The aim of the present pilot study was to evaluate the preliminary effectiveness and feasibility of the ecofit intervention in a ‘real-world’ setting, using a scalable implementation model. We found improvements in most health-related outcomes at 6-weeks and 20-weeks. Participants were overall satisfied with the ecofit program, however, study retention was relatively low (66.1% at 6-weeks and 41.3% at 20-weeks).
Overall, these results are in line with the efficacy trial which reported similar effects (7). However, it should be noted that the magnitude of the effect sizes were smaller than those reported in the efficacy trial. This may be explained by the smaller sample in the present study and/or the ‘voltage drop’ of the intervention dose in the real-life delivery setting where the fidelity of the program may have been compromised. Meeting both the aerobic and the muscle strengthening physical activity guidelines among this population has been associated with many physiological, psychological and clinical benefits (1, 2). Thus, the results from this study are promising given the prevalence of meeting the physical activity guidelines is very low among this population age group (6).
People were satisfied with the program, however many participants reported not using the app due to poor internet connection. Indeed, using web-based technology may prove problematic in rural areas due to poor internet services, and/or poor technological literacy among older adults. This is an important consideration for future studies that plan to carry out web-based interventions in rural areas. Although, our findings also suggest the face-to-face component may have been sufficient to improve outcomes among this group (and indeed may be preferable).
Study retention at 20-weeks was relatively low (41.3% at follow-up). It remains unclear why participants dropped out of the study as this information was not documented by the council representatives. In addition, we were unable to assess other feasibility components (i.e., recruitment details and program adherence) as these were also not recorded. Further, while the council representatives were provided training in data collection, we acknowledge that there was no quality assurance process in place during the data collection periods. As such, the results should be interpreted with caution. For future implementation studies, it is recommended to provide rigorous training and ensure the protocol manuals and data collection sheets are easy to use for non-researchers. It is also suggested to implement a quality assurance protocol to ensure validity and reliability during the data collection process.
While many physical activity interventions have proven effective in controlled research settings, few studies to date have been conducted in ‘real world’ environments (16). Indeed, successful translation and maintenance of efficacious physical activity interventions is complex and challenging, and few successful examples appear in the published literature. For intervention strategies to shift populations to be more active, joint efforts between researchers, government agencies and the general community is essential for the ‘scale-up’ of efficacious interventions. (16). Thus, municipal local councils are in ideal positions to assist with physical activity promotion as one of their main objectives are to promote health and well-being amongst residents through the provision of facilities (17).
The main strength of this study is the implementation of an efficacious program in a real-world context with limited involvement from the researchers. Another strength is the design of the program. The ecofit program only requires simple infrastructure (i.e., railings, stairs, benches) and thus can be adapted to most outdoor locations. Limitations of the study include a non-randomized controlled trial design and the loss of sample at the 20-week follow-up. This research however, will hopefully guide researchers and practitioners in the design and implementation of practical programs which target the growing overweight and obese populations.