Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Abstract

Background: The Lifestyle-integrated Functional Exercise (LiFE) programme is a fall prevention programme originally taught in a resource-intensive one-to-one format with limited feasibility for large-scale implementation. The aim of this paper is to present the conceptual framework and initial feasibility evaluation of a group-based LiFE (gLiFE) format developed for large-scale implementation. Methods: The conceptual gLiFE framework (part I) is based on three pillars, LiFE Activities and Principles, Theory of Behaviour Change and Behaviour Change Techniques, and Instruction. The feasibility of gLiFE was tested (part II) within a multimodal approach including quantitative questionnaires measuring safety, acceptability (1 = best to 7 = insufficient), and adherence to the LiFE activities (range = 0-14) as well as a focus group interview. Exploratory self-reported measures on behaviour change including self-determined motivation (range = 1-5), intention, planning, action control, and habit strength (range = 1-6) were assessed pre and post intervention. Data analyses were performed using descriptive statistics and qualitative content analysis. Results: The development process resulted in a manualised gLiFE concept containing standardised information on gLiFE's content and structure. Feasibility testing: Six older adults (median = 72.8 years, 5 female) completed the feasibility study and rated safety (median = 7.0, IQR = 0.3) and acceptability as high (median = 1, IQR = 1). Participants implemented 9.5 LiFE activities (IQR = 4.0) into their daily routines. No adverse events occurred during the study. In the focus group, the group format and LiFE activities were perceived as positive and important for maintaining strength and balance capacity. Self-determined motivation intention, planning, and habit strength were rated higher post intervention. Conclusion: The developed conceptual gLiFE framework represents the basis for a gLiFE format with potential for standardised large-scale implementation. Proof-of-concept could be demonstrated in a group of communitydwelling older adults at risk of falling. The public health potential of gLiFE in terms of (cost-)effectiveness is currently being evaluated in a large trial.

Group or Individual Lifestyle-Integrated Functional Exercise (LiFE)? A Qualitative Analysis of Acceptability

“…LiFE's main aim was well received and understood by gLiFE and LiFE participants. These results underline ndings from previous LiFE feasibility studies delivered one-to-one (6,13) or in a group (9,14,30), further supporting that LiFE can be seen as a promising alternative to structured fall prevention programs (5), also in a group setting.…”

“…LiFE aims to reduce fall-related outcomes and promote long-term physical activity in community-dwelling older adults by integrating balance and strength activities into daily routines. gLiFE (9) and LiFE (20) are described elsewhere. Table 1 provides an overview of similarities and differences of both formats.…”

“…Table 1 Similarities and differences between LiFE and gLiFE conducted in the LiFE-is-LiFE trial (19) Trainers teach the participants how to perform the activities (e.g., squat), where (e.g., in the bedroom), and when to implement these into daily routines (e.g., each time when reaching for the oor drawer). New movement habits are created by linking the LiFE activities to speci c daily situations based on behavior change concepts (9,21).…”

“…All participants receive the German participant's manual (22) and a workbook, including a modi ed activity planner (9), and an activity counter to plan and monitor activity performance.…”

“…LiFE has been shown to support participants' adherence (6), but its delivery through seven one-to-one home visits requires considerable time and human resources. This has recently been addressed by Kramer and colleagues (9), who developed a potentially resource-saving group-based LiFE (gLiFE) concept, delivered to 8-12 participants by two trainers in seven group sessions.…”