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

项目总结 走路对保持独立性很重要，老年人非常重视走路。证据仍在继续 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on the Move(OTM)，这是一个旨在改善老年人行走的集体锻炼计划。由PCORI资助的 整群随机试验表明，OTM在改善护理锻炼方面优于常规护理锻炼计划 行走能力。尽管我们和其他人已经证明了通过锻炼提高机动性的好处， 这些程序很少在研究环境之外使用(即证据-实践差距)。在我们的PCORI试验中， 我们开始通过在社区环境中进行OTM来解决这种证据与实践之间的差距，然而， 干预由研究人员进行。OTM发展的下一步是作为一个 可实施的干预措施是进行有效性(阶段IV)研究，其中干预措施是 由社区提供商在社区环境中提供。在高度对照试验中测试的干预措施通常会 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，因为它可能会降低干预效力，并可能导致错误的结论 关于(缺乏)有效性。当从受控程度较高的环境过渡到受控程度较低的环境时 监测和测量干预保真度以准确解释研究结果势在必行。因此， 我们提出了一项混合I试验，它融合了有效性和实施(即干预保真度)研究 目标。使用整群随机试验，我们将测试OTM在提高移动性方面的有效性 在44个老年社区中心(目标1)的502名老年人中进行调查，并评估干预保真度，包括 忠诚度和能力，以及组织、讲师和学员级别因素对 干预保真度(目标2)。我们还将确定干预保真度在多大程度上缓和 OTM的有效性(目标3)。这项研究的意义在于它解决了步行限制，这是一种常见的 对于老年人来说，这是一个代价高昂的问题，它将临床锻炼计划过渡到了社区。临床和 研究项目提供给选定的一组个人。过渡到以社区为基础的计划 社区讲师的授课将极大地扩大OTM的覆盖范围。通过会见老年人，他们在那里 生活(城市、农村、高/低资源区)，OTM将对步行和健康产生更广泛的影响。我们的 结果将通过展示OTM作为健康促进的现实效果来影响该领域 改善老年人行动能力的计划，从而缩小研究与实践之间的差距。

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.