Effects of Active Learning Education on Arterial Stiffness of Older Adults with Low Health Literacy: A Randomized Controlled Trial

Aim: We examined the effects of active learning education on arterial stiffness and physical activity of community-dwelling older adults with low health literacy. Methods: This study is a secondary analysis of randomized controlled trial of 60 participants aged 65 and older with low health literacy. The intervention group (n = 30) participated in a weekly 90-minute active learning program session for 24 weeks, which addressed health promotion in older age. The control group (n = 30) attended a 90-minute health education class in a didactic manner. The outcomes were measured at baseline and in week 24. The degree of arterial stiffness was assessed based on the cardio-ankle vascular index (CAVI) using the VS-1500 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). The shortened version of the self-reported International Physical Activity Questionnaire was used to assess the amount of total physical activity determined by the metabolic equivalent hours per week. We used analysis by intention-to-treat, with multiple imputation for missing data. Results: Seven participants (11.7%) dropped out prior to the post-intervention assessment. The multiple imputation analysis revealed that the intervention group showed significant improvement in CAVI [between-groups difference (95% confidence interval) = -0.78 (-1.25 to -0.31), Cohen's d = 0.82] and physical activity [32.5 (0.3 to 64.7), Cohen's d = 0.57] as compared with the control group. The sensitivity analysis for the complete cases showed similar results. Conclusion: Active learning health education may be effective in improving arterial stiffness and physical activity in older adults with low health literacy.