Expanding Exercise Programming for Veterans Through Telehealth

背景：锻炼是管理慢性病的一种循证干预，但 大多数退伍军人都不活跃。团体远程健康(GT)提供的锻炼可能会改善获得 和参加体育锻炼。GT锻炼课程可以通过提供社交活动来增加锻炼参与度 支持，但需要更好地了解这一格式的可行性和可接受性。远程医疗 交付的演习计划应设计为启动和维护阶段，但没有 就提供运动维持干预措施的战略达成共识。锻炼的技巧 启动和维护是不同的，专注于其中之一的干预不太可能导致 持续的运动参与。 意义/影响：由于退伍军人健康管理局是美国最大的综合医疗保健系统 在美国，实施成功的锻炼计划可能会对公共健康产生深远的影响。全国 包括远程保健和获得护理以及慢性病管理在内的优先事项 通过制定GT运动启动和维护干预措施来解决。 创新：GT运动结合了集体锻炼的好处，如社会支持，以及 远程医疗技术。还没有研究将GT运动助推器疗程和文本进行比较 单独向文本消息发送消息，以支持运动维护。这两个策略将被用作 多方面的方法来改善运动维护。 具体目标： 目标1：采用循证运动成分进行团体远程健康(GT)运动干预，有指导 通过利益相关者的投入。使用定性的方法，我将通过焦点来探索利益相关者的观点 小组和访谈。干预发展将包括迭代方法和形成性评估。 目标2：进行随机试点试验，评估GT运动启动的可行性和可接受性 和维护计划。我将使用下肢骨关节炎(OA)作为模型来进行这项工作 因为：1)下肢骨关节炎(OA)是退伍军人中的常见病，2)锻炼是第一位的 3)我有过大腿骨性关节炎的经验。 患有下肢骨关节炎的退伍军人(n=50)将随机接受干预。我将评估可行性(即 推荐、保留、数据收集)和可接受性(即出席的会话数量、短信数量 答复、参与者和提供者反馈)。 目标3：确定与远程保健的成功实施和可持续性有关的背景因素 在退伍军人事务部内提供锻炼计划。Gerofit，一个现有的远程健康交付的退伍军人锻炼计划 在多个地点实施，将被用作典范。解释性的顺序混合方法设计将 用来描述现场特点，同时探索现场人员的观点， 使用调查和访谈数据。 方法论：实用的稳健实施和可持续模型(PRISM)，一个概念性的 将使用将卫生干预措施转化为实践的框架，并加以传播和实施 科学的方法。具体地说，将使用定性方法来获取利益相关者的观点，以设计 GT提供了锻炼计划。GT演习将采用随机试验设计进行试验 评估可行性和可接受性的干预措施。将使用混合方法来确定上下文因素 这与成功实施和维持有关。 下一步/实施：这项形成性工作将用于未来更大规模的单站点试验，以测试 评估GT运动启动和维持干预措施的实施效果。

Background: Exercise is an evidence-based intervention for the management of chronic conditions, yet the majority of Veterans are inactive. Group telehealth (GT) delivered exercise can potentially improve access to and participation in exercise. GT exercise sessions may increase exercise participation by providing social support, but a better understanding of the feasibility and acceptability of this format is needed. Telehealth delivered exercise programs should be designed with initiation and maintenance phases, but there is not consensus regarding the strategies for delivering exercise maintenance interventions. Skills for exercise initiation and maintenance differ, and interventions that focus on one or the other are not likely to result in sustained exercise participation. Significance/Impact: As the Veterans Health Administration is the largest integrated health care system in the US, implementing successful exercise programs could have a profound impact of public health. National priorities including telehealth and access to care as well as management of chronic conditions will be addressed by the development of this GT exercise initiation and maintenance intervention. Innovation: GT exercise combines the benefits of group exercise sessions, such as social support, and telehealth technology. There have been no studies comparing GT exercise booster sessions plus text messaging to text messaging alone to support exercise maintenance. These two strategies will be used as a multi-faceted approach to improving exercise maintenance. Specific Aims: Aim 1: Adapt evidenced-based exercise components for a group telehealth (GT) exercise intervention, guided by stakeholder input. Using qualitative methods, I will explore the perspectives of stakeholders through focus groups and interviews. Intervention development will include an iterative approach and formative evaluation. Aim 2: Conduct a randomized pilot trial to assess the feasibility and acceptability of the GT exercise initiation and maintenance program. I will use lower extremity osteoarthritis (OA) as a model to conduct this work because: 1) lower extremity osteoarthritis (OA) is a prevalent condition among Veterans, 2) exercise is a first line recommendation for the management of lower extremity OA, and 3) I have previous experience in OA. Veterans with lower extremity OA (n=50) will be randomized to the intervention. I will assess feasibility (i.e. referral, retention, data collection) and acceptability (i.e. number of sessions attended, number of text message responses, participant and provider feedback). Aim 3: Determine contextual factors related to successful implementation and sustainability of telehealth- delivered exercise programs within VA. Gerofit, an existing telehealth-delivered VA exercise program implemented at multiple sites, will be used as a model. An explanatory sequential mixed methods design will be used to describe site characteristics and simultaneously explore the perspectives of the site personnel, using survey and interview data. Methodology: The Practical Robust Implementation and Sustainability Model (PRISM), a conceptual framework for translating health interventions into practice, will be used with Dissemination and Implementation Science methods. Specifically, qualitative methods will be used to obtain stakeholder perspectives to design a GT delivered exercise program. A randomized pilot trial design will be used to pilot the GT exercise intervention to evaluate feasibility and acceptability. Mixed methods will be used to identify contextual factors related to successful implementation and sustainment. Next Steps/Implementation: This formative work will be used in a future larger, single site trial to test the effectiveness and evaluate the implementation of the GT exercise initiation and maintenance intervention.