Individual and Environmental Mechanisms of PA Change

PA 变化的个体和环境机制

• 批准号: 7103402
• 负责人: PAUL ESTABROOKS
• 金额: $ 47.73万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7103402
• 关键词: DVD /CD ROM; behavior modification; body physical activity; cardiovascular disorder risk; clinical research; computer assisted patient care; disease /disorder prevention /control; environment; exercise; geographic site; health behavior; health care cost /financing; health care service availability; heart rate; human ecology; human subject; human therapy evaluation; information dissemination; information systems; interactive multimedia; longitudinal human study; motivation; patient oriented research; socioenvironment; telemedicine

DESCRIPTION (provided by applicant): There is a dearth of information on the mechanisms, and potential moderators, of physical activity (PA) intervention effectiveness. Understanding the mechanisms of PA change will aid in successful intervention development while understanding moderators and will allow a matching of intervention components to individual needs of particular populations. To definitively understand mechanisms and moderators of behavior change it is necessary to develop theory-based interventions that include specific strategies that target proposed mechanisms of change while monitoring the proposed mediating and moderating variables prior to and following intervention. This proposal highlights the use of the Ecological Model of Physical Activity (EMPA) as a theoretical guide to strategy development. The EMPA highlights the necessity to address individual (biological & psychosocial) and environmental variables (e.g., PA resource accessibility) when developing and implementing interventions. Health care patients who have been referred for a treadmill cardiovascular stress test--but do not present abnormal ECG or chest pain during testing-will be will be stratified by diagnosis of low heart rate recovery, a potential biological moderator of intervention effectiveness. To detect the potential independent and combined effects of individual motivation and environmental accessibility we will conduct a randomized 2X2 factorial trial to test proposed mediators of effectiveness. Participants (n=500) will be randomized to an individual (I), environmental (E), combination (l+E), or matched contact nutrition control. All intervention conditions will include a CD-ROM session, 3 tailored mail, and 3 tailored automated telephone follow-ups over a 6-month period. We will assess the reach, effectiveness, clinician adoption, and staff implementation of these interventions, individually, in combination, and when compared to controls among an understudied and high need population--individuals who are at an elevated risk, but have not yet suffered a serious cardiac event (approximately 3,000,000 individuals/year in the US). The results of this project will identify the causal, and potentially additive, relationships of environmental and individual mediators of PA change and allow the examination of potential biological moderators of effectiveness. Because intervention typically effects decrease over time and studies do not address setting-related issues necessary to ensure sustainability of delivery at the organizational level we will determine the maintenance of intervention effects on causal mechanisms and PA, 6 & 12 months following intervention. The interventions will be developed for delivery within the regular scope of treadmill stress testing by typical medical staff and cost of delivery will be assessed for each intervention condition. This project uniquely utilizes methods that will facilitate institutionalization of the intervention components following the successful completion of the trial and potential adoption of the intervention in other health care settings.

描述（由申请人提供）： 关于身体活动（PA）干预效果的机制和潜在调节因素的信息缺乏。了解 PA 变化的机制将有助于成功制定干预措施，同时了解调节因素，并将干预措施的组成部分与特定人群的个人需求相匹配。为了明确了解行为改变的机制和调节因素，有必要制定基于理论的干预措施，其中包括针对拟议的变化机制的具体策略，同时在干预之前和之后监测拟议的中介和调节变量。该提案强调使用身体活动生态模型（EMPA）作为战略制定的理论指南。 EMPA 强调在制定和实施干预措施时必须解决个人（生物和社会心理）和环境变量（例如 PA 资源的可及性）。被转诊进行跑步机心血管压力测试但在测试期间没有出现心电图异常或胸痛的医疗保健患者将根据低心率恢复的诊断进行分层，低心率恢复是干预效果的潜在生物调节因素。为了检测个人动机和环境可达性的潜在独立和综合影响，我们将进行随机 2X2 析因试验来测试提议的有效性中介因素。参与者 (n=500) 将被随机分配到个体 (I)、环境 (E)、组合 (I+E) 或匹配的接触营养控制组。所有干预条件将包括为期 6 个月的 CD-ROM 会话、3 封定制邮件和 3 封定制自动电话随访。我们将单独或组合评估这些干预措施的范围、有效性、临床医生的采用和工作人员的实施情况，并与未充分研究和高需求人群（风险较高但尚未遭受严重心脏事件的个体）中的对照进行比较（美国每年大约有 3,000,000 人）。该项目的结果将确定 PA 变化的环境和个体调节因素之间的因果关系和潜在累加关系，并允许检查有效性的潜在生物调节因素。由于干预效果通常会随着时间的推移而减弱，并且研究没有解决确保组织层面交付可持续性所必需的环境相关问题，因此我们将在干预后 6 个月和 12 个月确定干预效果对因果机制和 PA 的维持情况。干预措施将由典型的医务人员在跑步机压力测试的常规范围内开发，并将针对每种干预条件评估分娩成本。该项目独特地利用了在试验成功完成后促进干预措施制度化的方法，并有可能在其他医疗机构中采用干预措施。