Transforming Health by Reversing Inactivity among older Veterans Everywhere! (THRIVE!)

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Project Goals. The specific aims of this application are to establish the efficacy of novel telehealth-assisted exercise delivery models and plan for a state-of-the-art Phase II telehealth effectiveness trial. Long-term aim of Phase II. The long-term goal of our work is to transform the delivery of exercise-related health care for older Veterans anywhere and everywhere “Transforming Health by Reversing Inactivity among older Veterans Everywhere! (THRIVE!)”. We have a strong evidence base for our facility-based programs now in place at 15 sites across the VHA, and are in the early phase of developing new models of exercise delivery using telehealth. The results of this Phase I THRIVE! planning grant will accelerate the next phase of research by determining the effectiveness of telehealth-delivered exercise. Our facility- based program is already a VHA Best Practice designated as an effective alternative to institutional long-term care. The results of the planned Phase II trial, will contribute to a fully validated toolbox of exercise delivery options suitable for scaling up to meet the growing needs of the aging Veteran population anywhere and everywhere. Innovation. We will utilize an innovative screening algorithm that uses electronic diagnostic codes to identify Veterans eligible for safe home-based exercise. Our ability to reach Veterans anywhere in the country will allow us to test innovative models of exercise delivery deploying the new VHA platform for home- based care, Virtual Care Manager (VCM). With VCM we will pilot various methods of exercise delivery; once-a-week exercise supplemented by website-guided exercise or text messaging, remote exercise directly into the gym, and tailoring program offerings to Veteran preferences. We will assess patient safety, types of exercise feasible from the home, frequency of sessions, staffing load, ease of use, and adaptations of exercise for frail Veterans. Impact. Gerofit program participation results in robust outcomes indicating reduced risk for institutionalization. Four years after program enrollment, our Veterans demonstrate a sustained reversal of a once declining functional trajectory. We also documented significantly improved mental health, reduced prescribed medication use, a favorable cost to benefit ratio relative to Veterans Equitable Resource Allocation allocations along with compelling personal transformative stories. The ability to scale Gerofit-facilitated exercise throughout the country using tele-health has high potential to transform the care of aging, mobility impaired Veterans due to its evidence of cost savings and high quality of life impact. Phase I accomplishments. (1) To pilot a tele-health delivered exercise program to the home using the newest VA telehealth platform, VCM. (2) To assess the feasibility and success of VCM for group-based delivery as a “Go/ No Go” criterion for advancement to a Phase II trial. (3) To convene and engage a diverse Veteran Stakeholder group to serve as members of the planning group. 4) To convene and engage key VHA program office stakeholders in the planning and design of a Phase II multi-site effectiveness trial with program office supported dissemination and sustainment plans. Next Steps. Upon completion of this study, we will deploy and scale advances in tele-health that will facilitate bold transformations in the effective delivery of health promoting exercise to meet the growing needs of the aging Veteran population anywhere and everywhere