The Back for Action Program for Increasing Everyday Activity Levels: Its Rationale, Design and Experimental Evaluation with People Over 70 Years of Age

Population ageing and its impact on government provisions for healthcare has focused attention on the development of appropriate services and policies for older people. Considerable resources are being directed towards health promotion media campaigns which aim to encourage older people to initiate and maintain healthier and more active lifestyles. From a behaviour analytic (or ABA) perspective, improving the health and wellbeing of older people involves arranging supportive environments and applying self-management strategies for long-lasting behaviour change from sedentary to more active lifestyles. This important area of application of ABA principles has so far received surprisingly little attention from behaviour analysts. This thesis describes the rationale, development and evaluation of the Back for Action Program (BAP), a comprehensive intervention based on ABA principles that aims to increase the everyday physical activities of older people. The main components of the BAP are described, including how it selects, measures and reinforces increased physical activity in people over 70 years of age. The first research study undertaken consisted of 7 single-case experiments that were designed to evaluate the effectiveness of the main components of the BAP: client feedback based on objective measures of daily activities, behavioural consultation including goal setting and problem solving, and self-management strategies for maintenance. The second research study consisted of a repeated measures group design evaluation involving arbitrary allocation of participants (n = 19) to either the BAP as a package or a ‘control’ condition. The effects of the BAP were evaluated using a comprehensive set of direct and collateral dependent measures of health and wellbeing. These covered participants’ physical, biochemical and psychological health and wellbeing. Research questions included whether the BAP leads to increases in daily activity and reduces sedentary behaviours, and whether higher levels of activity lead to improvements in measures of physical, biochemical, and psychological health and wellbeing. Results provided strong evidence in support of the BAP and showed that increasing daily activity levels by 20% to 103% had clinically significant health benefits even for this older group of people. In so doing, this thesis provides an overdue account of a comprehensive, effective behavioural approach to increasing ‘healthy ageing’ activities of free-living older people in the community.