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Background: The Active Connected Engaged [ACE] study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial [RCT] with an internal pilot phase. The ACE study incorporates a multi-level mixed methods process evaluation including a systems mapping approach and an economic evaluation. ACE aims to test the effectiveness and cost-effectiveness of a peer-volunteer led active ageing intervention designed to support older adults at risk of mobility disability to become more physically and socially active within their communities and to reduce or reverse, the progression of functional limitations associated with ageing. Methods/design: Community-dwelling, older adults aged 65 years and older (n = 515), at risk of mobility disability due to reduced lower limb physical functioning (Short Physical Performance Battery (SPPB) score of 4–9 inclusive) will be recruited. Participants will be randomised to receive either a minimal control intervention or ACE, a 6-month programme underpinned by behaviour change theory, whereby peer volunteers are paired with participants and offer them individually tailored support to engage them in local physical and social activities to improve lower limb mobility and increase their physical activity. Outcome data will be collected at baseline, 6, 12 and 18 months. The primary outcome analysis (difference in SPPB score at 18 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. Discussion: ACE is the largest, pragmatic, community-based randomised controlled trial in the UK to target this high-risk segment of the older population by mobilising community resources (peer volunteers). A programme that can successfully engage this population in sufficient activity to improve strength, coordination, balance and social connections would have a major impact on sustaining health and independence. ACE is also the first study of its kind to conduct a full economic and comprehensive process evaluation of this type of community-based intervention. If effective and cost-effective, the ACE intervention has strong potential to be implemented widely in the UK and elsewhere. Trial registration: ISRCTN, ISRCTN17660493. Registered on 30 September 2021. Trial Sponsor: University of Birmingham, Contact: Dr Birgit Whitman, Head of Research Governance and Integrity; Email: researchgovernance@contacts.bham.ac.uk. Protocol Version 5 22/07/22. [ABSTRACT FROM AUTHOR]

Background: Gait impairment limiting mobility and restricting activities is common after stroke. Auditory rhythmical cueing (ARC) uses a metronome beat delivered during exercise to train stepping and early work reports gait improvements. This study aimed to establish the feasibility of a full scale multicentre randomised controlled trial to evaluate an ARC gait and balance training programme for use by stroke survivors in the home and outdoors. Methods: A parallel-group observer-blind pilot randomised controlled trial was conducted. Adults within 2 years of stroke with a gait-related mobility impairment were recruited from four NHS stroke services and randomised to an ARC gait and balance training programme (intervention) or the training programme without ARC (control). Both programmes consisted of 3x30 min sessions per week for 6 weeks undertaken at home/nearby outdoor community. One session per week was supervised and the remainder self-managed. Gait and balance performance assessments were undertaken at baseline, 6 and 10 weeks. Key trial outcomes included recruitment and retention rates, programme adherence, assessment data completeness and safety. Results: Between November 2018 and February 2020, 59 participants were randomised (intervention n=30, control n=29), mean recruitment rate 4/month. At baseline, 6 weeks and 10 weeks, research assessments were conducted for 59/59 (100%), 47/59 (80%) and 42/59 (71%) participants, respectively. Missing assessments were largely due to discontinuation of data collection from mid-March 2020 because of the UK COVID-19 pandemic lockdown. The proportion of participants with complete data for each individual performance assessment ranged from 100% at baseline to 68% at 10 weeks. In the intervention group, 433/540 (80%) total programme exercise sessions were undertaken, in the control group, 390/522 (75%). Falls were reported by five participants in the intervention group, six in the control group. Three serious adverse events occurred, all unrelated to the study. Conclusion: We believe that a definitive multicentre RCT to evaluate the ARC gait and balance training programme is feasible. Recruitment, programme adherence and safety were all acceptable. Although we consider that the retention rate and assessment data completeness were not sufficient for a future trial, this was largely due to the UK COVID-19 pandemic lockdown. Trial registration: ISRCTN, ISRCTN10874601, Registered on 05/03/2018, [ABSTRACT FROM AUTHOR]

Background: Fidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.Methods: The delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0-5) to assess competence and completeness of delivery for each technique and delivery process. "Competent delivery" was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.Results: The mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0-2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.Conclusions: This study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving. [ABSTRACT FROM AUTHOR]

Background: Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention.Methods: The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated.Results: The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs.Conclusions: REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials. [ABSTRACT FROM AUTHOR]

Tourism is traditionally presented as an escape from daily life and located at places we do not normally visit. Against a backdrop of problematic pressures on (urban) tourist centres and mobility systems, some scholars have explored the possibility of tourism nearer the home. Such locations, however, are often perceived too mundane or are not sufficiently equipped as tourist destinations. In addition, the study of tourist experiences is often dominated by motorised transport, and with limited consideration of older age groups. This article combines different strands of literature to consider the role of active mobility among older people and its contribution to age-friendliness and more proximate forms of tourism. Two case studies in the contrasting mobility contexts of the Netherlands and the United Kingdom show how everyday mobilities contain implicit and explicit tourism elements. Commutes, local visits, and active travel itself may act as springboards for tourism close(r) to home. Using biographical and mobile methods, this article shows how local tourism roots in individual lifecourses, is shaped by the transport environment, and supports social and physical well-being. The findings provide much-needed empirical insight in the convergence between tourism and everyday mobilities and underline the growing importance of slower and more age-friendly approaches to tourism. [ABSTRACT FROM AUTHOR]

Abstract: There are an estimated half a million wheelchair users over the age of 60 in the UK. The wheelchairs are provided free of charge to users through 160 designated National Health Service Wheelchair Centres. Referral is from hospital consultants, general practitioners or accredited assessors who have undergone specific training. Most people are suitable for one of two types of standard wheelchairs: a self-propelling wheelchair or a transit (attendant) propelled wheelchair. People dependent on a wheelchair as their main form of mobility, or who have postural seating problems, are assessed in the wheelchair centres for a modular wheelchair that is capable of considerable individual customisation. People commonly report their wheelchair feels too heavy, or is difficult to get in and out of a car. These issues can be addressed by considered assessment and wheelchair modifications. [Copyright &y& Elsevier]

Abstract: Both the UK and the US have rapidly ageing and increasingly diverse populations very dependent on driving. A comparative study commissioned by the UK Department for Transport found that in both the UK and the US adult children of older drivers, whilst often concerned about their parents’ continued driving, were also worried about the burden they would carry when their parents stopped driving, although there were differences by race and ethnicity. This study suggests that a policy window may be opening through which babyboomers can advocate for a range of driver training, roadway and vehicle improvements, expansion and enhancement of traditional public transportation and community transport options, improvements in accessibility and pedestrian infrastructure, and supportive land use and housing policies that would allow older people to drive safely longer, and, find meaningful mobility options when they can no longer drive. Policy responses must recognise and respond appropriately to differences by race and ethnicity. [ABSTRACT FROM AUTHOR]

Objective: to investigate the apparently incongruous coupling of poor physical functioning with high QoL. Study design and setting: face-to-face interview survey of random sample of 999 people aged 65+ across Britain. Results: twenty-one per cent of respondents reported fairly to very severe levels of functional difficulty, and 62% of these rated their QoL as 'good'. Better self-rated health, lower burden of chronic disease, not having fallen, higher social engagement and higher levels of perceived control over life, distinguished between people who had difficulties with physical functioning and who perceived their QoL to be 'good', rather than 'not good'. The open-ended survey responses broadly supported the quantitative findings. Conclusion: people with difficulties with physical functioning, who perceived their QoL to be 'not good', as opposed to 'good', were adversely affected by a higher burden of disease and having fewer socio-psychological resources to help them to cope effectively. [ABSTRACT FROM AUTHOR]

Describes the mobility of older people Great Britain. Provision of public transport in Western Europe; Ways in which people travel in Europe; Driving licenses among older people; Background on the concept of the family of public transport services; Analysis of the travel of people who live in different types of area. INSETS: Table 1;Table 2;Table 3;Table 4a. . .