Community-based Intervention Effects on Older Adults' Physical Activity and Falls

项目摘要/摘要 尽管有证据表明，以腿部力量和平衡为目标的体力活动(PA)可以减少跌倒，但不到12% 大多数老年人经常参加这些活动，跌倒的比率继续上升。研究 对激励老年人参与PA的干预策略的研究很少，也没有定论。这个 拟议的研究旨在解决跌倒预防科学中的这一差距。这项建议的目的是 确定导致PA增加的行为改变策略，并持续12个月，进而导致 减少跌倒，提高生活质量(QOL)。在先前研究的基础上，拟议的研究将使用 析因实验设计检验行为改变策略的相对影响 组件。这些组件由不同的行为改变策略集组成，这些策略代表 激励人们采取行动的两种不同方式：个人间的和个人内部的，与 关于行为变化和寿命发展的理论，以及经验证据。这些组件 将与包括Otago在内的核心干预内容相结合，Otago是一种以证据为基础的、减少跌倒的PA 协议，以及用于自我跟踪的PA监视器。我们将招募308名70岁及以上的社区居住成年人 随机将他们分配到以下四种情况之一：(A)奥塔戈+PA-MONITOR；(B)奥塔戈+PA-MONITOR+INTER- 个人部分；(C)Otago+PA-MONITOR+个人部分；和(D)Otago+PA-MONITOR+ 人与人之间+个人内部的组成部分。所有条件下的内容将在8周内交付至 社区中心的小团体。我们将在干预后重新评估所有参与者：立即，6 两个月和12个月来评估干预成分的短期和长期疗效。我们 假设接收到人际成分的参与者相对于没有接收到的参与者 这一组成部分将有a)在所有3个随访时间点的PA有临床意义的增加；以及b) 干预12个月后跌倒的减少和生活质量的改善。我们还将探讨以下方面的影响 有针对性的机制、激励结构(社会支持；就绪性；自我 规则)和跌倒风险的身体标志(功能平衡和力量)，以及这些是否 发病机制与PA和Fall的结局有关。我们假设收到个人间的 激励因素，相对于没有收到这个因素，将导致激励因素的增加 跌倒风险的结构和物理标志，它们将中介干预对PA和跌倒的影响。这个 提出的研究具有创新性，因为它代表了面向生物力学的实质性扩展 A)检查哪些行为改变策略会产生持续的影响(例如，12 几个月)，以及在下降，以及生活质量；和b)探索PA和 瀑布。这项拟议研究的长期目的是优化针对老年人的PA干预，该干预可以 被社区组织用来推广PA，减少跌倒，改善生活质量。

Project Summary/ Abstract Despite evidence that physical activities (PA) targeting leg strength and balance reduce falls, less than 12% of older adults engage in these activities on a regular basis and fall rates continue to increase. Research examining intervention strategies that motivate older adults to engage in PA is scarce and inconclusive. The proposed research aims to address this gap in fall prevention science. The objective of this proposal is to identify behavioral change strategies that elicit increased PA, sustained for 12 months and, in turn, lead to a reduction in falls and improved quality of life (QOL). Building on prior research, the proposed study will use a factorial experimental design to test the relative influence of behavioral change strategies separated into two components. These components are comprised of distinct sets of behavior change strategies that represent two different ways of motivating people to take action: inter-personal and intra-personal, consistent with theories of behavioral change and life-span development, as well as empirical evidence. These components will be combined with core intervention content that includes Otago, an evidence-based, fall-reducing PA protocol, and a PA-monitor for self-tracking. We will recruit 308 community-dwelling adults > 70 years old and randomly assign them to one of four conditions: (a) Otago + PA-monitor; (b) Otago + PA-monitor + inter- personal component; (c) Otago + PA-monitor + intra-personal component; and (d) Otago + PA-monitor + inter-personal + intra-personal components. Content within all conditions will be delivered over 8 weeks to small groups in community centers. We will re-assess all participants post-intervention: immediately, 6 months and 12 months to evaluate the short and long-term efficacy of the intervention components. We hypothesize that participants receiving the inter-personal component, relative to participants not receiving this component, will have a) clinically meaningful increases in PA at all 3 follow-up time points; and b) reductions in falls and improved quality of life 12 months post-intervention. We will also explore the effects of intervention components on targeted mechanisms, motivational constructs (social support; readiness; self- regulation) and physical markers of fall risk (functional balance and strength), and whether these mechanisms are associated with PA and fall outcomes. We hypothesize that receiving the inter-personal motivational component, relative to not receiving this component, will elicit increases in motivational constructs and physical markers of fall risk, which will mediate the intervention’s effects on PA and falls. The proposed research is innovative, because it represents a substantive expansion of biomechanically-oriented fall-reducing PA protocols to a) examine which behavioral change strategies elicit sustained effects (e.g., 12 months) on increased PA, as well as on falls, and QOL; and b) explore underlying mechanisms of PA and falls. The long-term intent of the proposed research is to optimize a PA intervention for older adults that can be used by community-based organizations to promote PA, reduce falls, and improve QOL.