iSTEP: an mHealth Physical Activity and Diet Intervention for Persons with HIV

iSTEP：针对艾滋病毒感染者的移动健康身体活动和饮食干预

• 批准号: 9330935
• 负责人: Brook Henry
• 金额: $ 61.41万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-11 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9330935
• 关键词: Accelerometer; Acquired Immunodeficiency Syndrome; Address; Adherence; Alzheimer' s disease risk; Anti-Retroviral Agents; Attention; Behavior Therapy; Blood; Body fat; Brain; Car Phone; Cardiovascular Diseases; Cholesterol; Comorbidity; Consumption; Control Groups; Development; Devices; Diet; Dietary History; Dietary Intervention; Disease; Dyslipidemias; Energy Metabolism; Exhibits; Feedback; Functional disorder; Grant; Guidelines; HIV; HIV-associated neurocognitive disorder; Health; Health behavior; Impaired cognition; Impairment; Incidence; Individual; Inferior; Inflammation; Interruption; Intervention; Juglans; Lipids; Lipodystrophy; Measures; Mediating; Medical; Memory; Metabolic; Metabolic Diseases; Metabolic Marker; Metabolic syndrome; Methods; Moderate Exercise; Modification; Monitor; Morbidity - disease rate; Neurocognition; Neurocognitive; Neurocognitive Deficit; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Physical activity; Polypharmacy; Polyunsaturated Fatty Acids; Population; Protocols documentation; Public Health; Questionnaires; Randomized; Reporting; Research; Resources; Risk Factors; Running; Services; Strenuous Exercise; Testing; Text; Time; Travel; Update; Virus; Visit; Work; abdominal fat; arm; base; cardiovascular disorder risk; cardiovascular health; cognitive performance; design; effective intervention; executive function; exercise intervention; experience; fitbit; follow up assessment; frailty; group intervention; high risk; improved; inflammatory marker; lifestyle intervention; lipid disorder; mHealth; medical complication; medication compliance; mortality; neurocognitive test; novel; personalized approach; sedentary lifestyle; service intervention; socioeconomics; therapy design; tool; treadmill

SUMMARY/ABSTRACT People who live with HIV (PLWH) experience a high incidence of neurocognitive deficits and HIV- associated non-AIDS (HANA) disorders, including cardiovascular disease (CVD), metabolic dysfunction, and autonomic decline. While antiretroviral treatment (ART) has reduced AIDS-related morbidity, both the virus and the medications are associated with lipid disorders that also increase CVD risk, including dyslipidemia and lipodystrophy. Consequently, the development of effective lifestyle interventions to reduce the incidence of HIV-associated neurocognitive disorders (HAND) and decrease metabolic disorders is a high priority. Physical activity (PA) has been utilized as an effective tool to improve health in PLWH, but may not be sufficient by itself to improve lipid levels. Existing PA interventions in PLWH typically required strenuous PA and significant resources that limit feasibility for many people living with the disease. Recent work indicates that interrupting periods of sedentary behavior (SB), independent of PA, also has a significant beneficial effect on metabolic function, but SB has not been well-studied in PWLH. Mediterranean-style diets (MedDiet) are also effective at improving CVD risk factors in HIV-uninfected individuals and are reported to reduce cognitive decline in persons at risk for Alzheimer's disease, but have not been widely tested in PWLH. We recently developed a novel and personalized Short Message Service (SMS) mobile phone text messaging intervention (iSTEP) that is designed to increase moderate PA in PLWH (R21MH100968). Our objective is to expand upon this work and conduct an RCT examining the efficacy of iSTEP in combination with a mobile mHealth MedDiet intervention tailored to PLWH. 180 PLWH will be randomly assigned to a control group (n = 60), a 6-month iSTEP group with just a PA/SB intervention (n = 60), or a 6-month intervention with both PA/SB and MedDiet components (n = 60), where participants receive daily interactive SMS/MMS messages designed to increase moderate PA, reduce SB, and promote adherence to a MedDiet, including walnut consumption. PA/SB will be quantified by accelerometer, Fitbit step counts, and self-report, MedDiet adherence will be assessed by self-report (Diet History Questionnaire and weekly SMS feedback) and objective measures (polyunsaturated fatty acid levels - PUFA in blood), and we will quantify metabolic and inflammatory markers. We will also conduct a follow-up assessment 6 months after the end of the intervention (accelerometer, neurocognitive testing, PUFA levels) to assess PA and MedDiet adherence. We hypothesize that iSTEP (both intervention arms) will increase PA, reduce SB, and improve neurocognition compared to control; the iSTEP + MedDiet group will demonstrate improvement in CVD risk factors and neurocognition compared to the PA/SB intervention alone. Findings from this proposal will lay the groundwork for development of novel large-scale mobile PA/diet interventions dedicated to treating HAND and improving cardiovascular health for PLWH.

摘要/摘要 艾滋病毒感染者 (PLWH) 神经认知缺陷和艾滋病毒感染的发生率很高 相关的非艾滋病 (HANA) 疾病，包括心血管疾病 (CVD)、代谢功能障碍、 和自主神经衰退。虽然抗逆转录病毒治疗 (ART) 降低了艾滋病相关发病率，但 病毒和药物与血脂紊乱有关，也会增加 CVD 风险，包括 血脂异常和脂肪营养不良。因此，开发有效的生活方式干预措施以减少 HIV 相关神经认知障碍 (HAND) 的发生率和代谢紊乱的减少是 高优先级。体力活动 (PA) 已被用作改善 PLWH 健康的有效工具，但 其本身可能不足以改善血脂水平。通常需要对感染者进行现有的 PA 干预 繁重的 PA 和大量资源限制了许多患有该疾病的人的可行性。最近的 研究表明，中断久坐行为（SB）的时间与 PA 无关，也具有 对代谢功能有显着的有益作用，但 SB 在 PWLH 中尚未得到充分研究。 地中海式饮食 (MedDiet) 也能有效改善未感染 HIV 的 CVD 危险因素 据报道可以减少有阿尔茨海默病风险的人的认知能力下降，但 尚未在 PWLH 中进行广泛测试。我们最近开发了一种新颖的个性化短信服务 (SMS) 手机短信干预 (iSTEP)，旨在增加适度的 PA 感染者 (R21MH100968)。我们的目标是扩展这项工作并进行随机对照试验（RCT）检查 iSTEP 与专为 PLWH 量身定制的移动 mHealth MedDiet 干预措施相结合的功效。 180 感染者 将被随机分配到对照组 (n = 60)，这是一个为期 6 个月的 iSTEP 组，只有 PA/SB 干预 (n = 60)，或同时采用 PA/SB 和 MedDiet 成分的 6 个月干预 (n = 60)，其中 参与者每天都会收到互动短信/彩信，旨在增加适度的 PA，减少 SB， 并促进遵守医疗饮食，包括食用核桃。 PA/SB 将量化为 加速度计、Fitbit 步数和自我报告，MedDiet 依从性将通过自我报告进行评估（饮食 病史调查问卷和每周短信反馈）和客观措施（多不饱和脂肪酸 水平 - 血液中的 PUFA），我们将量化代谢和炎症标志物。我们还将举办一次 干预结束后 6 个月进行随访评估（加速度计、神经认知测试、 PUFA 水平）来评估 PA 和 MedDiet 的依从性。我们假设 iSTEP（两个干预组） 与对照相比，会增加 PA，减少 SB，并改善神经认知； iSTEP + MedDiet 小组 与 PA/SB 干预相比，将证明 CVD 危险因素和神经认知有所改善 独自的。该提案的研究结果将为新型大型移动设备的开发奠定基础 PA/饮食干预措施致力于治疗 HAND 并改善 PLWH 的心血管健康。