Individual and Environmental Mechanisms of PA Change

描述（由申请人提供）： 有一个缺乏信息的机制，和潜在的主持人，身体活动（PA）干预的有效性。了解PA变化的机制将有助于成功的干预发展，同时了解调节剂，并将允许干预组件匹配特定人群的个人需求。为了明确地理解行为改变的机制和调节者，有必要制定基于理论的干预措施，包括针对拟议的改变机制的具体策略，同时在干预之前和之后监测拟议的中介和调节变量。该建议强调使用身体活动的生态模型（EMPA）作为战略制定的理论指导。EMPA强调了解决个人（生物和心理社会）和环境变量（例如，在制定和实施干预措施时，应考虑到巴勒斯坦权力机构资源的可获得性。健康护理患者已被转介进行跑步机心血管负荷试验-但在测试期间没有出现异常ECG或胸痛-将根据低心率恢复的诊断进行分层，这是干预有效性的潜在生物调节剂。为了检测个人动机和环境可及性的潜在独立和综合效应，我们将进行一项随机2X2析因试验，以测试拟议的有效性介质。参与者（n=500）将被随机分配至个体（I）、环境（E）、组合（I +E）或匹配的接触营养对照。所有干预条件将包括一次CD-ROM会议、3次定制邮件和3次定制自动电话随访，为期6个月。我们将评估这些干预措施的覆盖范围、有效性、临床医生采用情况和工作人员实施情况，包括单独、组合以及与研究不足和高需求人群（风险升高但尚未发生严重心脏事件的个体（美国约3，000，000人/年））中的对照组进行比较。该项目的结果将确定的因果关系，并可能添加剂，PA变化的环境和个人介质的关系，并允许检查潜在的生物调节剂的有效性。由于干预的效果通常会随着时间的推移而下降，研究并没有解决必要的设置相关的问题，以确保在组织层面上的交付的可持续性，我们将确定维持干预的因果机制和PA的影响，6 & 12个月后干预。将由典型的医务人员在跑步机压力测试的常规范围内制定干预措施，并评估每种干预条件下的分娩成本。该项目独特地利用了一些方法，这些方法将在成功完成试验后促进干预部分的制度化，并有可能在其他卫生保健环境中采用干预措施。

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.