Age UK's Fit as a Fiddle final evaluation webinar, Ecorys and Keele University, 16th January 2013, presentation

1. Evaluation of the fit as a fiddle portfolio Final
Report – Key Findings
Nicola Smith, Ecorys
Bernadette Bartlam & Julius Sim, University of
Keele

2. Introduction
• fit as a fiddle was a £15.1 million portfolio funded
by Big Lottery Fund and delivered across the 9
English regions from 2007
• fit as a fiddle aimed to “Increase the opportunities
for older people to undertake physical activities and
improve their eating habits, contributing to an overall
improvement in mental health.”
• fit as a fiddle comprised two national and 24
regional projects, delivered by over 200
organisations (99 of which were local Age UK’s/Age
Concerns)

3. Evaluation Methods
Longitudinal evaluation - qualitative and
quantitative methods:
•A paper based survey of older people across
three time points
.
•2,189 completed surveys
• 859 at start of involvement
• 816 at end of involvement
• 514 three months after involvement
•20 completed case studies
• One SROI case study

4. Evaluation Methods
• Web and paper based survey of project delivery
staff, regional co-ordinators, volunteers and
partners (221 responses)
• 11 Community evaluators
•38 filmed interviews with older people
• 20 qualitative interviews with national stakeholders
• Data analysis
•SNAP monitoring data
•Project outcomes and financial data
•End of project evaluation reports

5. Impacts on older people
Bernadette Bartlam & Julius Sim, Keele
University

6. Impacts on older people
20 project level case studies
38 in-depth interviews conducted by a team of
11 community evaluators
Survey:
• 2,189 self-completion surveys
• socio-demographic details
• general health and wellbeing
• limiting long-standing illness
• daily activities
• participation in the programme
• 881 participants
• 859 at start of involvement
• 816 at end
• 514 at least three months on
• 416 at all three timepoints

7. Who took part
• 665 women (75%) - average age 72
• 216 men (25%) - average age 71
• Ethnicity:
• White British (81%)
• Indian (4%)
• Black Caribbean (3%)
• 11 other ethnic groups
• Limiting long-standing illness: 46%
i.e. heart disease, diabetes, asthma,
emphysema, and arthritis.

8. Who took part: living
arrangements

9. Taking part
• 60% physical activity or exercise
• 35% healthy eating activity
• 2% volunteering or mentoring activity
• 3% stated 'other' activity

10. Impacts on Healthy Eating
• Targets exceeded:
• 178,521 older people eating more healthily
against an overall target of 155,836
• Activities included:
• Cookery courses promoting fresh ingredients
rather than using ready meals
• Smoothie making and fruit tastings
• Health promotion messages on '5 a day', portion
sizes, using alternative types of 'fat', keeping
hydrated, salt intake etc
• Gardening.

11. Changes in attitude
No. of
At the At the end responses at
start of fit of fit as a the 3 time
as a fiddle fiddle Follow-up points
Full sample:
I don’t think healthy eating is important
35 (4%) 32 (4%) 8 (2%)
for my health
I think … but I am not doing anything
154 (18%) 81 (9%) 23 (5%) 864, 866, 424
about it at the moment
I think … and I am doing something
675 (78%) 753 (78%) 393 (93%)
about it at the moment
Portions of fruit & vegetables eaten
No. of
At the At the end responses at
start of fit of fit as a the 3 time
Sample as a fiddle fiddle Follow-up points Significant?
Total 4 4 4 830, 838, 407 —
Restricted 4 4 4 384 Yes*
English average= 3.5 (men); 3.8 (women) Aresu M, Bécares L, Brage S, et
al (2009) Health Survey for England 2008: Physical activity and fitness. NHS
Information Centre for Health and Social Care

12. Portions of fruit & vegetables
eaten cont.

13. Come to tea at Haunton Hall
“One gentleman, who has no
conversation, came into the allotment
and said ‘green beans’ and then started
to say what was growing in the
allotment –
before that, he hardly said a word and
so we know now that he has an interest
and knowledge of gardening which we
didn’t know before”.
(Staff member)

14. Impacts on Physical Activity
• Significant change over the duration
• More people recognising the importance
• More people doing something about it
• Activities included:
• Walking, including nordic walking
• Swimming
• Aerobic exercise classes (aqua,
armchair etc)
• Gardening

15. Changes in attitude
No. of
At the At the end responses at
start of fit of fit as a the 3 time
as a fiddle fiddle Follow-up points
Full sample:
I don’t think physical activity is important for
my health 27 (3%) 25 (3%) 8 (2%)
I think … but I am not doing anything about
it at the moment 172 (20%) 86 (10%) 30 (7%) 856, 858, 421
I think … and I am doing something about
it at the moment 657 (77%) 747 (87%) 383 (91%)
Restricted sample:
I don’t think physical activity is important for
my health 14 (3%) 11 (3%) 7 (2%)
I think … but I am not doing anything about
it at the moment 73 (18%) 22 (5%) 30 (7%) 409*
I think … and I am doing something about
it at the moment 322 (79%) 376 (92%) 372 (91%)

16. Changes in behaviour
Median minutes of: walking, per day (blue
line); activity making breathe harder, per week
(green line); activity for strength and
endurance, per week (pink line)

17. Impact
“It's things like climbing the stairs, I've got one flight of
stairs, normally by the time I get to the top I’m knocked
out, you know, I have to stop and have a rest.
Now I’m managing to get up the stairs and walk to my
room without a rest…
Recently I went out to Portugal and the place we went
to was quite hilly… I was finding I was managing the
hills a lot better than I would have been perhaps 18
months to two years ago, so the benefits are there.”
(Participant: Older Men project at Springbok Farm
Estate)

18. Impact cont.
“I had had two hip replacements and a complete
shoulder replacement. My mobility, stamina and
confidence were poor…
I can now swim both breast stroke and crawl again,
can complete an hour’s exercise in the water… I really
enjoy myself and have made friends and now bring
two more ladies to the sessions.
All this has made a great difference to my life, I can
now walk anywhere including uneven ground, manage
steps, stairs, run and dance; I recommend exercise
swimming to everyone.”
(Female participant, Fit as a Fish project Devon)

19. Impacts on Mental Health
Health is more than absence of ill-health -
related to four items:
1. Health and functioning
2. Existence of relationships and social
support
3. Material circumstances
4. Opportunities for personal growth and
development
Higgs, P., Hyde, M., Wiggins, R. & Blane, D. (2003). Researching quality of life
in early old age: the importance of the sociological dimension. Social Policy
and Administration, 37, 239–252.

20. Complex relationship…
“In fact, I think that's the biggest impact it has really, you
see the people coming in and they always say things like 'I
am so glad I came to this group' and 'I haven't been going
out'… You see them starting to make friends and it’s just
fantastic." (Case Study East Midlands)
“Also the fact that it's a social thing, you know, it's something
that somebody can attend on a social level with other
participants also helps to alleviate any, perhaps, negative
feelings, feelings of isolation and so on and I've got evidence of
this through letters and testaments and so on.” (Project
Coordinator)

21. Warwick Mental Health Scale
No. of
responses at
At the start of At the end of the 3 time Signific-
Sample fit as a fiddle fit as a fiddle Follow-up points ant?
Total 33.51 34.97 36.16 754, 770, 391 —
Restricted 33.53 35.07 36.25 337 Yes*
Significant increase in mental wellbeing
across the duration of the programme and
also between the beginning of the
programme and follow-up

22. Satisfaction with life
No. of
responses at
At the start of At the end of the 3 time Signific-
Sample fit as a fiddle fit as a fiddle Follow-up points ant?
Total
7.26 7.62 8.06 827, 826, 403 —
Restricted
7.28 7.66 8.08 374 Yes*
Significant positive increase across the
duration and between the beginning of and
follow-up stage

23. Impacts on Mental Health
Control and autonomy: frequent examples of older people being
consulted about the type of activities projects would offer & how they
would be structured. Taking part in the activities clearly gave people a
sense of being better able to deal with – and indeed at times
overcome – impairments related to their health or mobility.
Meaning and purpose: reports throughout of participants feeling
valued and contributing to their communities in ways that had not
previously been available to them, e.g. healthy eating initiatives
encouraging participants to grow produce that their communities then
used. Participation gave many people a meaning-making structure to
their daily lives that had previously been missing.
Pleasure: participants spoke frequently of how much enjoyment they
got from participation, from a general improved sense of wellbeing,
through to making new friends and experiencing increased self-
esteem and confidence.

24. Impact: the example of Ella
Ella is 88 and has lived in Cranfield, a sheltered housing
complex, for 35 years; she doesn’t participate in any
activities outside the complex. Ella and other residents took
part in armchair exercise classes based on site, which were
therefore easy to access. For other activities, such as
swimming, which were offered off site and which she would
have considered joining in, she was unable to participate
because of a lack of appropriate transport. As Ella put it "I
can’t really get on the bus because if I get on, I can't get off".
"Now we chat away like we are bosom pals"
"I go shopping into town with the other girls.“
The classes have resulted in making Monday "a special day
and have provided me with an extension of my life."

25. Cascade effect…
Participants:
Frequent reports of bringing friends along, encouraging
others to take part, disseminating information
Staff:
Increased sense of professionalism, support, and
achievement
Ella has a partner of 86 who suffers from
osteoporosis. At home she encourages him
to try some of the exercises. The exercise
class leader produces a written outline of
the exercises so that participants are very
clear about what they are doing in each
class. Ella finds this very helpful on the day
but it also acts as a memory aid for
practising between sessions, and as a tool
to help her explain the exercises correctly to
her partner.

26. Nicola Smith, Ecorys
Wider impacts of the programme

27. Partnership Working
"All partners, whether from the statutory, community or
voluntary sector have brought enthusiasm, commitment,
energy and ideas. All partners… have given contribution "in
kind" to help [us] continue." (Project and partner survey
feedback)
48% project co-ordinators worked with other organisations
97% of projects felt partnerships were effective
Impact of partnership working
• Engaging target groups e.g. BME, frail older people and
older men
• Boosting project reach – extending capacity
• Delivering new activities
• Avoiding duplication
Challenges
• Funding cuts to statutory services
• Staff turnover in partner organisations
• Communication with partners

28. Equality and Diversity
"It's important to think creatively about how you might
deliver something, sometimes you might make certain
risks and see what might happen.” (Project staff)
• Key target groups - older men, Black Minority
Ethnic groups and frail / isolated older people
• Mix of specifically targeted projects and
outreach work by partners
• Activities for target groups need to be
appropriate to ensure participation
• above national average levels of engagement by
some ethnic groups
• Men 2 Mentor engaged men with targeted
activities e.g. men only keep fit and golf

29. Equality and Diversity
• National cascade project worked with a range of
faith and community groups to engage them in
activities and reached 5,532 older people
• Effective approaches working with BME groups
included
• Men and women only sessions
• Using translators
• Using local community venues and volunteers
• Intergenerational work
• Working in care homes and sheltered
accommodation to attract frail elderly people, chair
based exercises
• Come to Tea and Life and Soul project

30. Health Literacy
• 808,060 educational resources distributed to
older people
• 168,357 Blood Pressure Association leaflets
• 100 older men’s leaflets
• 50 Equalities and Human Rights Guides
• Promotional material including t shirts, ‘stress
relieving’ fruit, recipe books, DVDs and
newsletters
• Case study of health literacy materials in care
homes
• 95% rated very or fairly useful
• Promoted the portfolio and raised
awareness of the programme
• Raised awareness of healthy eating

31. Tackling Obesity Age Concern Kingston
Project Aim: To tackle obesity through
physical activity and promotion of a
healthier lifestyle
•Ten 6 week courses attracting 166 older people in
activities such as Nordic Walking, Keep Fit and
Bollywood dancing
•88% of participants taking part in moderate exercise 3-
5 times a week
•Social Return on Investment (SROI) analysis suggests
an approximate social return on investment generated
by the project of £3.50 for every £1 invested
•Generated through reductions in use of GP services,
treatment for falls related incidents and reductions in
unpaid informal care

32. Sustainability
“Some parts are likely to continue with local
PCTs or social services covering some costs.
Also where volunteers are used it is hoped
they will continue.” (Project coordinator)
• Projects being effective in planning for the
continuation of their activities
• A third of projects expected to continue some
form of fit as a fiddle activity
• Projects likely to continue are to be scaled
down
• Statutory bodies and volunteers will play a
role in continuing sustained activity
• Greater focus on sustaining physical activities

33. Models of Sustainability
• External follow on or continuation funding
• Internal of core funding models
• Fee paying models
• Volunteer led models of sustainability
• Constituted groups
• Instructor packs
• Continuation with no funding

34. Conclusions and recommendations
• fit as a fiddle widely viewed as a success achieving
national recognition and offering a unique service to
older people
• fit as a fiddle identified by Age Action Alliance as a
model for delivering healthy ageing services
• fit as a fiddle achieved positive outcomes for older
people and clear impacts on healthy eating, physical
and mental wellbeing
• fit as a fiddle achieved positive outcomes on
volunteers and volunteering capacity
• Cost per participant ranged from £36.56 to £408.12