Physical Activity Leaders Network

Greater Southern Area Health Service

Abstract

Physical activity programs designed to improve balance, strength, mobility, fitness and bone density have been identified as primary prevention strategies to reduce falls injury.

One of the barriers to implementation of evidence based population health falls prevention interventions of this nature is the lack of a suitable delivery system. Rurality, large geographic distances and limited exercise providers complicate the implementation of low cost, accessible fall- safe activities.    

The Physical Activity Leaders Network (PALN) is a support strategy designed to train and support community volunteers to deliver effective fall-safe physical activity classes in areas with low population density. Preliminary data suggests volunteers are willing to provide low cost activities in their communities and the target population are supportive of localised strategies.

 Download the presentation given at the 2008 NSW Health Expo (787 KB).

Aim

The PALN aims to train and support community volunteers to establish and deliver fall-safe activities on a not for profit basis.

Nature of the Problem

Access to low cost fall-safe physical activity programs within a reasonable geographic distance of where people live is necessary for community-dwelling older people to reduce their risk of falling. Similarly “immunising” against falls by introducing falls safe activities at an earlier age builds protective effects  (NSW Health, 2003).  Establishing and maintaining fall-safe physical activity programs in smaller communities is difficult due to limited providers, infrastructure and geographic isolation. Falls account for 35% of all hospitalisations across NSW. Higher hospitalisation rates per 100,000 for fall-related injuries in older people were recorded in outer regional and remote areas (CHO Report 2004).

Extent of the Problem

Health development planning processes identified contextual issues of ageing population and limited physical activity providers. Further, the provision of classes in low population density areas, access, cost for participants and sustainability were key concerns.  A review of current population health prevention initiatives indicated ad hoc provision of programs. Pre-amalgamation program surveying data from the Rural Falls Injury Prevention Program (RFIPP), 2005 identified barriers to undertaking falls safe activities as

Outcome data identified that a network of physical activity providers would be important to achieve sustainability in providing low cost programs (RFIPP, 2005). The health impacts of establishing a physical activity leader network were verified by undertaking a Health Impact Assessment screening report.

Strategic Importance

The strategy relates to goal one of the State Health Plan - making prevention everyone’s business. This goal is achieved by engaging both volunteers and the health services by a mutual obligation contract. There is also an active and ongoing commitment by elderly Australians to improve their own health. This strategy has a direct relationship to the state indicator: Dashboard 5 - reduce illness and death from falls related injury. Locally, the strategy is implemented through the Area Falls Management Plan and is a key result area of the Health Development Plan 2006 - 2009.

Planning and Implementation Solutions

Establishment of the PALN included:

Outcomes and Evaluation

Seventy six volunteers undertook training attaining accreditation to perform the Tai Chi for Arthritis program. Forty eight registered as GSAHS volunteers and seventy five committed to the mutual obligation contract. The PALN is functional, with dissemination of support products. Systems for data collection and safety monitoring are established. Contextual and learnt practice information is shared amongst leaders by the circulation of two travelling storybooks.

A telephone survey at six months achieved a response rate of 98% (n 75 leaders). Seventy two leaders are delivering classes.  Forty three rural communities now have programs.

Figure 1 Geographical reach of programs

There are approximately 760 participants per week attending classes. In a twenty week period eight hundred and seventy eight classes with fourteen thousand five hundred occasions of participation have occurred. The seventy five and plus age group is the highest number of participants (n 283).

Table 1 Age range of participants

The most common venue is community halls and clubs. The seventy five years age group predominately attend in nursing homes, hostels and retirement homes. Preliminarily data is suggesting the program can be delivered over a large geographic area.

Table 2 Participation and venues

Sustaining Change

The PALN strategy is disseminating resources, collecting information and building grass roots community capacity and skills in a large number of small rural communities across GSAHS. The current willingness of volunteers to establish and run not for profit classes and the communities’ motivation to participate is suggestive of broad based acceptance of the strategy.  Using the same methodology the PALN is currently expanding to introduce community exercise leader training. Extensive monitoring and evaluation of this strategy is planned for two years.

Future Scope

The evaluation of the first year of implementation, will determine if the PALN model has recruited and retained sufficient volunteer leaders, reached adequate numbers of ageing rural Australians and maintained active and ongoing community participation. While the physical activity programs implemented are evidenced based further evaluation and monitoring of outcomes and quality will determine whether the model has potential to provide a sustainable avenue to deliver population based interventions. The outcome of investigations will increase knowledge of community based health promotion approaches in rural settings that reduce fall – related hospitalisation rates. Translating the implementation model into more widespread health practice is envisaged.

References

Contact

This project was entered in the 2008 NSW Health Awards, Making Prevention Everybody's Business category.