Promoting walking, less sitting and better mental health in older adults

This is a quasi-experimental trial, consisting of four conditions: experimental with ambassadors (motivationally trained resident ambassador and motivationally trained walkers), experimental walkers only (no resident ambassadors but motivationally trained walkers), control with ambassadors (ambassadors and walkers who have not received motivational training but only general information about walking and practicalities), and control walkers only (walkers only who have only received general information about walking and practicalities). Resident ambassadors are residents in the retirement villages who are healthy and already physically active themselves and who are willing and demonstrate commitment to take on this role. Residents from 13 retirement villages in WA (most located in the Metropolitan area of Perth) took part in the trial, specifically 3 in the experimental with ambassadors condition, 3 villages in the experimental walkers only, 3 in the control with ambassadors, and 4 in the control walkers only arm. All resident ambassadors were trained by members of the research team via a 1.5 hour face-to-face workshop on safe walking and information regarding practicalities of organising small group-led walks. This workshop consisted of training in how to lead group walks in a safe manner, what to do in case of emergencies and specify the tasks needed to coordinate and lead the group walks. The workshop consisted of practical exercises and participants received manuals with printed hand-outs to support learning. Approximately 1.5 hours were added to the workshop for the resident ambassadors in the experimental villages to train the ambassadors in applying motivational techniques to empower their physically inactive peers to increase walking, reduce sitting and improve mental health through a combination of group-led walks, group educational sessions, and booklets incorporating key behaviour change techniques. In these workshops, the ambassadors were briefly introduced to the basic principles of the motivational framework underpinning the intervention (i.e., SDT), and were engaged in practical exercises that aimed to show how to support other residents' autonomous motivation for walking and for reducing sitting behaviours. Specifically, the different motivations underpinning engagement in these behaviours were described and illustrated. The resident ambassadors were then introduced to ways in which autonomous motivation could be supported, for example via promoting participants' feelings of competence, personal volition and choice, and feelings of connectedness with other members of the walking group. Such activities have been shown in the SDT literature to support key psychological needs and hence boost autonomous motivation. The resident ambassadors were encouraged to discuss concrete examples of how they could put these principles into practice. They were also provided with relevant examples. Resident ambassadors were trained to be supportive, encourage participants' involvement and opinions in making choices (e.g., walking routes, ways to break up sitting time), use open-ended questions, be empathetic, avoid judgemental or controlling language, provide rationales for activities, and encourage personal responsibility and initiative. Such behaviours have been associated with an "autonomy-supportive" interpersonal communication style and sustained changes in individuals' motivation and well-being. This first workshop was supplemented by a 1.5 hour booster session at the end of week 2 of the intervention to catch up on progress, trouble shoot challenges in implementing the motivation strategies and plan the tasks for the remaining part of the intervention. All resident ambassadors were asked to lead 3 weekly group walks for 10 weeks, each lasting 20-30 minutes. Resident participants were encouraged to engage in 2 further self-organised walks per week of similar duration for 10 weeks. After 10 weeks, the resident participants were encouraged to independently organise 5 weekly 20-30 minute walks for a further 6 weeks. Resident participants received one group-taught 1-hour session delivered face to face by the research team, at the beginning of the intervention, on the benefits of walking and reducing sitting time for health, and were provided with outdoor walk route maps, and information on step counts for specific walks to destinations inside and outside the villages. The participants also received a tips sheet on ways to break up sitting time which were based on the strategies. Further, all participants were provided with log-books for the documentation of step counts on a daily basis. They were also encouraged to use a tick sheet to indicate how many times per day they took a break from sitting (when sitting more than 30 minutes). Approximately 1 hour was added to the workshop for the resident participants in the experimental conditions on motivation and self-regulation strategies, and received printed materials and activity sheets to support their learning.