The single most effective and cheapest contribution society can make to promote successful ageing

is to encourage an active lifestyle.

To members of the Age Action Alliance

Introduction

An active lifestyle involves keeping physically and mentally active, eating a healthy diet, not smoking, drinking in moderation, pursuing one or a number of interests and leading a sociable life.

The availability of effective medical treatment is important for those affected by illness, though even for these a healthy life style helps older people manage illness and disability better, thus ensuring they can lead a more independent life, and retain their function for a longer period of time. To some extent this is already happening. There is evidence that today’s 70 year olds are much fitter compared to those of thirty years ago. This must relate to the healthier lifestyle people are now generally leading. It certainly cannot have anything to do with people having healthier genes.

The recommendations made by the Chief Medical Officer(i) for physical activity for older adults, provided the first official recognition that keeping physically active is essential for a better quality of life in older age. However, recent studies have highlighted that there is more that we could do, and in spite of greater public awareness only a small percentage of those who would benefit from an active lifestyle are making the necessary lifestyle changes. Significant benefits can be achieved through increased physical activity. From its simplest form, increasing the level of walking in daily life, through to regular attendance at community based fitness classes - which have the added benefit in addressing aspects of loneliness and Isolation

This paper has been endorsed by the Public Health and Active Lifestyles (PHAL) Working Group,and will be the first in a series that will promote a way forward,that when translated into practical action should ensure our communities have the opportunity to embrace a healthier lifestyle.

Background

The Age Action Alliance was launched 30 September 2011. It is an independent Alliance of organisations from across all sectors. To date approaching 230 organisations have joined. As the first national initiative of its kind members work together to improve the lives of the most disadvantaged older people, prevent deprivation in later life and challenge age discrimination. In part to achieve this Alliance looks to build on current best practice within the voluntary, private and public sectors.

The intial work of the Alliance has been taken forward by eight working groups.Of these PHAL has a membership that is formed from organisations that are experts in the field, able to transfer their skills and knowledge to the work of the Alliance. The Group also had regard to the new and emerging health and well being structures and the potential to provide a considered view on possible approaches that would promote increased physical activity.

Theme

At its inaugural meeting the Group agreed, as an underlying theme, to use the “5 Ways to Health and Wellbeing” (ii) emerging from research conducted by the New Economics Forum, commissioned by Foresight. To achieve the “5 ways” an individual needs to connect, take notice, be active, learn and give.

In order to identify the most effective way forward, the Group analysed a whole range of local and national initiatives / approaches which support the theme. The Group agreed that programmes would be selected which met a set of principles.

Programmes should:

  • Promote and deliver physical and mental health and well being
  • Be sustainable with a proven track record of delivery.
  • Community based
  • Have published evaluation
  • Deliver value for money.

Additional criteria

  • Have been in widespread use for several years
  • Reach the disadvantaged
  • Be user friendly and accessible by local people
  • Involve volunteers
  • Maintain function
  • Prevent falls/ Reduce isolation and loneliness/ Promote discussion on healthy diet
  • Include carers of people with mental and physical problems
  • Have been used in care homes and sheltered housing schemes
  • Be appropriate for use in the work place as a preventive measure
  • Potential to be scaled up to form a national programme.

This paper recognises that both nationally and locally there are a number of programmes which although may not meet all of the criteria set out above would still add value to a structured programme of physical activity. Notwithstanding that point the Group felt it should “shine a light” on approaches that meet both the principles above and deliver against the 5 Ways to Health and Well being.

APPROACHES

A large number of projects have been launched in recent years to promote healthy living. For example, the Link Age Pilots brought local authorities together with their partners in health and the voluntary and community sectors to find innovative ways to break down traditional organisational and financial barriers and to join up services, and more recently the Ageing Well Initiative.

The Working Group considered these and a number of other approaches/models that might meet the previously agreed criteria. Here we briefly describe two which meet many of the criteria.

  • Positive Ageing Programme – Beth Johnson Foundation
  • Fit As A Fiddle – Age UK

Beth Johnson Foundation (BJF) - Positive Ageing Programme. ‘Active in Age’

The Active in Age physical activity programme for older people has been funded primarily by the PCTs (and now by Public Health and Joint Commissioning) for the past 11 years to run across North Staffordshire and Stoke-on-Trent. It has been re-funded to 31/3/13.

The aim of the project is to deliver accredited training to volunteers (and those directly working with older people) so that they can deliver exercise programmes to groups of older people in a variety of settings (community and faith groups, housing complexes etc).

BJF has also developed a Train the Trainer programme so that the model can be rolled out further.

The strengths of this model are:

  • Long term sustainability – the activity sessions are not run by BJF but by volunteers and workers trained through the programme. The activity groups are supported by BJF but run outside of the organisation
  • Rolling out through Train the Trainer
  • Accredited through the Open College Network (OCN), the programme is available to be purchased and BJF has arranged training in areas such as Yorkshire and Humber and in London

Impact assessments are conducted annually and show that the exercise groups are multi-functional; apart from providing physical activity they also become part of a social network so reducing loneliness and improving health and well-being. Locally the groups are seen to contribute to the Falls Prevention pathways.

Fit as a Fiddle.

The Fit as a Fiddle portfolio was set up in October 2007 with support from the Big Lottery Fund as part of its wellbeing programme. Funding runs until 2012. The portfolio aims to reach disadvantaged people living in communities who have not previously had access to services that actively improve their physical health and mental wellbeing. By 2011 4.5K people had been trained as ‘volunteer buddies’ or activity organisers to support individuals participating in the portfolio who would be prepared to continue taking part in activities once funding is no longer available thus demonstrating the programme’s sustainability. Included within the portfolio are activities which address loneliness and isolation, obesity, diet, cooking and nutrition, general wellbeing, intergenerational activity, as well as support for carers.

To date over 250K older people have taken part in a Fit as a Fiddle programme in a wide range of activities, ranging from Abseiling to Zumba. The oldest participant is 105 with many people in their 80’s taking part in ‘extreme sports’. Over 450 organisations including 99 local Age UKs have delivered activities as part of a Fit as A Fiddle programme. To illustrate the sustainability of the programme, 87% of the 600 projects delivered in the South East have become self-sufficient either through additional funding or volunteers continuing to lead and manage the groups

The Approach - Empowers older people and communities to take ownership of their health and wellbeing. It relies on volunteers, ambassadors and partner organisations to provide the ‘reach’, and the momentum to sustain activities. It provides interventions which are tailor-made, building on the assumption that everyone can do something to improve their health, wellbeing and independence, from the most active to the most frail.

A more detailed case study that includes a detailed evaluation of the approach taken by Kingston Age Concern to address obesity is included at Appendix 1. Although this award winning programme was established to reduce obesity, in fact it can be seen as having the much broader aim of promoting a healthier lifestyle.

With the programme’s funding ending in 2012, Age UK is currently working with partner organisations to ensure that the “Approach” can be taken forward independently as partner organisations look to work with commissioning boards as part of the new Health and Well Being procurement and delivery structures.

Conclusion:

These programmes, in their current format, meet the criteria set by the Working Group to receive endorsement. In addition the recommendation builds on good practice and does not look to promote a new approach. Both Programmes are locality based and sufficiently adaptable and flexible to meet the needs of the local community. Fully costed and evaluated they have the scale, and with additional support, the capacity to become approaches that should be attractive to the newly formed Health and Well Being Commissioning Boards. Evidence from across England indicates that some of the existing commissioning structures are already considering further investment into the preventative agenda. In Wiltshire a health promotion grant from the Council will enable Age UK Wiltshire to continue the fit a fiddle project until March 2013 and plans are currently being drawn up for this additional phase. Age UK Coventry has secured additional funding from the Local Authority to support 15 classes when the project ends

Material is being preparedby expert researchersto go to the Health and Wellbeing boards with a call for action

Recommendations

This paper recommends that all members of the Alliance give priority in their work to programmes that promote healthy living and work towards the 5 Ways to Health and Wellbeing; to connect, take notice, be active, learn and give

Members of the Alliance are asked to report whether they are already engaged in these or other relevant activities by the end of 2012. All activities reported to the Alliance will be posted on the web-site so that it will be possible for those who consult the site to identify relevant activities by locality, by type of organisation (private, not for profit, LA etc) and by type (volunteer-led, paid staff led, group focused, individual focused etc.).

We would encourage members of the Age Action Alliance not engaged in any relevant activity to consider embarking on one of the examples described in this paperin association with one or more other organisations in their locality.

One year from now we will expect every member of the Alliance to be involved in some new activity or to have increased their involvement in an activity in which they are already engaged.

Promoting an active lifestyle remains the most effective way society can encourage physical and mental wellbeing and reduce loneliness and social isolation. The Alliance, through its members, with the active participation of older people, should be a powerful influence to achieve this objective.

Dr Nori Graham

July 2012

Appendix 1

Case study report – Tackling Obesity in Kingston

Introduction

Ecorys was commissioned by Age UK London to evaluate Age Concern Kingston's Tackling Obesity project. This case study looks at this fit as a fiddle project which ran from April 2010 until March 2011. Fit as a fiddle is a five year health and wellbeing programme targeted at older people, funded by Big Lottery Fund.

The case study has been informed by in-depth interviews conducted with key stakeholders and beneficiaries triangulated with other data sources including monitoring data, reports and self-evaluation outputs generated by the project.

Interviews were conducted with the project management team within Age Concern Kingston; and with key partner stakeholders such as Kingston Primary Care Trust (PCT), the Royal Borough of Kingston upon Thames Local Authority, and DC Leisure, who provide the leisure services for the borough. In addition a focus group was carried out with 13 older people who had been involved in the Alpha Road and YMCA fit as a fiddle projects. The fieldwork was carried out by Nicolas Lee, Ecorys, from 6th-15th July 2011.

Background information

The aim of Age Concern Kingston's fit as a fiddle project was to tackle obesity through physical activity and promoting a healthy lifestyle. The programme comprised of ten 6-week courses delivered across the borough over the course of a year. These courses lasted 2 hours each week and were divided between an hour of physical exercise, which aimed to promote flexibility, strength, balance, coordination and muscle tone, and a similarly timed healthy lifestyle workshop which focused on healthy eating, menu planning, sharing recipes, mapping exercises, and incorporated a weekly weigh-in. In addition to the weekly weigh-in, waist and BMI measurements were recorded at the start and end of each 6-week programme. These measurements in combination with self-evaluation questionnaires completed by older people at the start and end of the programme provided evidence of the impact on the beneficiaries. While there are alternative weight management programmes and activities promoting greater participation in the area, there is nothing that specifically focuses on older people.

“I went to my Doctor’s surgery and everywhere I could and there was nothing for senior citizens, nothing at all.” (Participant)

The project was initially targeted to engage around 80 older people, but achieved more than double this target with 166 older people participating from across the borough. This was in part due to the activities which aimed to be both fun and involve moderately intensive activity to support weight loss and fitness. Activities included: Nordic Walking, Keep Fit, Bollywood Dancing, Line Dancing and Aquacise. These activities were chosen both in consultation with older people themselves and were also the most popular activities in an 'Active Living' programme for people aged over 50 which ran in the borough which was a precursor to fit as a fiddle.

The programme included mechanisms to quantitatively evidence weight loss across the each 6-week programme. Weight was measured on a weekly basis in addition to measurements in body mass index & waist size taken at the beginning and end of the course. Self completion questionnaires completed at the beginning and end of the programme also provided qualitative data relating to improvements in eating habits.

The programme was publicised in a wide variety of areas including in local community shops, doctor surgeries, neighbourhood centres, libraries, presentations to social clubs, and in college course booklets.

“It’s a fantastic programme and is flexible as its focus evolves, last year it was obesity and this year its mental health.It’s driving [the areas that are] prominent. It’s not just an activity programme; it actually has a focus on a specific population, which I think makes the difference”. (Partner organisation)

Given this previous Active Living initiative there were minimal teething problems in establishing fit as a fiddle, strategic partnerships were already in place, and the that programme acted as a template in setting up the fit as a fiddle activities. However the more successful projects tended to exist in areas where there was a strong community spirit such as at the Alpha Road project and with the Milaap Centre for Asian Elders among others.

Fit as a fiddle funded one member of staff for 25 hours per week to both coordinate and deliver the programme for the year. Initially volunteer mentors were proposed to lead each groups, however in order to make it very local to specific target groups the project coordinator had to ensure activities were provided within the targeted community. Therefore instead each activity was lead by a local champion, these were participants who were either identified prior or during the programme and whose role it was to provide a focal point to the activity, to help with publicity, and ultimately to play a role in the sustaining of the activity.

“The key thing that makes it a lot more concentrated and successful is that you have a dedicated coordinator, who is just running this programme.” (Partner organisation)

Impacts on older people

The courses had a high degree of success on reducing older people's weight and improving body shape. Results of tests and measurements showed:

73% of participants lost between 1-5 kilograms in weight

63% reduced their waist size by between 1-5 centimetres

55% reduced their Body Mass Index by 1-3 points

Overall 77% of participants demonstrated a reduction in one or more of these measurements. The exit questionnaire revealed that 82% of participants felt that they had lost weight.

Healthy eating

Feedback from questionnaires showed the number of participants who reported that they ate a healthy balanced diet had increased from 58% to 94% by the end of the programme; the number of participants who now ate fish twice a week had increased from 48% to 73%; and those that ate wholemeal bread, pasta, or rice increased from 73% to 88% by the end of the programme. 93% claimed that they had learnt health eating habits, and 75% claimed that they applied healthy eating habits.