Peer-Facilitated Physical Activity Intervention Delivered During Methadone Maintenance

摘要 有250万美国人滥用或依赖阿片类药物。美沙酮维持 治疗(MMT)是阿片类药物依赖最常见的治疗方法。虽然MMT在 在改善药物使用结果的同时，绝大多数人继续从事不健康的生活方式(例如， 缺乏体力活动)会导致严重的心理和身体健康疾病，如心血管疾病 疾病、糖尿病、高血压、肥胖、抑郁、睡眠困难和认知障碍。给定 体力活动(PA)对身心健康的益处，针对MMT患者PA增加的干预措施 患者可能会对降低总体发病率和死亡率产生重大影响。 本研究的目的是开发一种可行、可接受和有效的多水平PA干预 解决在健康护理环境中传递的个人和人际因素(即， 美沙酮诊所)。为此，我们建议对已经从事PA的MMT患者进行培训 对缺乏身体活动的MMT患者实施基于群体的PA干预的公共卫生建议水平 在一家大型社区美沙酮诊所。越来越多的同行促进的PA干预已经 被发现有效地增加和维持体力活动水平，尽管没有实质上的滥用 人口。同龄人在增加MMT的体力活动方面可能扮演着特别重要的角色，因为这 人群面临着独特而重大的PA障碍(例如，抑郁、吸烟、吸毒的诱因 环境)。已成功通过这些障碍并进行身体活动的MMT同龄人 可以共享信息，帮助解决问题障碍，充当榜样，并提供支持和 鼓励，从而帮助不活跃的MMT患者提高自我效能和维持PA的动力。 这项研究的设计分两个阶段进行--R21阶段将专注于开发 同伴促进的PA+Fitbit干预(Peer-PA+Fitbit)，而R33阶段将评估Peer-PA+Fitbit的疗效 PA+RCT中的Fitbit。R21阶段将包括：1)与潜在同行和实际合作伙伴组成的重点小组 不活跃的MMT患者；2)开发一本整合了Fitbit使用的PA手册；3)开发培训 对等点协议；4)确定参与社区的安全、可步行路径；5)为期12周的开放试点 试验(n=20)，以测试Peer-PA+Fitbit干预的可行性和可接受性。R33阶段将 将目前正在接受MMT的150名患者随机分为三组：1)Peer-PA+Fitbit干预， 2)联系控制健康小组(Well+Fitbit)，3)日常护理(UC)。后续评估将是 在3个月、6个月和12个月时进行，以确定短期和长期坚持体育锻炼的情况。我们 期望该项目将导致开发可扩展的、多层次的同行促进的PA干预 为MMT的患者量身定做，从而改善这一高危人群的整体健康和福祉。

ABSTRACT There are 2.5 million Americans who abuse or are dependent on opioids. Methadone maintenance treatment (MMT) is the most common treatment for opioid dependence. While MMT has been effective in improving drug use outcomes, the overwhelming majority continue to engage in unhealthy lifestyles (e.g., physical inactivity) that lead to significant mental and physical health morbidities such as cardiovascular disease, diabetes, hypertension, obesity, depression, sleep difficulties, and cognitive impairments. Given the mental and physical health benefits of physical activity (PA), interventions targeting increases in PA in MMT patients could have a significant impact on reducing the overall morbidity and mortality. The purpose of this study is to develop a feasible, acceptable and effective multilevel PA intervention that addresses both individual and interpersonal factors delivered in the context of a health care setting (i.e., methadone clinics). To do so, we are proposing to train MMT patients who are already engaging in PA at public health recommended levels to deliver a group-based PA intervention to physically inactive MMT patients at a large community-based methadone clinic. An increasing number of peer-facilitated PA interventions have been found to effectively increase and sustain physical activity levels, though none in substance abusing populations. Peers may play a particularly important role in increasing physical activity in MMT, as this population faces unique and significant barriers to PA (e.g., depression, smoking, triggers for drug use in environment). MMT peers who have successfully navigated through these barriers and are physically active can share information, help in problem solving barriers, act as role models, and offer support and encouragement, thereby helping inactive MMT patients increase self-efficacy and motivation for sustaining PA. The design of this study takes place in 2 phases -- the R21 phase will be focused on the development of a peer-facilitated PA+Fitbit intervention (Peer-PA+Fitbit), while the R33 phase will evaluate the efficacy of Peer- PA+Fitbit in an RCT. The R21 phase will consist of: 1) focus groups with potential peers and physically inactive MMT patients; 2) development of a PA manual that integrates use of the Fitbit; 3) developing a training protocol for peers; 4) identifying safe, walkable paths in participant neighborhoods, and 5) a 12-week open pilot trial (n=20) to test the feasibility and acceptability of the Peer-PA+Fitbit intervention. The R33 Phase will involve randomizing 150 patients currently receiving MMT to one of three arms: 1) Peer-PA+Fitbit intervention, 2) contact control wellness groups (Well+Fitbit), and 3) Usual Care (UC). Follow-up assessments will be conducted at 3, 6, & 12-months to determine both the short- and long-term adherence to physical activity. We expect that this project will lead to the development of a scalable, multilevel peer-facilitated PA intervention tailored to patients in MMT, thereby improving the overall health and well-being of this at-risk population.