Eat Better & Move More (EBMM) was designed for the Older Americans Act Nutrition Program, the USA’s largest nutrition assistance program for older adults, as a means to Promote health, decrease malnutrition, and prevent physical/mental deterioration¹. The Nutrition Program targets those in greatest social or economic need, particularly poor minorities and those in rural areas. It annually provides ~250 million meals to 3 million adults age 60+ at 4,000 local agencies.

The Eat Better & Move More Guidebook for Community Programs

(http://nutritionandaging.fiu.edu/You_Can/07.2YouCanGuide book.pdf) has 12 weekly sessions with nutrition and physical activity mini-talks and interactive activities. Due to its popularity, a Guidebook Part 2 is now online. Emphasizing fruits, vegetables, calcium-rich foods, and dietary fiber, EBMM addresses serious deficiencies and portion sizes. Also emphasized are walking, using step counters, simple stretches, and hydration. People take home Tips & Tasks sheets to fill in and bring the next week.

In our study², we chose 10 community sites that had no physical activity programming and could recruit 50+ people and collect/submit data. Grantees ($10,000) included congregate dining centers, neighborhood recreation centers, and housing complexes in urban inner city, suburban, and rural sites, and a Native American reservation. Each facilitator (8 dietitians, 1 nurse, 1 Native manager) attended a 1.5-day workshop and our Center provided technical assistance via biweekly conference calls and a listserv. A total of 999 were enrolled. Inclusion criteria were age 60+ and the ability to walk with/without assistive devices. Discretion was given to exclude those with cognition problems. The nutrition and activity questionnaires had a ‘Stage of Change’ question.

Results

Completers numbered 620 (62%). Completion rates differed by site (35-85%), but not ethnicity. The lowest completion rate at a subsidized high-rise housing site had the highest mean nutrition risk score. Those residents often have greater needs than those in traditional community housing. Completers’ mean age was 75 years. The oldest was 101 (5 were in their 90s; 162, in their 80s); 82%, females; 41%, minorities. Half lived with family and 38% with a spouse. They had fewer health conditions and lower nutrition risk, but were otherwise similar to non-completers.

About 3 in 4 completers not in maintenance stage preintervention significantly advanced >1 ‘Stages of Change’ for both nutrition and activity. Daily food intakes increased significantly by >1 serving of vegetables for 37%; fruits, 31%; fiber, 33%; calcium-rich food, 42%; fluids, 31%. Daily steps increased 35% to ~4200. Blocks walked and stairs climbed increased. Timed Up & Go improved as risk of falling decreased. Of the 94% not reporting excellent health pre-intervention, 24% improved >1 health categories. Self-rated health can predict functional abilities and mortality in the community-dwelling. Almost all recommended the program and 93% and 90% said it helped them Eat Better and Move More respectively. Facilitators’ salary was the main expense due to the focus on documenting outcomes.

Implications

Characteristics of successful nutrition education programs commonly limit messages to 1 or 2; reinforce and personalize messages; provide hands-on activities and access to health professionals³. Each EBMM nutrition message was introduced 1 week and reinforced the next. Tips & Task sheets visually reinforced goals and gave more food choices. Weekly sessions were interactive, used real foods, labels, and Program meals, and were led by culturally sensitive health workers, who could answer questions beyond the intervention’s scope. Personalized step goals and self-pacing likely improved outcomes. Overall, EBMM was successful because it was easy to use, inexpensive, tailored for older adults, while simultaneously geared to changing both nutrition and activity behaviors. Another success factor was hands-on coordination by the Center.

We and other translational researchers believe that nutrition education is enhanced by integrating activity. We encourage use of our 2 Guidebooks and interdisciplinary collaboration. As community-residing older adults often need extra encouragement to Eat Better and Move More, more communities should encourage healthy aging by offering similar programs.