The Development and Implementation of a Peer-Led Diet and Exercise Intervention in Older Urban Dwelling Veterans with Dysmobility

在接下来的十年里，65岁以上的退伍军人占退伍军人总数的比例将增加到50%以上 人口。随着年龄的增长，安全地保持机动性的能力至关重要。患有多发性慢性病的老年退伍军人 健康状况更有可能经历流动性下降，我们的初步数据显示，他们也有 与年长的非退伍军人相比，饮食质量下降。他们进一步报告说，他们减少的体力 运动和糟糕的饮食质量与缺乏锻炼设施、不良习惯和缺乏 动力或无聊。虽然许多干预措施试图解决不良的饮食和身体状况 老年人缺乏活动；大多数人使用了资源密集型的专业主导的饮食或运动干预措施， 很少有人关注年长退伍军人的独特需求。同行支持提供潜在的低成本、轻松 可扩展的方法，鼓励长期的饮食和体力活动改变。 在这项建议中，我们寻求开发和试点为期12周的以老年人为目标的同伴主导的生活方式干预 退伍军人有多种慢性健康状况和运动障碍，在两个不同的城市地区有很高的 代表不足的少数族裔退伍军人的百分比(马里兰州巴尔的摩和德克萨斯州圣安东尼奥)。我们会 通过两个具体目标来实现这一点。目标1：发展理论驱动、同行主导的营养和锻炼 为患有运动障碍的老年退伍军人量身定做的干预措施。目标2：确定以下项目的可行性和可接受性 同伴主导的干预，以评估覆盖范围(招聘、保留)、采用(满意度、感知效用、 出席率、参与度)和执行情况(干预的保真度)；以及估计的规模和 对20岁以上患有运动障碍的老年退伍军人的选定结局(即饮食质量和活动能力)的潜在影响 和多种慢性健康状况(N=10个/站点)。我们来自Aim 2的结果将与Gerofit数据进行比较，以 确定项目的长期潜力。随着这种干预措施的成功开发和试点，我们 将定位于提交多站点康复和研发(RR&D)奖励申请 重点是使用同伴主导的干预措施，以改善老年人对生活方式干预的长期依从性 患有多种慢性病的退伍军人。

Over the next ten years the share of Veterans age 65+ years will increase to over 50% of the total Veteran population. The ability to safely maintain mobility with aging is critical. Older Veterans with multiple chronic health conditions are more likely to experience mobility decline and our preliminary data show they also have decreased diet quality when compared to older non-Veterans. They further report that their reduced physical activity and poor dietary quality are related to a lack of access to exercise facilities, poor habits, and lack of motivation or boredom. While a multitude of interventions have attempted to address poor diet and physical inactivity in older adult; most have utilized resource-intensive professionally led diet OR exercise interventions, and few have focused on the unique needs of older Veterans. Peer support offers a potentially low-cost, easily scalable approach to encourage long-term dietary and physical activity change. In this proposal we seek to develop and pilot a 12-week peer-led lifestyle intervention that targets older Veterans with multiple chronic health conditions and dysmobility, in two diverse urban areas with a high percentage of underrepresented minority Veteran populations (Baltimore, MD and San Antonio, TX). We will accomplish this through two specific aims. Aim 1: Develop a theory-driven, peer-led nutrition and exercise intervention tailored for older Veterans with dysmobility. Aim 2: Determine the feasibility and acceptability of the peer-led intervention, to asses reach (recruitment, retention), adoption (satisfaction, perceived utility, attendance, engagement) and implementation (fidelity of intervention); as well as the estimated magnitude and potential impact on selected outcomes (i.e diet quality and mobility) in older 20 older Veterans with dysmobility and multiple chronic health conditions (N=10/site). Our results from Aim 2 will be compared to Gerofit data to determine long term potential of the project. With the successful development and pilot of this intervention we will be positioned to submit a multisite Rehabilitation and Research and Development (RR&D) Merit application focused on the use of peer-led interventions to improve long-term compliance to lifestyle intervention in older Veterans with multiple chronic conditions.