Texercise Select: Building an
Evidence-Based Program in your
own backyard
Doris Howell, MPH
Texas A&M Program on Healthy Aging
Cindy Quinn
Texas A&M Program on Healthy Aging
Aging in Texas
Conference 2015
Acknowledgement
The evaluation of the Texercise program was funded through the Texas Department
of Aging and Disability Services and completed through a partnership between the
Texas A&M Health Science Center’s Program on Healthy Aging and the Scott &
White Healthcare Community Research Center for Senior Health.
Background
• Lifestyle behaviors including physical activity are
seen as key to healthy aging and well-being
• Increasing number of evidence-based programs
• Yet, a concern with program dissemination, costs
and sustainability
What can we learn from
practice-based
programs?
Purpose
• Introduce Texercise Select
including example of program tools
• Examine effectiveness of 2012/2013
Texercise Select study on lifestyle
behaviors, mental health
outcomes, and physical
functioning
• Discuss conclusions
• Review current and future
steps
Texercise Classic
•
•
•
•
12 week program
Community Cheerleader
1 time a week
12 week Daily Fitness logs and Pledge sheet
“No fancy gear, no health club dues – just a fun,
practical guide to looking and feeling your best.”
Texercise Materials





Handbook
DVD
Pedometers
Exercise bands
Fact sheets
Texercise Select: Formation
2010/2011 DADS seeking evidence-based status for existing program
September 2012 Texas A&M Health Science Center awarded RFI to evaluate Texercise
program
September/October 2012 Creation of Texercise Select structured program incorporating
behavioral change principles
September 2012 – August 2013 Implementation of Texercise Select for evaluation
Texercise Select: Program
Components
Participant
Engagement
Trained
Facilitators
Program
Length
Potential Benefits
of Participation
• Physical activity
30-45 min
• Education
focusing on
physical activity
and nutrition
topics
• Classes led
by at least
one trained
facilitator
• 12 Week
Program-10
weeks of
classes
• 2 x/week
for 90 min
each
• Increased selfefficacy (pre/post)
• Improved
physical activity
and nutrition
behaviors
• Improved
mobility (TUG)
Texercise Select: Program
Component Examples
Two-Step Action
Plan
Texercises
Texercise Select:
Two-Step Action Plan
• Participants set two (one
physical activity and one
nutrition based) broad goals
• Each week they set a two-step
action plan, a task that they
can accomplish in one week’s
time that helps them towards
their broader 10 week goals.
• Step 1 is what task they wish
to do that week
• Step 2 is how often they will
do that task within the week
Texercise Select: Texercises
• Facilitators lead
participants through a
series of exercises for 30-45
minutes.
• Exercises focus on
improving endurance,
strength, balance and
flexibility
Warm-up/
Study Methods
• Participants completed assessments at baseline
and the 10-week follow-up
• Multiple domains assessed including physical
activity, eating behaviors, physical functioning, and
quality of life with standard instruments
• Percent improvement and effect sizes were
calculated to compare study results with other
programs
• See papers for more detailed analyses
Study Characteristics
• Program Infrastructure
o 4 training sessions-29 trained facilitators
o 14 workshops
o 7 senior centers, 4 multipurpose facilities, 2 faith-based organizations, 1 senior
housing facility
• Workshop Participants
o
o
o
o
Older: 74 years old
Female: 85% female
Non-Hispanic white : 93%
Multiple chronic conditions :
2.4 conditions
• Class attendance
o On average, attended 12 of the
20 workshop sessions
• 220 older adult enrollees with 127
completing the post test
Physical Activity and Nutrition*
Variable
Baseline
Mean
Post-Tx
Mean
Improvement
Effect Size
Aerobic PA
3.9
4.6
16.3%
.64
PA Confidence
6.1
7.4
18.9%
.38
Fruit/Veggie
consumption
3.3
3.8
12.7%
.31
Dietary behavior 7.6
confidence
8.2
7.4%
.21
Social Support
for Lifestyle
Behaviors
11.4
26.7%
.45
*significant at
p<.05
9.0
Physical Functioning and
Quality of Life*
Variable
Baseline
Mean
Post-Tx
Mean
Improvement
Effect Size
Timed get up
and go
12.9 s
11.7s
10.8%
.27
General health
status
2.9
2.8
7.2%
.24
Unhealthy
physical /mental
health days
7.7
4.9
31.6%
.24
Days Limited
from usual
activity
2.2
1.4
39.6%
.17
*significant at
p<.05
Texercise Select: Program Products
Structured Program Implementation Manual
Facilitator Training Protocol
Review of Texercise History and Reach
Report on Stakeholders Perceptions
Published Manuscript on Outcomes
Current Study
•
•
•
•
Study groups in Denton and Montgomery County
Accelerometers and TUG testing
Intervention and non intervention groups
Quality of life measures
Texercise Select: Feedback
“(Texercise is) a win- win for
everyone; the older adults
are happier and healthier
and have a better quality of
life and there is less need for
the costly services.”
“Great program!! I now
carry a pedometer and
walk at least 6,000 steps
a day. And I try to eat 5
fruits and veggies a day.
Plus the exercises are
very
appropriate for seniors.
Thank you for hosting
this program!”
Future Directions
•
•
•
•
Online Training
Achieve highest EBP criteria
Offer program in additional
communities throughout
Texas
Offer Texercise program as
complementary to other
evidence-based
programs/bundling (AMOB,
CDSMP, DSMP, etc.)
Conclusions
• A multi-component lifestyle program can have
many positive effects, with some variability across
domains
• Program manualization and structured training are
important for ensuring lifestyle programs are
delivered with fidelity.
• Important to reduce barriers to full program
participation
• Widespread dissemination requires capitalizing on
and expanding traditional delivery systems
Resources
•
Ory, M. G., Smith, M. L., Jiang, L., Howell, D., Chen, S., Pulczinski, J. C., & Stevens, A.
B. (2014). Texercise effectiveness: Impacts on physical functioning and quality of
life. Journal of Aging and Physical Activity, (in-press).
•
Ory, M. G., Smith, M. L., Howell, D., Zollinger, A., Quinn, C., Swierc, S. M., & Stevens,
A. B. (2014). The conversion of a practice-based lifestyle enhancement program
into a formalized, testable program: From Texercise Classic to Texercise Select.
Frontiers in Public Health Education and Promotion, (in-press).
•
Ory MG, Smith MLS, Howell D, Zollinger A, Quinn C, Swierc S, and Stevens A. The
Establishment and Evolution of Texercise: A Lifestyle Enhancement Program for
Older Texans. Frontiers in Public Health Education and Promotion. In Review.
•
Stevens AB, Thiel S, Thorud JL, Smith ML, Howell D, Cargill J, Swierc SM, and Ory MG.
Increasing the Availability of Physical Activity Programs for Older Adults: Lessons
Learned from Texercise Stakeholders. Journal of Aging and Physical Activity. In
Review.
•
Smith ML, Ory MG, Jiang L, Howell D, Chen S, Pulczinski J, Swierc S, and Stevens AB.
Texercise Select Effectiveness: An Examination of Physical Activity and Nutrition
Outcomes. Trans Behav Med. Provisionally Accepted 2014
Questions