity Guidelines for Americans, and help them work towards improved health.

As the Guidelines for children and adolescents state, young people should engage in a variety of activities that they enjoy.  There are over 100 different activities that count towards earning the PALA including skateboarding, soccer, baseball, rock climbing, canoeing, and the increasingly popular video-based physical activity or exer-games.    This variety exemplifies the breadth of physical activities, including sports and recreational activities, in which individuals of all ages and abilities can participate to maintain or improve their health. 

People need to start someplace and by doing the amount of activity required to earn the PALA, youth and adults are well on their way to realizing the health benefits of physical activity.  If you have the capacity to influence a child’s life, take a moment to consider challenging them to earn the PALA.  The program is for individuals ages 6 and older, therefore, adults (e.g., parents, grandparents, big brothers or sisters, coaches) have the opportunity to set an example for the children they influence by earning their own PALA, too. 

What kinds of tools are you using to increase levels of physical activity among the children you serve?  Do you believe that adults can serve as physical activity role-models for youth?  Have you had success using awards programs to encourage youth or adult physical activity?