Optimization of a behavioral intervention to increase physical activity in older adults living with HIV

优化行为干预以增加艾滋病毒感染者老年人的体力活动

• 批准号: 10693938
• 负责人: Jason V Baker
• 金额: $ 68.86万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693938
• 关键词: Accelerometer; Address; Affect; Age; Aging; Behavior Therapy; Behavioral; Behavioral Research; Cardiovascular Diseases; Caring; Chronic; Classification; Clinical Trials; Cognitive; Cognitive Therapy; Conduct Clinical Trials; Coping Skills; Counseling; Data; Development; Disease; Elderly; Enrollment; Evaluation; Exercise; Fatigue; Friends; Future; Goals; Guidelines; HIV; Health Benefit; High Prevalence; Individual; Intervention; Interview; Life; Life Style; Mediation; Mediator; Mental Depression; Mental Health; Mental disorders; Modeling; Monitor; Outcome; Pain; Participant; Persons; Phase; Phenotype; Physical activity; Preparation; Primary Care; Privatization; Public Health; Quality of life; Recommendation; Refractory; Research; Risk; Risk Factors; Social support; Specific qualifier value; Testing; Walking; antiretroviral therapy; brief advice; cardiovascular disorder risk; chronic pain; clinical risk; comorbidity; design; efficacy evaluation; efficacy validation; exercise intervention; experience; experimental study; fitbit; frailty; healthspan; human old age (65+); improved; lifestyle factors; multidisciplinary; multiphase optimization strategy; physical conditioning; primary outcome; programs; recruit; secondary outcome; social; theories; therapy development

Increasing numbers of persons living with HIV (PLWH) are living to older ages. Older PLWH are at increased risk for a wide spectrum of co-morbid conditions such as cardiovascular disease, frailty phenotype, and mental health disorders. Practical primary care-based interventions are needed for older PLWH that target lifestyle factors to reduce complications of aging and improve healthspan. Most PLWH engage in less physical activity (PA) than is recommended by public health guidelines. Thus, increasing PA can lead to numerous mental and physical health benefits among PLWH. Current studies in PLWH typically focus on the impact of supervised exercise. However, there are many barriers to this type of PA. Lifestyle physical activity (LPA) programs that focus on integrating PA, especially walking, into everyday life, may be more successful in producing a sustained increase in PA. The long-term goal of this research is to develop an effective and efficient primary care intervention that increases LPA among older PLWH. We leverage the Multiphase Optimization STrategy (MOST) as a framework for developing, optimizing, and evaluating a multicomponent behavioral intervention. MOST is comprised of three phases. First, in the preparation phase, an empirical and theory-driven conceptual model is developed that identifies differentiable intervention components and specifies optimization criteria (i.e., goal of intervention development). We have completed this phase. Second, in the optimization phase, the impact of each intervention component on the desired outcome is empirically examined. The goal is to determine which components to include in a final intervention package that is optimized for efficacy and efficiency. The proposed study reflects the second phase, or an optimization trial. Finally, in the evaluation phase, the optimized intervention package is evaluated for efficacy in a traditional RCT; this will be the next step in this line of research following the currently proposed project. In this project, we will test the impact of three separable intervention components on steps per day after 4 months of intervention. We will recruit 208 PLWH of age ≥50 year classified as low-active. All participants receive component ‘0’: brief advice to exercise and a Fitbit activity tracker. We then test 3 additional components in a factorial design: 1) PA Coaching— focused on goal-setting and self-monitoring; 2) Cognitive-Behavioral intervention for PA (CB-PA)—focused on identifying values and addressing internal barriers to PA such as pain, depression, or fatigue; 3) Social Support for PA (SS-PA)—a component which leverages the social functionality of the Fitbit app, promoting social support and friendly competition. The primary outcome will be steps per day during Month 4. The observed main and interaction effects for the 3 candidate components will guide selection of components to be included in an optimized intervention that will be tested in a future RCT. We will also examine potential mediators for each intervention component, as well as secondary outcomes including perceived physical health, mental health, cardiovascular disease risk, and the frailty phenotype.

越来越多的艾滋病毒感染者活到老年。老年艾滋病病毒携带者 广泛的共病风险，如心血管疾病、虚弱表型和精神疾病。 健康失调针对生活方式的老年艾滋病病毒携带者，需要基于实际初级保健的干预措施 减少衰老并发症和改善健康的因素。大多数PLWH参与较少的体力活动 (PA)比公共卫生指南推荐的要多因此，增加PA会导致许多精神和 艾滋病毒/艾滋病感染者的身体健康福利。目前对PLWH的研究通常集中在监督的影响， 锻炼的然而，这种类型的PA存在许多障碍。生活方式体育活动（LPA）计划， 专注于将PA，特别是步行融入日常生活，可能会更成功地产生一个 PA的持续增长。本研究的长期目标是开发一种有效和高效的初级 护理干预增加老年艾滋病毒携带者的LPA。我们利用多阶段优化战略 （MOST）作为开发，优化和评估多成分行为干预的框架。 MOST由三个阶段组成。首先，在准备阶段，一个经验和理论驱动的概念 模型的开发，确定可区分的干预组成部分，并指定优化标准 (i.e.,发展目标）。我们已经完成了这个阶段。其次，在优化阶段， 对每一干预组成部分对预期成果的影响进行了实证研究。目标是 确定在针对疗效进行优化的最终干预包中包括哪些组件， 效率拟议的研究反映了第二阶段，或优化试验。最后，在评价中 在第一阶段，在传统RCT中评估优化的干预方案的有效性;这将是下一个 在目前提出的项目之后，在这一研究领域迈出了一步。在这个项目中，我们将测试 干预4个月后，每天步行三个可分离的干预部分。我们将招募208名 年龄≥50岁的PLWH被归类为低活性。所有参与者都收到组件“0”：锻炼的简要建议 和一个Fitbit活动追踪器然后，我们在析因设计中测试3个附加组件：1）PA教练- 重点是目标设定和自我监控; 2）PA的认知行为干预（CB-PA）-重点是 识别价值观并解决PA的内部障碍，如疼痛，抑郁或疲劳; 3）社会支持 for PA（SS-PA）-一个利用Fitbit应用程序的社交功能的组件， 支持和友好竞争。主要结局将是第4个月期间每天的步数。观察到的 3个候选成分的主效应和交互效应将指导选择要纳入的成分 将在未来的随机对照试验中进行测试。我们还将审查潜在的调解人， 每个干预组成部分，以及次要结果，包括感知的身体健康，心理 健康、心血管疾病风险和脆弱表型。