A multi-centre randomised controlled trial of a peer-volunteer led active ageing programme to prevent decline in physical function in older people at risk of mobility disability. The ACE (Active, Connected, Engaged) study

Research Question: What is the effectiveness of the ACE intervention compared with an information-only control group for preventing decline in lower limb physical function in community-dwelling older people at risk of mobility disability? Background: Approximately 38% of people aged over 70 are at increased risk of mobility-related disability. In the UK’s ageing population this generates major individual and societal challenges, including reduced quality of life, loss of independence, reduced productivity amongst carers and increased health and social care costs. Interventions that can prevent decline in physical functioning would therefore have great public health value. In older people, modest changes in physical activity can prevent the onset of mobility-related disability. Using peer-volunteers to support engagement in physical activity by at-risk older people has the potential to prevent decline in physical function at relatively low cost. However, such programmes have not been robustly evaluated. Aims /objectives: This study will evaluate the effectiveness and cost-effectiveness of the Active Connected Engaged (ACE) intervention, a 6-month peer-volunteer led active ageing programme designed to engage older people at risk of mobility disability in physical activities that will maintain or improve their lower limb physical function. ACE will be delivered by the Royal Voluntary Service (RVS). Methods: We will conduct a 2-arm individually randomised controlled trial with an internal pilot study. Participants will be 515 community-dwelling adults aged 65 years or more, at risk of mobility disability (Short Physical Performance Battery (SPPB) score 4-9) and 150 peer volunteers. Intervention arm: A series of peer volunteer meetings with participants and telephone support to take part in local activities of interest that may involve a physical activity or muscle-strengthening component. Control arm: The control group will receive written information on healthy ageing and attend one meeting at 12 months to promote ongoing engagement with the study. Assessments: Baseline, 6, and 18 months. Primary outcome: SPPB score (lower limb functional ability) 18 months post-randomisation. A mixed-methods process evaluation will include a whole systems approach to identify the wider impacts of the ACE intervention and the best ways to implement it. It will also assess intervention fidelity and explore how effectiveness and uptake vary with a range of socio-demographic factors. Public Involvement: The ACE intervention was co-created with service users and service providers. Service user representatives will sit on our Trial Management and Trial Steering Committees. Participant Advisory Groups at each site will help to design patient-facing materials, interpret data and disseminate the findings. We will train 30 volunteer Citizen Scientists to support data collection. Impact / dissemination: If the findings are positive, we will seek to roll out the intervention nationally and impact public health policy on active ageing. We will co-develop a dissemination strategy with our Participant Advisory Groups, the RVS, Age UK, Sport England and Public Health England. A key output will be the ACE delivery toolkit. This will be promoted to health, public health and social care policy makers and practitioners and voluntary sector organisations. Dissemination will include events with participants and volunteers, academic publications and conferences.