Texercise: A Multi-Component Lifestyle Enhancement Program for Older Texans

Background:  There is greater awareness of the importance of multi-component interventions for maintaining the health and functioning of middle-aged and older adults.  This study focuses on the repackaging of a long-standing community-based exercise program to be an evidence-based life enhancement program for older adults.  More specifically, it documents the: (1) evolution of Texercise Classic into Texercise Select; (2) newly developed training infrastructure; and (3) effectiveness of Texercise Selecton multiple lifestyle behaviors and mental health outcomes.

Methods: In 2012-2013, Texercise Select, a 12-week exercise program including behavioral change principles and hands-on exercise training was delivered to 220 participants across 8 Texas counties.  Participants completed assessments at baseline and the 12-week follow-up in multiple domains including physical activity, eating behaviors, physical functioning, and depression. Both self-report and objective measures were collected. Linear mixed models were used for continuous outcome variables and GEE models with logit link function for binary outcome variables. Effect sizes were calculated to compare study results with other programs.

Results:The majority of participants were older (average age=74.9 years), female (85.3%), non-Hispanic white (92.9%), and had multiple co-morbidities (average=2.4 chronic conditions). The program demonstrated significant benefits on aerobic physical activity (P<0.001, ES=0.64), fruit and vegetable consumption (P<0.01, ES=0.31); physical functioning P<0.001, ES=0.27), and reduced depression (P<0.05, ES=0.18).  

Conclusions: A multi-component lifestyle program can have many positive effects, suggesting an additive intervention effect.  Program manualization and structured training are important for ensuring lifestyle programs are delivered with fidelity. On-line training will help ensure widespread dissemination.