"ACTIVE-DAY": feasibility of an intervention for older adults focussing on physical activity, sedentary behaviour and sleep, from hospital to home.

The intervention we have titled "ACTIVE-DAY" combines and extends existing evidence- and behaviourally- based interventions, with the goal of helping people to sit less and move more for improved health and well-being outcomes both while in hospital and in the early period following discharge home. It consists of an inpatient phase and a home-based outpatient phase Inpatient phase: participants will receive - x1 face to face and one-on-one 20 minute consultation with a registered physiotherapist that works through the content of a written information handout about hospital associated deconditioning and uses a personalised coaching approach and conversation guide (https://movingmedicine.ac.uk/consultation-guides/condition/adult/hospital-associated-deconditioning/). - up to x10 individual (one-on-one) exercise/mobility sessions (each up to 20 minutes duration) on weekdays over 2 weeks or until discharge (whichever occurs sooner). The exercise/mobility program will use a tiered and standardised program with the starting level for each session to be individually prescribed by a registered physiotherapists, and based on participants current safe mobility level. Participants completion of the exercise/mobility program will be supervised face to face by a physiotherapy assistant/student, in the hospital ward area. The goal for each session is to have provided 20 minutes of supervision within which to complete as much physical activity as possible (this time includes rest breaks). Within each session, participants should start working at the highest level aligned with their functional ability for as long as they can. Once they are no longer able to continue at that level (based on observation limits, change in perceived exertion, signs or symptoms) they should step-down a program level and then complete those activities for as long as they can, and so on until the 20-minute period is complete. The program has set end points relating to the highest and lowest level of functional ability it can cater for. - Highest level of function is at least light intensity physical activity - Lowest level of function is active assisted exercises in bed The highest level has a focus on walking and physical activity, with stepped down (lower) levels based on functional (chair stand) training, followed by body-weight resistance training in a standing (hip abduction, knee flexion, bilateral heel raises, bilateral toe raises), seated (knee extension, side step/marching, knee flexion heel slides, seated heel raises, seated toe raises) or in-bed position (bridging, knee extension over fulcrum, hip abduction, heel slides, ankle pumps). - Adherence to the inpatient phase will be recorded, with data about session dates/occurrence, reasons for non-completion, session content and any patient symptoms to be extracted from medical records. Outpatient (home-based) phase: participants will receive x3 home visits (face to face) and x4 phone consults for delivery of a health behaviour coaching program, based on an adaptation of the i-STAND and HART programs (References: DOI: 10.1123/japa.2019-0470, DOI: 10.1016/j.cct.2021.106593). This phase will be delivered by a registered physiotherapist. Participants will receive a workbook and consumer level activity tracker (Garmin brand) device to support self-monitoring. The workbook was developed specifically for this ACTIVE-DAY study by D.Rosenberg (Kaiser Permanente for the i-STAND and HART trials, supported by grants R21AG043853 and R01HL132880) and adapted in collaboration with C.Baldwin and L.Lewis (Flinders University). The workbook authors intend to make the workbook freely available by request under a creative commons license (i.e. the workbook is not yet freely available from a public source). The workbook will be used as the guide for each coaching session (whether face to face or via phone call), such that participants are not expected to use the workbook outside of coaching sessions, but will have it continuously available as a resource to refer to at their discretion (including recording daily goal progress if desired). The program is provided individually and individualised to each participant as the program works though progressive goal setting and building new habits, integrating use of the activity tracker as one of the outward reminder strategies and inner reminders from bodily cues. The home visits at weeks 1, 2 and 12 post discharge will be 1-1.5 hours duration, and phone calls at weeks 3, 5, 7, and 11 post discharge will be 15-30 minutes duration. The focus of each coaching session is as follows, - Home visit week 1: 'activity profile', understanding what the last week has been like in terms of activity, sedentary, and sleep behaviours, home safety for activity check (20 minutes intervention; remaining home visit time for study outcome assessments) - Home visit week 2: Workbook provision. Introduction (info about activity, sedentary behaviour and sleep health) and getting started (goal setting, different types of reminders, outward reminders using the activity tracker, opportunities in the home environment, action plan) (1 hour) - Phone call week 3: moving forward (reflection on goals, inner reminders/body cues, habit reminders, action plan) (15-30 minutes) - Phone call week 5: continuing progress (reflection on goals, dealing with setbacks, pacing, action plan) (15-30 minutes) - Phone call week 7: rewarding yourself (reflection on goals, celebrating success, uncovering motivations, action plan) (15-30 minutes) - Phone call week 11: thinking about others (reflection on goals, impacts of social cues and settings, action plan) (15-30 minutes) - Home visit week 12: next steps in your journey (reflection on and setting of longer term goals using a whole of 24-day approach, revision or reminder strategies) (20 minutes intervention; remaining home visit time for study outcome assessments) - Adherence to the outpatient phase will be recorded in session attendance logs to be maintained by the research/intervention therapist. The Garmin device is primarily being used as an intervention tool, rather than an outcome tool. Therefore while Garmin data will be available to the researchers during the intervention, it is not for the purpose of adherence tracking.