Predictors of Reactivity to Physical Activity Measurement among Women in Midlife with Elevated CVD Risk: Examination Across 7 Studies

摘要 中年女性(40-60岁)患心血管疾病(CVD)的风险大幅增加。 中年期间增加体力活动(PA)可以降低这些风险，因此迫切需要 可以减少参与这一人群的障碍的研究。PA测量反应性，或 引入PA测量后，PA参与度的变化可能会使目标发生偏差 对PA的评估，这对于评估PA的推广工作至关重要。具体地说，PA测量 反应性可能会在监测期早期夸大PA的估计，并导致错误的结论 关于PA在高危人群中的参与度，例如中年妇女。然而，目前有证据表明， 支持PA测量反应性是PA研究中的一个关键混淆，包括初步的 私家侦探K23奖的证据。拟议的研究旨在解决以下三个关键限制 现有工作：(1)重视患心血管疾病风险较低的儿童或健康的年轻人，(2)缺乏 关于反应性的定义和最有可能受到影响的PA结果的一致性(S) (例如，每天几步或几分钟的中等到剧烈的活动[MVPA])，以及(3)缺乏对 反应性可能最具影响力的背景(例如，研究设计、个体差异 参与者)。在建议的R03中，我们将使用来自PI的K23活动、Mentors的 临床试验和公开可用的数据库，以检查妇女的PA测量反应性 心血管疾病风险升高的中年人(如肥胖、高血压；N=800)。使用协调分析 我们将采用多层次建模技术来实现以下目标：(1) 描述中年女性PA测量的四个结果的反应性：步数、分钟数 轻度活动、MVPA的分钟数和久坐不动的分钟数，(2)确定 测量反应性的存在或程度因研究等研究特征而异 设计(即，仅观察与PA评估干预前相比)和PA监测程序(即， 研究级加速度计与商用可穿戴设备的对比)，以及(3)确定 测量反应性的存在或程度因医学或心理原因而有所不同 特征，包括体重指数、参与PA的动机和抑郁症状。这项工作将 生成初步数据，以确定与PA问题水平相关的情况 测量中年女性的反应性，以及在高危人群中降低反应性的潜在目标。 因此，R03代表了PI的K23计划的创新扩展，它将利用机构 到目前为止的资源和见解，并对PA领域研究的科学严谨性做出贡献 测量和干预。因此，这项工作将支持PI作为领导者的发展 独立调查员，专注于推广PA以降低高危人群的心血管疾病风险。

Abstract Risks for cardiovascular disease (CVD) substantially increase for women during midlife (ages 40-60). Increasing physical activity (PA) during midlife can mitigate these risks and there is a critical need for research that can reduce barriers to engagement in this population. PA measurement reactivity, or a change in PA engagement in response to the introduction of PA measurement, may bias the objective assessment of PA that is critical to evaluating PA promotion efforts. Specifically, PA measurement reactivity could inflate estimates of PA early in a monitoring period and lead to incorrect conclusions about PA engagement among at-risk groups such as women in midlife. At present, however, evidence supporting PA measurement reactivity as a key confound in PA research is mixed, including preliminary evidence from the PI’s K23 award. The proposed study is designed to address three key limitations of existing work: (1) emphasis on children or healthy, young adults with low risk for CVD, (2) lack of consistency with respect to the definition of reactivity and the PA outcome(s) most likely to be affected (e.g., steps vs. minutes of moderate-to-vigorous activity [MVPA] per day), and (3) lack of attention to the contexts whereby reactivity may be most influential (e.g., study designs, individual differences between participants). In the proposed R03, we will use 7 existing datasets from the PI’s K23 activities, mentors’ clinical trials, and publicly available databases to examine PA measurement reactivity among women in midlife with elevated CVD risk (e.g., obesity, hypertension; N = 800). Using a coordinated analysis approach, we will employ multilevel modeling techniques to achieve the following aims: (1) To characterize midlife women’s PA measurement reactivity across four PA outcomes: steps, minutes of light activity, minutes of MVPA, and minutes spent in sedentary behavior, (2) To determine whether the presence or extent of measurement reactivity differ based on study characteristics such as research design (i.e., observation only vs. PA assessment pre-intervention) and PA monitoring procedures (i.e., research-grade accelerometers vs. commercially available wearables), and (3) To determine whether the presence or extent of measurement reactivity differ based on medical or psychological characteristics, including BMI, motivation to engage in PA, and depressive symptoms. This work will generate preliminary data to identify circumstances associated with problematic levels of PA measurement reactivity among women in midlife and potential targets for reducing it in an at-risk group. This R03 thus represents an innovative extension of the PI’s K23 program that will leverage institutional resources and insights to date and contribute to the scientific rigor of research in the fields of PA measurement and intervention. Consequently, this work will support the PI’s development as a leading independent investigator, focused on promoting PA to reduce CVD risk in at-risk populations.