Effectiveness of the On the Move group exercise program to improve mobility in community-dwelling older adults

项目摘要 散步对保持独立性很重要，老年人非常重视。证据继续 积累集体锻炼计划对老年人健康的积极影响。我们的团队 开发了在移动（OTM），一个团体运动计划，以改善老年人的步行。A.变革和组织振兴举措供资 一项随机分组的试验表明，OTM在改善 行走能力。虽然我们和其他人已经证明了通过锻炼提高流动性的好处， 这些方案很少在研究环境之外使用（即证据-实践差距）。在我们的PCRI试验中， 我们开始通过在社区环境中进行OTM来解决这一证据-实践差距，然而， 干预由研究人员提供。OTM的下一步发展是作为一个全面的 可实施的干预是进行有效性（第四阶段）研究，其中干预是 由社区提供者在社区环境中提供。在高度对照的试验中测试的干预措施通常 在有效性试验中应用于现实生活中时，不会产生相同的结果。干预保真度差 可能会导致这种效果的稀释，因为它可以降低干预的效力，并可能导致错误的结论 缺乏（有效性）。当从更受控制的环境过渡到更不受控制的环境时， 必须监测和衡量干预的保真度，以准确地解释研究结果。因此，我们认为， 我们提出了一个混合I试验，它混合了有效性和实施（即干预保真度）研究 目标。使用随机分组试验，我们将测试OTM在改善流动性方面的有效性 在44个老年社区中心的502名老年人中（Aim 1），并评估干预保真度，包括 坚持和能力，以及组织，教师和参与者水平因素对 干预保真度（目标2）。我们还将确定干预忠诚度在多大程度上缓和了 OTM的有效性（目标3）。这项研究的意义在于它解决了行走限制，一种常见的， 这对老年人来说是一个昂贵的问题，它将临床锻炼计划转移到社区。临床和 研究项目只提供给一组经过挑选的个人。过渡到以社区为基础的方案 由社区教师提供的培训将大大增加OTM的覆盖面。通过与老年人会面， 生活（城市，农村，高/低资源地区），OTM将对步行和健康产生更广泛的影响。我们 结果将通过展示OTM作为健康促进的实际有效性来影响该领域 改善老年人流动性的计划，从而缩小研究与实践的差距。

PROJECT SUMMARY Walking is important for maintaining independence and is highly valued by older adults. Evidence continues to accumulate on the positive impact of group exercise programs on the health of older adults. Our team developed On the Move (OTM), a group exercise program to improve walking in older adults. A PCORI-funded cluster randomized trial demonstrated that OTM was superior to a usual care exercise program for improving walking ability. Though we and others have demonstrated the benefits of improving mobility through exercise, the programs are seldom used outside of the research setting (i.e. evidence-practice gap). In our PCORI trial, we began to address this evidence-practice gap by conducting OTM in community settings, however, the intervention was delivered by research personnel. The next step in the development of OTM as a fully implementable intervention is to conduct an effectiveness (Stage IV) study in which the intervention is delivered in community settings by community providers. Interventions tested in highly controlled trials often do not yield the same outcomes when applied in a real-life context in effectiveness trials. Poor intervention fidelity may cause this dilution of effect, as it can reduce intervention potency and potentially lead to faulty conclusions about (lack of) effectiveness. When transitioning from more controlled to less controlled environments it is imperative to monitor and measure intervention fidelity to accurately interpret the research findings. Therefore, we propose a Hybrid I trial, which blends effectiveness and implementation (i.e. intervention fidelity) research aims. Using a cluster-randomized trial, we will test the effectiveness of OTM in terms of improving mobility among 502 older adults in 44 senior community centers (Aim 1) and evaluate intervention fidelity, including adherence and competence, and the impact of organizational, instructor, and participant level factors on intervention fidelity (Aim 2). We will also determine the extent to which intervention fidelity moderates the effectiveness of OTM (Aim 3). This study is significant in that it addresses walking limitations, a common and costly problem for older adults and it transitions a clinical exercise program to the community. Clinical and research programs are available to a select group of individuals. Transitioning to a community-based program delivered by community instructors will greatly increase the reach of OTM. By meeting older adults where they live (urban, rural, high/low resource areas), OTM will have a much wider impact on walking and health. Our results will impact the field by demonstrating the real-world effectiveness of OTM as a health promotion program for improving mobility in older adults thus decreasing the research-practice gap.