October 2005

Grant Results

SUMMARY

The American Association for Retired Persons (AARP) conducted a social marketing project from 2002 to 2004 to promote increased physical activity in Richmond, Va., and Madison, Wis., two demonstration sites under the Robert Wood Johnson Foundation's (RWJF) national program, Active for Life®: Increasing Physical Activity Levels in Adults 50 and Older.

AARP's project, called the Active for Life Campaign, was the marketing communications component of RWJF's national program. The campaign had two additional components: partnership/coalition-building and environmental change.

RWJF also contracted with two firms that conducted evaluations of aspects of the demonstration projects: Sutton Group on the partnership component in Richmond and Madison; and Princeton Survey Research Associates to conduct a multiyear, multiwave survey of the projects' impact in Richmond and Madison.

Key Results

  • The partnership/coalition building and environmental change efforts had mixed results:
    • Numerous partners in each city promoted physical activity and developed physical activity programming.
    • Both cities formed committees to influence public policies to improve the built environment.
  • Results of the marketing communications, based on the Princeton Survey Research Associates' survey findings (see Appendix 2 for further details) included:
    • One year after the launch of the campaign, both cities showed modest increases in overall rates of physical activity among those 50 and older and higher rates of participation in community-based exercise events than was the case prior to the campaign.
    • Two years after the inception of the campaign, adults 50 and older in Madison maintained modest behavioral and knowledge changes. But the positive changes in Richmond's older adults after one year were no longer evident.

Funding
RWJF provided a $4.3 million grant from October 2001 to September 2005 to support AARP's Active for Life Campaign. The campaign in Richmond and Madison also received $2,545,000 from AARP.

RWJF provided the Sutton Group — a contract of $223,624 for a focus group and two surveys of partners in Richmond and Madison.

RWJF provided Princeton Survey Research Associates with two contracts totaling $1,006,000 to conduct a multiyear, multiwave survey of the projects' impact in Richmond and Madison.

 See Grant Detail & Contact Information
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THE PROBLEM

Physical inactivity is one of the greatest modifiable threats to health and functional independence in later life. A May 2001 report, the National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older, sponsored by RWJF and five partners — American College of Sports Medicine, American Geriatric Society, Centers for Disease Control and Prevention (CDC) and the federal National Institute on Aging — confirmed that scientific evidence increasingly shows that physical activity can extend years of active independent life, reduce disability and improve the quality of life for older persons. An October 2000 conference at which 50 interested organizations provided input and recommendations provided the basis for the blueprint.

By the time they reach age 50, most Americans know what experts say they should be doing to stay healthy and fit, but few are acting on their knowledge. As a result, many midlife and older adults pay a harsh price in terms of disease, disability, and premature death. Physical inactivity and related obesity and overweight are direct contributing factors to the most prevalent and disabling diseases and conditions such as diabetes, heart disease, stroke, some kinds of cancer, arthritis and osteoporosis. CDC has reported that at least 300,000 deaths a year in the United States are linked to obesity.

What remains unclear is the question of what motivates older adults to exercise. To change physical activity behavior requires individuals changing not only perceptions of age-appropriate behavior and willingness to integrate physical activity into busy lives but also that the communities where people live become more activity friendly. There is consequently a need for a range of effective interventions that promote physical activity for older adults.

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RWJF STRATEGY

Promoting healthy communities and lifestyles is an RWJF goal area. One of RWJF's strategies to meet this goal has been to find ways to increase physical activity through community design and redesign and to build a stronger knowledge base from which to promote active living. RWJF has four active living programs:

  • Active Living Research Program stimulates and supports research to identify environmental factors and policies that influence physical activity (for more information see Grant Results). Findings are expected to inform environmental and policy changes that will promote active living among Americans.
  • Active Living by Design Program incorporates activity-promoting goals and processes into ongoing community planning efforts and supports the development and testing of local community active living projects, with special efforts to reach low-income Americans.
  • Active Living Leadership is working to increase the number of state and local elected and appointed leaders who understand and champion community design to promote active living.
  • Active for Life®: Increasing Physical Activity Levels in Adults Age 50 and Older seeks to increase the number of American adults age 50 and older who engage in regular physical activity. (For more information see Grant Results.)
  • Active Living Resource Center aims to improve health by encouraging collaboration among planning, health and nontraditional entities for the purpose of designing activity-friendly communities (for more information see Grant Results).

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THE PROJECT

AARP's Active for Life Campaign was a social marketing project to increase the physical activity of people age 50 and older, funded under the Active for Life program. During the Active for Life Campaign in Madison and Richmond, AARP worked with a range of partners to increase physical activity among people age 50 and older in these communities. AARP is a nonprofit, nonpartisan membership organization dedicated to making life better for people 50 and over.

The goal of the population-based Active for Life Campaign was to increase awareness of the benefits of physical activity to adults and to increase physical activity levels in target populations. The campaign promoted the specific exercise goal for older adults of moderate physical exercise at least 30 minutes a day, five days a week, in accordance with the guidelines in Healthy People 2010, the health objectives issued by the federal Department of Health and Human Services. The Active for Life Campaign in Madison and Richmond received $2,545,000 from AARP in addition to funds from RWJF.

AARP project staff worked on three components of the Active for Life Campaign under grant ID# 042913:

  • Marketing communications included paid advertising using television, radio and print media. A media relations effort reinforced the advertising. Direct mail to AARP members encouraged participation in "Active for Life" activities. Project staff developed books for use in the campaign, including community resource guides, a handbook and a partners' coordinators' guide (see the Bibliography).
  • Partnership and coalition-building included developing partnerships in Richmond, and Madison, with public health agencies, recreation and parks departments, health organizations, environmental groups, faith-based organizations, neighborhood associations, fitness facilities and clubs, major employers and others.
  • Environmental change focused on raising awareness among city planners, engineers and other policy-makers and officials about the importance of activity-friendly (in terms of walking and biking) neighborhoods as places conducive to physical activity.

Planning Activities

RWJF contracted with the Sutton Group, a Washington consulting firm, to conduct 12 focus groups during May and June 2001 in Baltimore; Jackson, Miss.; and Chicago (supported by a portion of funds from grant ID# 040245). These focus groups explored how older adults thought, felt and talked about physical activity. The focus groups included adults aged 60 to 75. AARP had previously contracted with the Sutton Group to conduct a similar series of focus groups with adults aged 50 to 59. Participants in the focus groups all had physical activity levels below Healthy People 2010 guidelines. A key finding was that most participants expressed a high level of ambivalence about becoming more physically active. Many noted the competing time pressures of work and family while others mentioned a high degree of boredom from repetitive exercise routines. (For a more detailed description of the Sutton Group focus group findings, see Appendix 1.)

AARP contracted with RoperASW, a New York-based market research and consulting firm, to field a telephone survey of 1,000 adults between the ages of 50 and 79 in March and April of 2002. The survey was representative of 50–79-year-olds living in the continental United States and included oversamples of African Americans and Hispanics. The survey probed respondents' current exercise behavior, their confidence in continuing to exercise when facing difficult situations and their interest and participation in community-based physical activity programs.

Among the findings were that only 15 percent of respondents currently participated in community classes; among the top reasons for exercising were to improve health and increase energy level; and 73 percent said they were interested in learning how to exercise safely. AARP used the results of the Sutton Group and Roper research in planning the social marketing projects in Richmond and Madison.

To better inform the environmental component of the campaign, AARP contracted with Bonney & Company, Virginia Beach, Va., to hold focus groups in Richmond, Va.; Madison, Wis.; and Birmingham, Ala., in October 2002 (two in each city). The focus groups explored consumer perceptions of the effect of the built environment on physical activity and their willingness to advocate for change in the environment.

The research indicated that barriers in the built environment were considered less important than such factors as lack of time or interest. The only issues that resonated with a large number of participants were concern for personal safety and a preference for physical activity in large public spaces such as malls and parks.

Campaign Implementation

Preparations for the May 2002 launch began in late 2001. AARP project staff hired site coordinators in Richmond and Madison, formed working groups of community partners, developed community resource guides for each site and launched a Web site as part of the AARP Web site, which was operational for about two years.

The first advertising campaign in Richmond and Madison, launched in May 2002, lasted about one year and focused on physical activity in general. Messages to older adults encouraged them to call a toll-free number to receive a personal handbook for a self-directed 12-week physical activity program. Messages also directed people to the Active for Life Web site.

AARP contracted with Mapes & Ross, Princeton, N.J., to field a telephone survey in Madison and Richmond in April and May 2003, with a total of 800 people over age 45 to determine the effectiveness of the media buys on influencing viewers' awareness, knowledge, behavior and receptivity to the ads. Unaided awareness of the campaign was nonexistent, and aided recall was very low, with only 13 percent having heard of the campaign.

A second advertising campaign in Richmond and Madison began in September 2003 and ran for four months. Because of the disappointing results from the ad tests, a new television commercial and two print advertisements were developed with an emphasis on walking. This new focus on walking coincided with AARP's strategic decision to focus on walking and a communitywide walking campaign was launched in both cities and the second ad campaign supported this.

Walking campaign messages encouraged older adults to obtain free step counters at community events, at the facilities of campaign partners — public health agencies, recreation and parks departments, health organizations, environmental groups, faith-based organizations, neighborhood associations, fitness facilities and clubs and major employers — and by calling a toll-free number.

Just before the second media campaign started, AARP contracted with International Communications Research of Media, Pa., to field a telephone survey in Richmond and Madison among 800 adults age 50 and older to be used as a baseline for this campaign. The survey asked about the types of physical activity respondents engaged in and community conditions for walking, among other topics. International Communications Research conducted a second survey in December 2003 and a third in May 2004.

Results from the surveys indicated that during the course of the campaign Madison adults over 50 had increased the amount of time they walked while adults in Richmond had no significant increases. The survey results showed, nonetheless, that respondents found the walking campaign ads more meaningful, believable and persuasive than the first, more general ad campaign.

AARP spent most of the costs for both ad campaigns on television, with radio next and print insertions in newspapers and magazines third. Fleishman-Hillard, a public relations firm based in St. Louis, provided assistance in 2002 and 2003 with publicity such as spokespersons, interviews and articles that featured personal success stories and physical activity events. These stories were all on message.

AARP site coordinators in Madison and Richmond worked to engage local partners to strengthen local programming and outreach. The partnering organizations offered classes and activities, distributed physical activity community resource guides, the handbook and step counters for a walking program, promoted increased physical activity to their constituencies and helped form local coalitions to improve conditions for walking and biking.

Some of the partners in the physical activity business had not reached out to the 50+ before and began doing so; other partners who were reaching the 50+ age group, but not with physical activities, began adding "health" or "physical activity" to their "menus" of offerings.

To assist with the environmental change component, project staff hired public health consultants, contracting in 2002 and 2003 with the department of health behavior and health education at the School of Public Health, University of North Carolina at Chapel Hill. The public health consultants conducted workshops in Richmond and Madison to train volunteers to assess their communities' walking and bicycling suitability.

The consultants held one workshop in Richmond and one in Madison as well as one workshop for traffic engineers in Richmond. A small group of volunteers in each city worked with the consultants to conduct the assessments. The consultants also developed a model for evaluation based on public awareness, neighborhood audits and community activism as ways to measure the campaign's impact (see Results).

Project staff also held information briefings and "tours" for local officials, advocated for change and participated in pedestrian safety projects.

Evaluation Activities

As part of its contract with the Sutton Group (ID# 040245), RWJF asked the firm to conduct interviews with project partners to provide baseline information about the state of the partnerships and marketplace prior to the Active for Life Campaign.

The Sutton Group conducted 48 interviews in September and October 2002 with 24 partners in each site. These interviews revealed many concerns by the partners, which project staff addressed by distributing a brochure to partners that described the project, emphasized the collaborative nature of the effort; holding networking meetings; and providing support materials and other resources.

Sutton Group staff members conducted follow-up telephone interviews in late February to mid-March 2004 with 20 partners in each city — in Madison: 14 partners from health and recreational sectors and six environmental-design partners; in Richmond: 13 partners from health and recreational sectors and seven environmental-design partners.

Follow-up interviews indicated partners' perception of the Active for Life Campaign and the AARP had changed for the better and that they felt a part of a larger movement to promote physical activity. (For a more detailed description of the Sutton Group partner interviews, see Appendix 1.)

To document the project's impact on the exercise behavior of adults age 50 and older, RWJF contracted with Princeton Survey Research Associates, Princeton, N.J., an independent research company (ID#s 041911 and 046220). Between 2002 and 2004, the survey firm administered four separate waves of telephone interviews in Madison and Richmond as well as in two cities of similar size, geography and sociodemographic characteristics: Lincoln, Neb., and Greensboro/Winston-Salem, N.C.

The survey focused on knowledge/awareness of exercise information, attitudes toward exercise and physical fitness, current exercise behavior and exposure to exercise information. The survey showed that before the campaign began, both Madison and Richmond had moderately active older adult populations who were generally aware of the overall benefits of regular physical activity but unsure how to implement appropriate exercise programs in their own lives. See Results for the findings from Princeton Survey Research Associates.

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RESULTS

The Marketing Campaign

Results of marketing communications, based on the Princeton Survey Research Associates' survey findings (see Appendix 2 for further details):

  • At six months, the survey found small positive changes in older adults' awareness of and attitudes toward exercise in the two pilot sites along with preliminary indications that behavior was beginning to change (September–November 2002).
  • One year after the launch, the survey indicated the campaign was having measurable effects on the 50 and older populations in both Madison and Richmond. Most important were shifts in behavior; both cities showed modest increases in overall rates of physical activity among those 50 and older and higher rates of participation in community-based exercise events than was the case prior to the campaign. These findings were tempered, however, by the relatively low recall of Active for Life advertising in the two cities and the absence of any change in residents' reported exposure to exercise information (March–June 2003).
  • Two years after the inception of the Active for Life campaign, adults 50 and older in Madison maintained modest behavioral and knowledge changes. But the positive changes in Richmond's older adults after one year were no longer evident (March–May 2004).

Partnership and Coalition-building

The key results of partnership and coalition-building, according to the project director, were:

  • In Madison, health clubs, YMCAs and other organizations revamped their physical activity offerings for those over 50 and increased their outreach efforts. The Adult Physical Activity Committee, one of five working groups created by the Mayor's Fit City Madison, and the Wisconsin Department of Workforce Development agreed to include messages about the importance of physical activity for those 50+ in their programming. Madison established a committee to ensure cross-city coordination of all physical activity projects in Madison and surrounding Dane County.
  • In Richmond, partners, including employers and parks and recreation departments, engaged in a variety of activities. DuPont used tools from the Active for Life campaign to reach out to its employees over age 50. Chesterfield Parks and Recreation, in a county adjoining Richmond, developed a new walking program for those over 50. The Active Living Forum, launched in Richmond in June 2004 in concert with city physical activity coordinators, included a number of partners from the campaign. The forum agreed to host quarterly meetings. A Web site for seniors regularly updated a community listing of physical activities. Oakwood Park, a city recreation facility, formed a task force to increase intergenerational use of city parks.
  • Partners in both cities actively supported the walking campaign that started in the fall of 2003:
    • More than 3,000 people in Richmond signed pledges committing to increased activity, and 4,000 did so in Madison.
    • 63 partners in both sites distributed step counters.
    • 25 partners in Richmond and 40 in Madison implemented walking programs.

Environmental Change

Results of the environmental change efforts, according to the project director, were:

  • In Richmond, the Active for Life Campaign staff joined with the Safe Kids International Walk to School program to add an intergenerational walking component. A PhotoJourney Project 2004 documented how walkable different neighborhoods were and increased awareness among students, teachers and local officials.
  • Both cities used the findings from the community walking and biking suitability assessments to advocate for improvements, and strong partnerships resulted with city traffic engineering staffs. Volunteers in Madison educated policy-makers in surrounding towns. Richmond volunteers influenced design changes — such as making traffic intersections safer for pedestrians — by the Departments of Transportation and Public Works. Both cities installed sidewalks and crosswalks and improved their maintenance, and added pedestrian signage.
  • Both cities formed committees to influence public policies to improve the built environment.

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LESSONS LEARNED

  1. When implementing an advertising campaign to increase physical activity, it helps to focus on a specific kind of exercise. The first ad campaign was neither memorable nor effective, probably because the message was not clear and it was too general. The second campaign focused on the benefits of walking (a more specific message), and there was a more specific call to action. More people remembered and liked the second campaign. (Project Research Adviser/Keenan)
  2. In planning an ad campaign to encourage physical activity among older adults, it is important not to refer to "exercise" or "fitness." In preparing the content of the first ad campaign, AARP emphasized messages and words that did not resonate with the target audience. The audience did not like to be told to exercise because it was too much like work. In other words, promoting walking or some other specific activity like dancing may be more effective than promoting either "exercise" or "physical activity." (Project Research Adviser/Keenan)
  3. When adding a new component to a program mix, it is essential to have adequate personnel. It was difficult at first to get the environmental component of the Active for Life Campaign started, partly because it was a new area for AARP and partly because the existing site coordinators were overwhelmed with program coordination and partnership building. Bringing on part-time coordinators to handle the environmental component helped the overall program gain momentum. (Project Manager/Hawkins)
  4. When recruiting partners for a campaign, allow enough time at the beginning for adequate organizing and relationship building. Social marketing projects such as the Active for Life Campaign usually take 18 months to organize but AARP completed the task in nine months, leaving some of the partners feeling neglected or peripheral, a situation that AARP later improved. (Project Manager/Hawkins)
  5. Conducting research, such as focus groups, before the start of a campaign allows project staff to design more effective interventions. Even with pilot programs such as those in Richmond and Madison, the interventions should be underpinned by audience research to understand motivations for taking action. (Program Officer/Bazzarre)
  6. Mass media campaigns do increase awareness and change behavior, but the changes may evaporate as the campaign ends. Expensive media campaigns may work best in communities where the infrastructure for environmental support is already in place. In Madison, where there was a more activity-friendly environment, the physical activity generated in part by the Active for Life program was maintained because there were more sidewalks and more recreational spaces — in other words, the social and physical environments supported efforts to be more active. In Richmond, this was not the case. There were also ethnic, demographic, safety perception and support system differences between Madison and Richmond that may have been related to the greater increases in physical activity in Madison. (Program Officer/Bazzarre)
  7. These results are consistent with research findings that awareness and knowledge of the benefits of physical activity do not necessarily lead to any long-term evidence of increased physical activity levels. However, they may suggest that future efforts may be more successful if they are targeted in communities that provide increased access to environments that are supportive of opportunities for safe physical activities like walking. (Program Officer/Bazzarre)

Communications

The program distributed over 17,000 community resource guides in Madison and 20,000 in Richmond. Project staff distributed 5,000 self-guided physical activity handbooks in Richmond and 3,000 in Madison. Staff also distributed almost 5,000 brochures that integrated health and pedestrian safety messages in Madison. There were over 20 partner events in Madison and 44 in Richmond, reaching some 2,500 and 4,700 people, respectively.

During the grant, AARP staff made over 22 presentations about the Active for Life Campaign in Richmond and Madison. AARP staff also presented information about Active for Life at conferences and meetings throughout the United States and Canada, including presentations at the Governor's Summit on Healthy Virginians, University of Virginia, Charlottesville, Va., the National Congress of Pedestrian Advocates, Silver Spring, Md., and the American Public Health Association Conference, also in Silver Spring.

The AARP project staff published handbooks, guides or tools for the Active for Life social marketing project. Project staff continues to share information with grantees of RWJF's Active for Life national program. See the Bibliography for details of available items.

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AFTER THE GRANT

AARP established a collaboration with CDC to promote healthy aging. In 2003, leadership from AARP and CDC formed a team to identify ways to extend the reach and effectiveness of both organizations. The team agreed on four initial areas of focus: walking, driver safety, preventive services (such as screening) and research. As part of its collaboration with CDC, AARP is applying the lessons learned gained from this social marketing project to help other communities throughout the country. AARP has developed toolkits on walking campaigns for its state offices, including kickoff ideas, consumer tip sheets and other how-to guides.

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GRANT DETAILS & CONTACT INFORMATION

Project

Improving Physical Activity Levels of Mid-Life and Older Adults through a Social Marketing Project in Richmond, Va., and Madison, Wis.

Grantee

AARP (formerly American Association of Retired Persons) (Washington,  DC)

  • Marketing Communications and Policy Component of Translating Research to Practice: Improving Physical Activity Levels of Mid-Life and Older Adults through Social Marketing
    Amount: $ 4,300,000
    Dates: October 2001 to September 2005
    ID#:  042913

Contact

Margaret Hawkins
(202) 434-2201
mhawkins@aarp.org

Grantee

Princeton Survey Research Associates (Princeton,  NJ)

  • Evaluation of AARP's Social Marketing Campaign for the Active for Life Initiative
    Amount: $ 750,000
    Dates: March 2002 to August 2003
    ID#:  041911

  • Follow-up Survey of Active for Life Social Marketing Campaign Participants
    Amount: $ 256,050
    Dates: September 2003 to July 2004
    ID#:  046220

Contact

Lawrence Hugick
(609) 924-9204
larry.hugick@psra.com

Grantee

Sutton Group (Washington,  DC)

  • Conducting Consumer Research on Mid-Life and Older Adult Physical Activity
    Amount: $ 223,624
    Dates: April 2001 to December 2003
    ID#:  040245

Contact

Sharyn Sutton
(202) 342-1333
ssutton@suttongroup.net

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APPENDICES


Appendix 1

Results of Sutton Group Focus Groups and Partner Surveys ID#40245)

On Reaching Age 50

  • Turning 50 triggered a number of changes in participants' physical and mental well-being. Many saw their 50s as a time of mixed blessings; their bodies and outlooks on life were changing.
  • Many participants said they wanted to age more successfully than their parents.
  • Most participants expressed a high level of ambivalence about becoming more physically active. Even though most could envision a time in their lives when they had been more active, they were pessimistic about the likelihood of becoming more active today. Many noted the competing time pressures of work and family; others mentioned a high degree of boredom from repetitive exercise routines.
  • Many of the women focused on their weight and the sense that they could not control it as in the past. In contrast, the men were concerned about their masculinity and their mortality, but expressed less conflict than women over making physical activity a priority in their lives.
  • Most participants were realistic about the benefits of being more active. They knew they would feel better about themselves, have more energy, have fewer aches and pains, have a better sex life and feel less stress if they decided to become more physically active.

Current Patterns of Physical Activity

  • Most participants were already walking. Some walked alone, but most walked with a friend or their spouse. Many said they walked through malls or through their neighborhoods. Social support may be an important predictor of physical activity behaviors like walking, especially for women age 50 and older.

Reactions to AARP Program Concepts

  • Participants' reactions to physical activity program concepts were generally mixed, with participants expressing only average interest in the concepts. Program concepts that were under consideration when the focus groups were held included walking or running events, fun/fitness relays, neighborhood walking groups, bicycle groups, fitness classes and workout partner services.

Suggestions for Helping People to Be More Active

  • Participants made a number of suggestions about what factors would aid in their becoming more physically active. The nine suggestions mentioned most often:
    1. Encouraging people to set realistic goals and celebrate small victories.
    2. Providing incentives such as discounts on walking shoes or on insurance.
    3. Giving guidance on age-appropriate activities for those initiating an activity program.
    4. Creating neighborhood-based exercise or walking groups.
    5. Developing an "Ask a Friend" program.
    6. Offering classes for older adults.
    7. Organizing workplace fitness programs during the day.
    8. Sponsoring television programs that people at home can exercise along with.
    9. Increasing awareness of free and affordable places to exercise.

The Sutton Group Project Partner Baseline Interviews Generated the Following Findings

  • In general, partners became involved in the Active for Life project because they saw the program as a natural extension or supplement to their existing job mission.
  • Most partners were proud of what they had accomplished in their own work, and they saw their cities as uniquely active in promoting physical activity.
  • The biggest programmatic draw to the Active for Life project was the advertising and promotion behind it. Most partners, and especially nonprofits, have limited budgets and few resources to promote physical activity, and they were highly appreciative of the AARP's investment in getting the message out. They saw two benefits: the promotion of their cause (physical activity) and marketing of and visibility for their specific programs and organizations.
  • Respondents supported the partnership concept but lacked a strong understanding of what partnership in the social marketing project meant in practice and a sense of ownership in the project. Most respondents could not specifically define what made an organization a partner.
  • Respondents made the following suggestions for strengthening the Active for Life partnerships:
    • Allow more local-level direction.
    • Create a stronger partnership network.
    • Increase communication with partners.
    • Hold events and follow up on them.
    • Expand the partnerships and reach out to more people through new channels.
    • Plan for sustainability.

The Sutton Group's Summary of Major Themes

  • Partners' perception of the Active for Life project and the AARP changed for the better. Partners shifted from perceiving Active for Life as primarily a media campaign to seeing important, concrete benefits. They felt a part of a larger movement to promote physical activity, benefited from interacting with Active for Life leaders and other partners and viewed the walking programs as a mechanism that added a tangible component to the effort.
  • Walking worked. The walking campaign appeared to transform Active for Life from a loosely defined program to a concrete movement generating interest and participation in physical activity programs. Most partners used 'walking' when asked to define Active for Life. The walking campaign also encouraged more partners to become involved in the program. Many partners mentioned that the campaign legitimized walking as a true form of exercise.
  • Awareness of and participation levels in physical activity programs increased. Partners credited the Active for Life project with increasing participation in physical activity programs and cited advertising as the biggest driver of awareness of and participation in programs and as a major benefit delivered by the Active for Life project, even though surveys suggested little awareness or recall of these campaigns.
  • Tools were well received. Partners received positive feedback from their participants on the Active for Life project's tools. Most frequently mentioned were the step counters and handbooks.
  • Networking proved to be an unexpected benefit. Partners were impressed with the benefits of being involved in an active network of like-minded organizations. They were able to brainstorm with these groups and leverage resources. They reported feeling part of a 'movement' that created momentum around their cause.
  • Mission alignment is critical. When the goals and target audience of the partner aligned with program goals, partners placed a higher priority on attaining those goals.
  • Sustainability. Partners from the health and recreation sectors were more optimistic about their ability to sustain programs, which they attributed to the fact that they had already shared the Active for Life project's mission and goals. Lack of funds and resources was the main reason some partners felt they could not sustain their efforts.


Appendix 2

Results of Princeton Research Survey Associates Survey (ID#s 041911 and 046220)

Wave 1 (March 12 to May 7, 2002)

  • Prior to the Active for Life project, 36 percent of Madison adults age 50 and older reported getting moderate or vigorous exercise for at least 30 minutes a day, five or more times a week — the recommended amount of physical activity for people their age. Thirty-nine percent said they followed a regular exercise routine. These percentages appear to be somewhat higher than norms reported in national surveys of self-report physical activity behaviors for older adults, according to Bazzarre, the RWJF program officer.
  • In Richmond, 28 percent were getting the recommended amount of physical activity, and 35 percent said they followed a regular exercise routine.
  • Older populations in both cities had fairly positive attitudes toward exercise and a general awareness of its many health benefits. Yet older adults in both cities were less sure about how to implement exercise programs in their own lives and how to stay motivated.
  • While 66 percent of Madison adults and 61 percent of Richmond adults reported exercising for the recommended 30 minutes or more on the days they exercised, most fell short of the goal of five or more days of exercise per week.
  • Prior to the Active for Life project, older adults in Madison and Richmond were most likely to get exercise information from the same three sources: general news coverage; friends and family; and their doctor, hospital or other health care provider.
  • There were few significant differences in any of the key evaluation areas (awareness, attitudes, behavior, exposure to information) between the test cities, Madison and Richmond, and their respective control cities, Lincoln and Greensboro.

Wave 2 (September 12 to November 12, 2002)

  • In Madison, there were slight knowledge and attitudinal changes among the target population, including a growing awareness of how much exercise someone their age needs to stay healthy and a greater tendency to think regular exercise helps older people improve their overall health. These positive changes were particularly pronounced among women in the target population.
  • In Madison, the percentage of people age 50 to 64 who reported exercising at least three days per week increased from 64 percent to 68 percent between Wave 1 and Wave 2. While falling short of Active for Life guidelines, this suggested a trend toward increased physical activity among Madison's older adults.
  • In Richmond, prior to the Active for Life project, just over one-quarter of the city's older adults were exercising at a moderate or vigorous level at least 30 minutes a day, five or more days a week. That figure rose to 33 percent six months later in Wave 2.
  • Most changes in Richmond, however, occurred within demographic subgroups of the older adult population, as opposed to across the entire 50 and older population. For example, there were slight increases among women on key measures such as frequency of exercise and perceptions about how often someone their age should exercise.

Wave 3 (March 18 to June 1, 2003)

  • In Madison, significantly more older adults (71 percent) were exercising for 30 minutes a day at least three days per week than was the case prior to the campaign (64 percent), but still did not meet the target of five days per week. Madison adults were participating in community-based exercise events more.
  • The percentage of Richmond adults exercising for 30 minutes at least three days a week climbed steadily since the Active for Life pilot program was introduced in that city, climbing from 58 to 67 percent. Prior to the Active for Life project, just over one-quarter of Richmond's older adults were exercising at a moderate or vigorous level at least 30 minutes a day, five or more days a week. That figure rose to 38 percent at the end of Wave 3. These positive changes are driven largely by increasing physical activity among Richmond's older female population.
  • These findings were strengthened by the Wave 3 "stages of change" analysis, which showed a significant increase in the percentage of Richmond older adults "maintaining" a regular exercise program (45 percent in Wave 3 versus 33 percent in Wave 1).
  • Richmond's older adults were increasingly involved in community events for physical activity.
  • Despite these measurable behavioral and knowledge changes, the Active for Life project's print and broadcast ads appeared to have only a limited impact. Older residents in Madison and Richmond were no more likely than they were before the ads started running to say they remembered getting exercise information from print or television advertisements. When asked specifically about the Active for Life project's advertising, just 14 percent of Madison older adults remembered seeing the ads and could accurately recall images or messages contained in them. The figure for accurate recall was 15 percent in Richmond.
  • Overall, there was positive change in both Madison and Richmond one year into the campaign. Particularly compelling were apparent behavioral changes in the 50 and older populations in the two test cities. While these results suggested that "Active for Life" was having the desired impact, a critical question remaining was whether the program would have a lasting effect on the physical activity of older adults in these communities, or if the target populations would revert back to pre-campaign behavior once the pilot program concluded.

Wave 4 (March 16 to May 25, 2004)

  • When length of exercise session was combined with frequency, the percent of Madison older adults who knew they should exercise at least 30 minutes a day five or more days a week increased significantly over the course of the Active for Life project — from 17 percent in Wave 1 to 24 percent in Wave 4.
  • This pattern was not observed in Richmond. By Wave 4, two years after the launch of the Active for Life project in Richmond, results showed older adults' exercise behavior had largely returned to pre-campaign levels, as had participation in community-based exercise and fitness events.
  • In both cities, the percent who said vigorous exercise was very important for someone their age increased significantly over the past two years. Similar increases in the two control cities, however, suggested the positive movement was due at least in part to a national emphasis on exercise and fitness.
  • When asked to rate their knowledge and awareness regarding physical activity, respondents in both cities continued to say that while they knew a lot about the importance of regular exercise for someone their age, they were not always sure how to achieve this goal.
  • When asked how often they got physical exercise of any kind, 69 percent of Madison older adults said they exercised at least three days a week, up from 62 percent in Wave 1. When frequency was combined with intensity, 69 percent of all older adults in Madison reported getting moderate or vigorous exercise for 30 minutes at a time at least three days per week. Yet at the same time, participation rates in community-based exercise activities and events in Madison returned to pre-campaign levels.
  • The stages of change analysis for Richmond showed that in Wave 3, 45 percent of physically able adults age 50 and older were maintaining a regular exercise routine, a significant increase from the 33 percent in Wave 1. However, in Wave 4 the percentage of Richmond adults age 50 and older in the maintenance category dropped back down to 34 percent.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books

Be Active for Life Handbook. Washington: AARP, 2002.

Be Active for Life Guide — Madison. Washington: AARP, 2002.

Be Active for Life Guide — Richmond. Washington: AARP, 2002.

Active for Life Motivational Letters 4 week, 8 week and 12 week. Washington: AARP, 2002.

Implementation Manual. Washington: AARP, 2002.

Model Program Guide. Washington: AARP, 2002.

10K-A-Day Coordinator's Guide. Washington: AARP, 2002.

Reports

Fleishman-Hillard, Inc. Active for Life Media Report Overview. Washington, AARP, 2003.

Emery J and Crump C. Active for Life Pilot Campaign, Process Evaluation of the Environmental Component. Chapel Hill, N.C.: University of North Carolina at Chapel Hill School of Public Health, March 15, 2004.

Sutton Group. AFL Partnership Evaluations Wave 2 Findings. Washington: Sutton Group, April 8, 2004.

An Evaluation of the Effects of a Pilot Social Marketing Campaign in Madison, WI and Richmond, VA. Princeton, N.J.: Princeton Survey Research, Wave 1 and Wave 2, July 2003; Wave 3, September 2003; Wave 4, August 2004.

DeZern P. Richmond Active for Life: Sustainability Plan Narrative January — June 2004. Washington: AARP, 2004.

Bauer J. Madison Active for Life Sustainability Plan for 2004. Washington: AARP, 2004.

Keenan TA. Active for Life™: Summary of Research and Evaluation. Washington: AARP, August 2004.

Keenan TA. Health & Wellness Research, 2003: Active for Life™ Research. Washington: AARP, May 2004.

Keenan TA. Highlights from Walking Campaign Surveys: Madison. Washington: AARP, March 2004.

Keenan TA. Highlights from Walking Campaign Surveys: Richmond. Washington: AARP, February 2004.

Keenan TA. Synthesis of AARP Research in Physical Activity: 1999–2003. AARP, Washington: January 2004.

AARP and RoperASW. Exercise Attitudes and Behaviors: A Survey of Midlife and Older Adults. Washington: AARP, May 2002.

AARP and RoperASW. Exercise Attitudes and Behaviors: Results from Over-Samples among African-Americans and Hispanics. Washington: AARP, May 2002.

Survey Instruments

"AARP Pilot Survey on Physical Activity." RoperASW fielded October 22–November 11, 2001.

"AARP National Survey on Physical Activity." RoperASW, fielded March 17–April 28, 2002.

"Active for Life Survey: Wave One." Princeton Survey Research Associates, fielded March 12–May 7, 2002.

"Active for Life Survey: Wave Two." Princeton Survey Research Associates, fielded September 12–November 12, 2002.

"Active for Life Survey: Wave Three." Princeton Survey Research Associates, fielded March 18–June 1, 2003.

"AARP Baseline Survey on Walking." International Communications Research, fielded September 3–19, 2003.

"AARP Post-Campaign Survey on Walking." International Communications Research, fielded December 9–30, 2003.

"AARP Final Post-Campaign Survey on Walking." International Communications Research, fielded May 10–24, 2004.

"Active for Life Survey: Wave Four." Princeton Survey Research Associates, fielded March 16–May 25, 2004.

Presentations and Testimony

Teresa A. Keenan. Motivating Midlife and Older Adults to be Active for Life™. Presented at the 57th Annual Meeting of the Gerontological Society of America, Washington, November 20, 2004.

John Bauer and Teresa A. Keenan. It's as Easy as Walking: Highlights from a Walking Campaign in Two U.S. Cities. Symposium at the 6th World Congress on Aging and Physical Activity, London, Ontario, Canada, August 6, 2004. Proceedings available for purchase online.

Teresa A. Keenan. Physical Activity and Constraints in the Built Environment. Presented at the 6th World Congress on Aging and Physical Activity, London, Ontario, Canada, August 4, 2004. Proceedings available for purchase online.

John Bauer and Teresa A. Keenan. Walking, Who Knew? Highlights from a Walking Campaign in Two U.S. Cities. Presented at the National Congress of Pedestrian Advocates, Silver Spring, Maryland, May 8, 2004. Available online.

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Report prepared by: Nanci Healy
Reviewed by: Janet Heroux
Reviewed by: Molly McKaughan
Program Officer: Terry Bazzarre
Program Officer: Robin Mockenhaupt

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