What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move

• Published in: PloS one 2023-05, Vol.18 (5), p.e0268164
• Main Authors: McKay, Heather A, Macdonald, Heather M, Nettlefold, Lindsay, Weatherson, Katie, Gray, Samantha M, Bauman, Adrian, Khan, Karim M, Sims Gould, Joanie
• Format: Article
• Language: English
• Subjects: Aged; Comparative analysis; Exercise; Exercise for the aged; Health aspects; Methods; Physical fitness
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0268164

Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases. We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older ([greater than or equal to] 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2. Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p