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STUDY PROTOCOL article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1555222
This article is part of the Research Topic Integrated Strategies for Lifelong Health: Multidimensional Approaches to Aging and Lifestyle Interventions View all 9 articles
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Background: Reduced physical mobility is common in older adults and is associated with adverse outcomes, including functional decline, depression, social isolation, and poor nutritional status. Group-based programs focusing on physical activity and nutrition to support healthier lifestyles have demonstrated benefits, particularly when paired with social engagement activities. This paper presents the protocol for a randomized controlled trial (RCT) to test a lifestyle intervention called EMBOLDEN: Enhancing physical and community Mobility in older adults with health inequities using community co-design. EMBOLDEN is a co-designed 3-month intervention to improve quality of life by incorporating physical activity, healthy eating, social participation, and system navigation. Participants receiving the EMBOLDEN intervention plus usual care are expected to show improvement in physical activity and other health outcomes compared to receiving usual care alone.Methods: This is a 2-arm Type II hybrid effectiveness-implementation pragmatic RCT. Eligibility criteria include older adults (55+ years), community-dwelling in urban neighbourhoods facing health inequities, able to speak or understand English or Mandarin (or access to family/friend interpreters), and able to walk 10 meters unassisted by another person (assistive devices permitted). Participants will be randomized to the intervention or control arm (1:1 ratio). The intervention arm is usual care plus: 1) 12 weekly group-based sessions to increase knowledge/skills and behaviour activation related to physical activity, healthy eating, fostering social connections and community resources; and 2) up to three tailored individual system navigation sessions. The control arm is usual care, in which participants identify and access services without research support. The primary outcome is time spent doing moderate-to-vigorous physical activity. Secondary outcomes will also be explored, including quality of life, life space mobility, depressive symptoms, nutritional risk, and loneliness. Data will be collected at baseline, 3 months (post-intervention) and 6 months. Mixed effects models will be used to analyze outcomes, intention-to-treat analysis will be employed, and multiple imputation will address missing data. Descriptive and qualitative data from participants, interventionists, and research documentation will be used to examine adaptations and implementation barriers/facilitators. Discussion: A community-based, co-designed lifestyle intervention may improve physical activity and other health outcomes in older adults living in neighbourhoods with health inequities.
Keywords: physical activity, nutrition, Social Participation, system navigation, Health inequity, older adults, Community-based intervention, Public Engagement
Received: 03 Jan 2025; Accepted: 24 Mar 2025.
Copyright: © 2025 Ganann, Phillips, Neil-Sztramko, Fisher, Alvarez, Kuspinar, Newbold, Moore, Macneil, Keller, Teggart, Thabane, Agarwal, Sherifali, Adams and Alshaikhahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Rebecca Ganann, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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