Maintaining Physical Activity in Older Adult MCO Members

描述（由申请人提供）：身体活动对成年人的好处是众所周知的，但在美国，尽管近年来广泛的临床建议增加身体活动，但只有不到三分之一的老年人达到了推荐的身体活动水平。以临床为基础的增加身体活动的方法是昂贵的，难以在繁忙的实践环境中实施，并且覆盖面有限。此外，这些方法有效性的证据是模棱两可的。以人群为基础的方法可能是提高老年人身体活动水平的更有效和成本更低的策略。对体育活动的人口研究表明，每年都有许多久坐不动的老年人开始体育活动，但几乎相同数量的活跃老年人变得久坐不动。在开始身体活动的老年人中，只有一半在3个月后继续活动。我们假设，以人群为基础的方法，强调身体活动的维持，可以大大提高老年人的身体活动水平。这一假设在一项为期24个月的随机试验中得到验证，该试验评估了一种创新的、基于理论的行为干预，以保持最近至少适度运动的50-70岁成年人的身体活动。1000名受试者将被随机分为两个实验组：1)“常规护理”对照组，2)基于电话和邮件的互动式干预项目，旨在为老年人保持身体活动量身定制。主要结局指标有：1)身体活动，以卡路里/周消耗来评估；2)身体活动维持，以相对于基线的后续卡路里/周消耗来评估。将仔细测量干预措施对具有良好特征的老年人口的渗透程度，并评估干预措施的成本。身体活动维持的社会心理和行为中介也将被检查。研究结果将与政策制定者、健康促进从业者和健康计划相关，并将提供有关旨在最大限度地提高老年人身体活动水平的干预措施的有效性、人口渗透率和成本的实用信息。

DESCRIPTION (provided by applicant): The benefits of physical activity for adults are well established, but less than one-third of older adults in the U.S. have achieved recommended levels of physical activity despite widespread clinical recommendations to increase physical activity in recent years. Clinic-based approaches to increasing physical activity are expensive, difficult to implement in busy practice settings, and have limited reach. Moreover, evidence of the efficacy of such approaches is equivocal. A population-based approach may be a more effective and less costly strategy to increase levels of physical activity in older adults. Population studies of physical activity have demonstrated that each year, many sedentary older adults initiate physical activity, but a nearly equal number of those who were active become sedentary. Among older adults initiating physical activity, only half continue to be active 3 months later. We hypothesize that a population-based approach that emphasizes physical activity maintenance can substantially increase physical activity levels in a defined populations of older adults. This hypothesis is tested in a 24-month randomized trial evaluating an innovative, theory-based behavioral intervention to maintain physical activity in a random sample of 50-70 year old adults who have recently become at least moderately active. One thousand (1000) subjects will be randomized to one of two experimental groups: 1) a "usual care" control group, and 2) an interactive phone- and mail-based intervention program tailored to maintaining physical activity in older adults. The primary outcome measures are: 1) physical activity, assessed as kcals/wk expenditure; and 2) physical activity maintenance, assessed as follow-up kcals/wk expenditure relative to baseline. Careful measurement of the penetration of the intervention into a well characterized older adult population, and the costs of the intervention, will be assessed. Psychosocial and behavioral mediators of physical activity maintenance will also be examined. Study results will be relevant to policy makers, health promotion practitioners and health plans, and will provide practical information on the effectiveness, population penetration, and costs of an intervention designed to maximize population levels of physical activity among 9 older adults.