The sustainability of a trauma- and violence-informed physical activity program for women experiencing interpersonal and structural violence

Background Women experiencing interpersonal and structural violence face significant barriers to physical activity, despite its well-established health benefits. To address these inequities, a Trauma- and Violence- Informed Physical Activity (TVIPA) program was co-designed and implemented in community sites across Canada to create accessible, safe, and culturally relevant opportunities for participation. The present study examines whether TVIPA can be implemented with fidelity and sustained under real‑world conditions once responsibility for delivery transitions from the research team to local providers. Methods We conducted a 12-month mixed methods study across three community sites, combining fidelity assessments and attendance data with qualitative interviews from program staff and organizational leaders. Fidelity was measured at four time points using a standardized checklist, while interviews explored factors influencing maintenance and sustainability. Data were analyzed using descriptive statistics and thematic analysis. Results Implementation fidelity was high across sites, with scores ranging from 68% to 100% and an overall median of 91%. Mean session attendance was 7.6 participants per session. Qualitative analysis of 10 interviews identified five themes influencing maintenance and sustainability. Continued program delivery was supported by strong organizational leadership and capacity-building from the prior implementation year. Implementation was shaped by relational stability, particularly continuity of the exercise facilitator, and by structural flexibility that allowed sites to adapt delivery without compromising core TVIPA principles. Sustainability concerns were prominent; sites emphasized the need for dedicated program management roles to avoid the instability associated with time‑limited, grant‑dependent programming. Conclusion Community-led delivery of TVIPA programming is feasible but requires intentional strategies to support fidelity, maintenance and and long-term sustainability. Embedding sustainability planning, dedicated staffing, and continued collaboration between community sites and research teams is essential to maintain program fidelity, responsiveness, and impact over time.