The START trial: a proof-of-concept sedentary reduction program for prefrail older adults

START 试验：针对体弱老年人的概念验证减少久坐计划

• 批准号: 10429646
• 负责人: Amal Asiri Wanigatunga
• 金额: $ 13.01万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10429646
• 关键词: Accelerometer; Address; Adult; Age; Aging; American; Anxiety; Award; Behavior; Biological; Biological Markers; Biology; Biometry; Clinical Research; Clinical Trials; Communities; Competence; Conduct Clinical Trials; Data; Development Plans; Dose; Effectiveness; Elderly; Epidemiology; Exercise; Faculty; Fatigue; Geriatrics; Goals; Guidelines; Habits; Health; Health behavior; Incidence; Inflammation; Infrastructure; Institutes; Interleukin-6; Intervention; Link; Measurement; Measures; Mentored Research Scientist Development Award; Mentors; Moods; Outcome; Pain; Pathway interactions; Patient Outcomes Assessments; Physical activity; Pilot Projects; Population; Psychology; Public Health; Randomized; Records; Research; Research Personnel; Risk; Self Efficacy; Serum; Stress; Structure; Syndrome; TNF gene; Teacher Professional Development; Testing; Time; Translational Research; Universities; Walking; age related; base; career development; combat; design; effectiveness evaluation; frailty; human old age (65+); improved; inflammatory marker; meetings; member; novel; pre-clinical; prevent; primary outcome; programs; psychosocial; receptor; response; secondary outcome; sedentary; sedentary lifestyle; therapy design

PROJECT SUMMARY Frailty is a syndromic state of vulnerability that puts adults aged ≥65 years at heightened risk of adverse health outcomes. An estimated 50% of older Americans are prefrail—a pre-clinical stage of frailty that might be more amenable to intervention efforts than frailty. Increasing physical activity is a promising intervention to better manage/help reverse the multisystem dysregulation that drives frailty and sequalae. However, initiating and maintaining habitual physical activity is difficult for sedentary older adults, particularly those encumbered by health challenges. The 2018 US Physical Activity Guidelines recommends that all adults perform ≥150 minutes/week of physical activity and reduce sedentary behaviors. Yet, traditional approaches to increase physical activity do little to address sedentary behavior reduction, especially for older adults. Lower sedentary behavior is associated with improved biological and psychosocial health—independent of meeting physical activity guidelines. Thus, there remains a critical need to implement and evaluate a structured way to reduce sedentary behavior as a potential pathway for habitual physical activity engagement. Using novel objectively measured physical activity metrics, our research group has shown that daily sedentary time, either in total or accrued in a prolonged manner, is associated with frailty. Our observation evidence shows that: 1) daily, non- exercise physical activity declines and becomes more fragmented with age (less continuous activity with longer sedentary bouts), 2) higher daily sedentary time and activity fragmentation are both associated with higher frailty incidence, and 3) sedentary time is positively associated with frailty-related markers of inflammation. We propose a pilot study in which we randomize 60 prefrail community-dwelling older adults to receive one of two interventions, each designed to gradually reduce sedentary time: 1) continuously to form a 30-minute walking bout, or 2) in a bouted manner to form three 10-minute walking bouts. Project goals are to: a) explore the effectiveness within and between interventions to decrease objectively measured sedentary time over 2 months; b) assess decreased sedentary time’s association with i) patient-reported outcomes and ii) frailty- related inflammatory markers. The primary outcome is accelerometer-determined sedentary time. Secondary outcomes include activity fragmentation, patient-reported outcomes, and inflammatory markers. With a transdisciplinary mentoring panel, my career development plan builds on my expertise in aging and physical activity epidemiology to gain proficiency in: 1) developing and implementing clinical trials for older adults, 2) designing interventions to improve health behaviors, 3) conducting frailty and inflammation related research and 4) gaining competencies to become an effective PI and leader. This project utilizes the infrastructure of the Johns Hopkins Institute for Clinical and Translational Research (ICTR) and Beacham Center for Geriatric Medicine which have strong records of supporting early-stage faculty. This award will facilitate my transition to an independent investigator and will also provide informative data for R21 and R01 applications.

项目摘要 脆弱是一种脆弱性综合症，使年龄≥​​65岁的成年人以不良健康的风险增加 结果。估计有50％的年长美国人是前养生的，这是一个临床前脆弱的阶段，可能会更多 可以比脆弱的干预工作。增强体育锻炼是一种更好的干预措施 管理/帮助扭转驱动脆弱和序列的多系统失调。但是，启动和 久坐的老年人很难保持习惯性体育锻炼，尤其是由 健康挑战。 2018年美国体育活动指南建议所有成年人的表现≥150 分钟/周的体育锻炼并减少久坐行为。但是，传统的方法增加 体育锻炼对减少久坐行为的影响无济于事，尤其是对于老年人而言。下久的久坐 行为与改善的生物学和社会心理健康有关 - 独立于身体 活动指南。这仍然是实施和评估减少结构化方法的迫切需求 久坐行为是习惯性身体活动参与的潜在途径。客观地使用小说 测量的体育活动指标，我们的研究小组表明，每天的久坐时间，无论是总数还是 延长的方式与脆弱有关。我们的观察证据表明：1）每天，非 - 进行体育锻炼会下降，并随着年龄的增长而变得更加分散（较少的连续活动与更长的时间） 久坐的回合），2）较高的每日久坐时间和活性碎片都与较高的 脆弱的事件和3）久坐时间与炎症相关的脆弱标记呈正相关。我们 提案一项试点研究，我们将60个预冰路社区的老年人随机进行，以接收两个 干预措施，每个设计旨在逐渐减少久坐时间：1）连续形成30分钟的步行 回合，或2）以繁琐的方式形成三个10分钟的步行。项目目标是：a）探索 干预措施内和之间的有效性，以减少2个以上的客观测量的久坐时间 月份； b）评估减少了久坐时间与i）患者报告的结局，ii）脆弱 - 相关的炎症标记。主要结果是加速度计确定的久坐时间。次要 结果包括活动碎片，患者报告的结果和炎症标记。与 跨学科指导小组，我的职业发展计划基于我在衰老和身体方面的专业知识 活动流行病学以获得：1）为老年人开发和实施临床试验，2） 设计干预措施以改善健康行为，3）进行脆弱和炎症相关的研究 4）获得成为有效的PI和领导者的能力。该项目利用 约翰·霍普金斯（Johns Hopkins）临床与翻译研究所（ICTR）和比奇姆老年中心 具有支持早期教师的有力记录的医学。该奖项将有助于我过渡到 独立研究者，还将为R21和R01应用程序提供信息性数据。