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携带者(PLWH)活到了高龄。较年长的PLWH正在增加 罹患多种并存疾病的风险，如心血管疾病、虚弱表型和精神疾病 健康障碍。针对生活方式的老年PLWH需要基于初级保健的实用干预措施 减少衰老并发症，提高健康寿命的因素。大多数PLWH从事较少的体力活动 (Pa)高于公共卫生准则所建议的水平。因此，增加PA可能会导致大量的精神和心理问题 PLWH的身体健康益处。目前在PLWH中的研究通常集中在受监督的影响 锻炼身体。然而，对于这种类型的PA来说，有很多障碍。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 持续增加的PA。这项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PLWH患者的LPA。我们利用多阶段优化策略 (MOST)作为开发、优化和评估多组分行为干预的框架。 MOST由三个阶段组成。首先，在准备阶段，经验和理论驱动的概念 开发了识别可区分的干预组件并指定优化标准的模型 (即，干预发展的目标)。我们已经完成了这一阶段。第二，在优化阶段， 对每个干预因素对预期结果的影响进行了实证检验。我们的目标是 确定最终干预方案中应包括哪些成分，该方案针对有效性和 效率。拟议的研究反映了第二阶段，即优化试验。最后，在评价中 在传统随机对照试验中，对优化的干预方案的有效性进行评估；这将是下一个阶段 在目前提议的项目之后进行这方面的研究。在这个项目中，我们将测试 干预4个月后，三个可分离的干预成分每天步数。我们将招募208人 ≥年龄50岁的PLWH被归类为低活动性。所有参与者都收到组件‘0’：关于锻炼的简短建议 和一个Fitbit活动跟踪器。然后，我们在析因设计中测试另外3个组件：1)PA培训- 侧重于目标设定和自我监控；2)认知-行为干预(CB-PA)-侧重于 确定价值观并解决PA的内部障碍，如疼痛、抑郁或疲劳；3)社会支持 For PA(SS-PA)-利用Fitbit应用程序的社交功能的组件，促进社交 支持和友好竞争。主要结果将是第4个月期间每天的步数。观察到的 3个候选组件的主要影响和交互作用将指导选择要包括的组件 在优化的干预中，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、精神健康、 健康、心血管疾病风险和虚弱表型。