Bridging the gap towards a healthy lifestyle for community-dwelling older adults: The implementation of the lifestyle intervention ProMuscle

As we get older, our muscle strength declines. Too much decline can have major consequences for physical independence, health, and quality of life. A healthy lifestyle can help prevent this excessive decline.
ProMuscle is a lifestyle intervention that focuses on improving muscle strength by combining resistance exercise training with a protein-enriched diet. Research has shown that ProMuscle is effective in improving muscle strength and physical functioning in older adults. However, lifestyle interventions like ProMuscle are still only offered to a limited extent by healthcare professionals. This is not because the intervention does not work, but because implementing an intervention in daily practice is often complex.
This reflects the broader challenge of translating research into practice, often referred to as the research-to-practice gap. This thesis aimed to bridge this gap by investigating implementation strategies to successfully implement ProMuscle in multiple community care settings in the Foodvalley region. A systematic, theory-driven approach was applied in codesign with relevant stakeholders throughout the process.
First, barriers and facilitators for implementing combined lifestyle interventions were identified from literature and with healthcare professionals and older adults. Key factors included collaboration with external organizations, patient needs, readiness for implementation, costs, knowledge and beliefs about the intervention, and internal network. Based on these insights, an Implementation Strategy Bundle (ISB) was developed in codesign with healthcare professionals and implementation experts. Subsequently, the strategies were operationalized into practical activities and integrated into a web-based implementation toolbox to support professionals with the implementation.
A pilot study showed that the ISB is an acceptable and feasible way to address the pre-identified barriers. Low recruitment rates and a long start-up were barriers that surfaced during the study and were taken into account for the larger trial.
A hybrid type-III stepped-wedge randomized cluster implementation effectiveness trial was conducted, involving 27 HCPs, to evaluate the impact of the ISB on the adoption of ProMuscle by HCPs across multiple community care settings. The results showed no statistically significant improvement in the mean adoption of ProMuscle. Remarkable results such as the limited reach, and significant decline of acceptability of ProMuscle over time suggest that other factors may have influenced the adoption of ProMuscle.
Therefore, a process evaluation was conducted. Based on interviews with 25 professionals, describing a Causal Pathway Diagram revealed that several factors, on individual as well as on organizational and system level, moderated the influence of the ISB on the adoption, reach, and fidelity of ProMuscle. Factors such as collaboration, available resources, financing, and policy support play a crucial role, which could not be effectively addressed by individual professionals.
Lastly, an assessment of the scalability of ProMuscle indicated that ProMuscle has strong potential for wider implementation. However, successful scale-up requires a supportive infrastructure, alignment with healthcare systems, and structural embedding in policy and funding mechanisms.
Overall, the PUMP-fit study shows that lifestyle interventions can only reach their full potential when healthcare, policy, research, and practice work together. Only then can they contribute to healthy ageing, reduce pressure on healthcare systems, and make prevention more accessible.