A new program offered at Nova Scotia YMCAs and developed with researchers at Dalhousie and Acadia universities aims to help aging adults use the proven benefits of exercise to manage chronic disease.
LiveWell is delivered by qualified exercise professionals who personalize programming to a range of participants across the disease and ability spectrum, with the goal of building strength, balance, and overall fitness. Though self-referrals and walk-ins are permitted, health-care professionals are encouraged to refer patients to the program.
With Nova Scotia’s aging population, the need for a community-based program for people managing chronic conditions has become increasingly important. Having seen the success of a similar program developed in Ontario, the YMCA's regional head advocated for the development of a similar program in Nova Scotia.
Scott Logan, a consultant and Dalhousie kinesiology graduate, leads LiveWell's team of researchers from Dalhousie’s Faculties of Health and Medicine and Acadia. The program was designed using significant learnings from Acadia’s Active for Life initiative — a 10-week program that helps older adults improve their fitness, balance, coordination, flexibility, strength and power through group exercise and lifestyle classes.
Bridging the gap
Jonathan Fowles, a professor of kinesiology at Acadia, has been working to develop the Active for Life program in collaboration with Nova Scotia Health and various chronic disease programs for a decade. He says a key aspect of the program is to provide solutions that ‘bridge the gap’ from acute health care to community wellness programming. It also seeks to address safety concerns related to the medical condition of older adults who are active. He hopes that the advanced training received by the personnel managing the program will encourage more referrals.
“To have a referral avenue for health care professionals to a community program for people with medical conditions delivered by a qualified exercise professional is something I am quite passionate about supporting. I am very happy that the YMCA has adopted our ‘Active for Life’ program model," says Dr. Fowles.
Under the Active for Life framework, a clinical exercise physiologist (CEP) who has specific training in assessing and prescribing exercise for people with chronic conditions, acts as a ‘navigator’ who receives referrals from healthcare providers and from the community. The CEP screens participants, and then designs and delivers evidence-based, safe, and effective exercise programming.
This approach is shown to build trust with the healthcare providers and the patients. Research by Dr. Fowles and his team show the model is effective and have received funding from the Department of Health and Wellness to further its develolment in Nova Scotia.
From pilot to permanent programming
The LiveWell program was initiated at both the Halifax and Bridgewater YMCA in April and is nearing the end of a 12-week pilot. With funding support from the Nova Scotia Department of Communities, Culture, Tourism and Heritage, Logan is eager to move beyond the Halifax/Bridgewater pilots and initiate permanent LiveWell programming at additional YMCA locations in Pictou and Amherst as early as this summer. The YMCA of Cape Breton will be following in the fall.
As expansion and reach continues, Logan hopes the trust of healthcare providers will be earned and increase their referrals to the program.
“It’s important for healthcare providers to know we’ve retained staff trained to assess and monitor patients and make sure they’re not at risk and that they’re safely progressing to improved, functional health,” he says. “We need to demonstrate to healthcare providers that when they refer someone, they are sending them to a qualified exercise professional that they can trust, is insured, and is trained specifically in clinical conditions and how deal with them.”
Logan says knowing that exercise is a proven benefit to both preventing and managing chronic conditions is the easy part. His team is trying to look beyond that body of evidence at the factors around participation and long-term retention.
“As someone like Dr. Robert Strang would say to me, Minimize readmissions to hospitals or minimize reoccurrence,” he says. “So that's where we want to go. Exercise can do those things, but if we don't have people in the right programs for extended periods, we won't achieve those broader goals.”
The team will be studying the program for three years with a goal of determining what makes people understand the benefits and make a commitment to exercise when they have so many competing priorities.
Olga Theou, a Canada Research Chair in Physical Activity, Mobility, and Health Aging and assistant professor in Physiotherapy and Geriatric Medicine at Dal, recently received a grant from Research Nova Scotia to complete an in-depth evaluation of an exercise program with a similar format focused on older adults with some level of frailty.
Dr. Theou has been involved in the design of the LiveWell program and will continue to advise at all stages.
“We all need to be more active but there is no one size fits all solution,” she says. “The most effective physical activity program is the one that people will stick to.”
Access and expansion
If all goes well, LiveWell will be expanded beyond the five Nova Scotia YMCA “hubs” and will be offered in numerous YMCA outreach communities to ensure accessibility for all those interested in participating. The program team is also eager to address health inequities and the needs of marginalized groups, and will engage with African Nova Scotians, Indigenous, and LGBTQ+ communities, who don’t typically access these types of services and encourage their participation in this program and others.
In future, Logan sees the program expanding even further, into what he calls prevention and ‘prehab.’
“LiveWell is focused on managing chronic conditions or what is called secondary prevention,” says Scott. “But as this grows, we have committed to looking at more primary prevention programming, so that further upstream we are helping develop healthy exercise habits with children, youth, new mothers and other specific populations.”
For now, older adults and their healthcare providers are encouraged to get involved. LiveWell’s physical activity programming can be adapted to almost everyone, regardless of previous experience, fitness level, or ability. And as Dr. Melanie Keats, Kinesiology Division Head in Dalhousie’s School of Health and Human Performance and program consultant says, “Most of us can benefit from being more physically active or more simply, just moving more.”