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

摘要 中年妇女（40 - 60岁）患心血管疾病的风险大幅增加。 在中年期间增加身体活动（PA）可以减轻这些风险，并且迫切需要 研究可以减少参与这一人群的障碍。PA测量反应性，或 由于引入了PA测量，PA参与的变化可能会使目标偏离 评估巴勒斯坦权力机构，这对评估巴勒斯坦权力机构的促进工作至关重要。具体而言，PA测量 反应性可能会在监测期的早期夸大PA的估计，并导致错误的结论 关于在中年妇女等高危群体中的PA参与。目前，证据显示， 支持PA测量反应性作为PA研究中的关键混淆因素是混合的，包括初步的 PI的K23裁决拟议的研究旨在解决三个关键的限制， 现有的工作：（1）强调儿童或健康，年轻的成年人低风险心血管疾病，（2）缺乏 反应性定义和最可能受影响的PA结局的一致性 (e.g.,步数与每天中等至剧烈活动的分钟数[MVPA]），以及（3）缺乏对 反应性可能最有影响力的环境（例如，研究设计，个体差异 参与者）。在拟议的R03中，我们将使用PI的K23活动、导师的 临床试验和公开可用的数据库，以检查 具有升高的CVD风险的中年人（例如，肥胖、高血压; N = 800）。使用协调分析 方法，我们将采用多层次建模技术，以实现以下目标：（1） 描述中年妇女PA测量反应性的四个PA结果：步骤，分钟， 轻度活动、MVPA分钟数和久坐行为分钟数，（2）为了确定是否 测量反应性的存在或程度因研究特征而异， 设计（即，仅观察与介入前PA评估）和PA监测程序（即， 研究级加速度计与市售可穿戴设备），以及（3）为了确定 测量反应性存在或程度基于医学或心理学而不同 特征，包括BMI，参与PA的动机和抑郁症状。这项工作将 生成初步数据，以确定与有问题的PA水平相关的情况 测量中年妇女的反应性和潜在的目标，以减少它在一个危险群体。 因此，R03代表了PI的K23计划的创新扩展，该计划将利用机构 资源和见解的日期，并有助于在PA领域的研究的科学严谨性 测量和干预。因此，这项工作将支持PI的发展， 独立研究者，专注于促进PA以降低高危人群的CVD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.