Keep it Movin': A Church-based Intervention to Improve Physical Function in African Americans

项目摘要 患有多种慢性疾病（MCC）的人经历残疾风险增加，生活质量降低， 增加住院率和死亡率。MCC的负担对非裔美国人（AAs）福尔斯尤其沉重 他们比非西班牙裔白人和西班牙裔有更高的多发病率， 身体机能下降，残疾率上升。我们在芝加哥西区戒酒协会的工作中 在社区中，我们观察到MCC对身体功能的这些不利影响。十多年来，拉什 研究人员和AA教会通过“活着的信仰网络”（AFN）合作，致力于健康公平 在芝加哥地区。最近对会众和社区进行的健康筛查显示， 下肢身体功能限制，身体功能限制最常见于那些 慢性病。由于体力活动（PA）提供了一种有效的方法，以减少发病率和死亡率 在经历MCC相关损伤的人中，教会合作伙伴呼吁进行PA测试 可以应对这一健康挑战的干预措施。因此，研究人员将测试一个多层次的PA程序， 社区成员将其命名为Keep It Movin'（KIM）。KIM干预建立在基于证据的基础上， 生活方式干预和老年人独立性（LIFE）研究表明，结构化的PA计划 可以减少身体功能受限的老年人的行动不便。生命的发现 以前没有在AA占主导地位社区进行过干预试验。KIM试点的参与者 一项研究报告了进行推荐的PA的重大障碍，包括疼痛等症状， 呼吸困难、害怕受伤和功能受限。因此，我们调整了LIFE干预措施， 实施，增加功能性教育，以帮助克服启动和维持常规PA的障碍 在MCC患者中。我们假设，这种增强的干预，这提高了能力， 教会成员通过知识渊博的康复专家提供额外的社会支持和教育， 将导致由于MCC导致PF受限的AA成人的身体功能增加和PA增加。 这项研究将确定，相对于来自比较教会的匹配参与者， 根据平均SPPB记录，保持运动干预将在6个月时改善身体功能 得分至少高出0.50分。次要目标包括测试KIM干预相对于教育 6个月和12个月时的对照条件对中度或剧烈PA、PA的社会支持、自我 PA疗效、生活质量和自我报告的身体功能。我们将使用RE-AIM框架来评估 推动成功采用、实施和维护“保持移动”的范围和因素 跨教会的干预

PROJECT SUMMARY Persons with Multiple Chronic Conditions (MCCs) experience increased risk of disability, reduced quality of life, increased hospitalizations, and death. The burden of MCCs falls particularly hard on African Americans (AAs) who have a higher prevalence of multimorbidity than non-Hispanic whites and Hispanics, and have earlier declines in physical functioning and higher prevalence of disability. In our work in Chicago’s west side AA community, we have observed these adverse impacts of MCCs on physical functioning. For over a decade, Rush researchers and AA churches have collaborated through the Alive Faith Network (AFN) to work for health equity in the Chicago region. Recent health screenings with congregants and the community demonstrated high rates of lower extremity physical function limitations, with physical function limitations most common among those with chronic illness. Since physical activity (PA) offers an effective approach to reducing morbidity and mortality among persons experiencing MCC-associated impairments, Church partners have called for the testing of PA interventions that might address this health challenge. Investigators will therefore test a multi-level PA program that community members named Keep It Movin’ (KIM). The KIM intervention builds on the evidence-based Lifestyle Interventions and Independence for Elders (LIFE) Study which showed that a structured PA program can reduce mobility disability among older adults with limitations of physical function. Findings from the LIFE intervention have not been previously tested in predominantly AA communities. Participants in the KIM pilot study reported significant barriers to engaging in recommended PA, including symptoms such as pain and dyspnea, fear of injury, and functional limitations. We have therefore adapted the LIFE intervention for implementation, adding functional education to help overcome barriers to starting and maintaining regular PA among persons with MCCs. We hypothesize that this augmented intervention, which enhances capability of church members through additional social support and education by knowledgeable rehabilitation specialists, will lead to both increased physical function and increased PA among AA adults with PF limitations due to MCCs. The study will determine if, relative to matched participants from comparator churches, participants receiving the Keep it Movin’ intervention will have improved physical function at 6 months, as documented by mean SPPB scores at least 0.50 points higher. Secondary aims include testing the KIM intervention relative to an education comparator condition at 6 and 12 months on outcomes of Moderate or Vigorous PA, social support for PA, self- efficacy for PA, quality of life and self-reported physical functioning. We will use the RE-AIM framework to assess reach and factors driving successful adoption, implementation, and maintenance of the Keep it Moving intervention across churches.