# Feasibility of scaling-up an evidence-based physical activity behaviour change intervention into routine ambulatory hospital care: a retrospective implementation evaluation using the RE-AIM framework

## TL;DR

This study evaluated the feasibility of scaling a physical activity program from one to five rural hospitals, finding it promising but limited by recruitment and funding.

## Contribution

The study provides insights into the challenges and successes of scaling an evidence-based physical activity intervention in rural hospital settings.

## Key findings

- Physical activity increased significantly from 460 to 840 MET-mins/week among participants.
- Sedentary behavior decreased from 8.0 to 7.0 hours/day, and vegetable intake improved.
- Program implementation was successful in five rural hospitals but was limited by short recruitment and lack of funding.

## Abstract

Scaling up evidence-based interventions to improve physical activity (PA) is important for enhancing health outcomes. The Healthy4U (H4U) program, initially successful in improving PA and health outcomes among ambulatory hospital patients, was expanded from one regional hospital to five rural hospitals. This study retrospectively examines the feasibility of implementing H4U at Scale (H4U-AS) over 12 months.

A feasibility implementation evaluation was conducted retrospectively using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The following variables were assessed within each RE-AIM domain: Reach: Number of program participants. Effectiveness: Measured changes in PA (Metabolic Equivalent of Task minutes (MET-mins/week)), sedentary behaviour (hours/day spent seated), fruit and vegetable intake (serves/day), and nicotine dependence score (Fagerström Test for Nicotine Dependence (FTND)) using paired t-tests or Wilcoxon signed-rank tests. Adoption: Type of setting, program integration, and behaviour change training uptake. Implementation: Participant and hospital recruitment adherence. Maintenance: Continuation of the program.

Reach: In total, 37 participants were recruited during the 6-month recruitment period; pre- and post-data were available for 33. Effectiveness: PA increased from a median of 460 MET-mins/week to 840 (p < 0.001). Sedentary behaviour decreased from 8.0 h/day to 7.0 (p < 0.001). Vegetable intake increased from 3.0 serves/day to 3.5 (p = 0.001). Fruit intake did not change significantly (p = 0.228). Nicotine dependence decreased non-significantly from 5.0 to 4.5 (p = 0.08). Adoption: The program was successfully implemented in five rural hospitals; feedback from hospital representatives indicated that recruitment procedures were integrated into existing hospital workflows. To support recruitment, processes were adapted to include mailing out invites to people on elective surgery wait lists. Implementation: 86% of participants completed the minimum 4 of 6 available sessions, and all hospitals recruited during the program period. Maintenance: Funding for the project was not available beyond the 12-month period. As a result, recruitment into the program was ceased.

H4U-AS suggests that implementing an evidence-based PA intervention from one regional hospital to five rural hospitals may be feasible. Participants improved PA and dietary behaviours. However, limited participant recruitment during the short recruitment period, and funding cessation, impacted the extent to which the program could be offered and evaluated at scale.

The online version contains supplementary material available at 10.1186/s12889-025-23614-2.