INSPIRE: Intervention to Support Participation in Regular Exercise in the Elderly

描述（由申请人提供）：患有多种慢性疾病的老年人残疾和不良临床事件的风险较高，可以通过体力活动改善结果，但目前还没有试验为这一弱势人群建立体力活动建议或临床指南。高并发症的老年人是一个迅速扩大的亚组，因此迫切需要开发有效的方法来激励维持体力活动以改善结果。申请人和导师最近进行的一项随机对照试验确定了诱导积极情感（幸福感和幸福感）在激励患有心血管疾病的老年人进行身体活动方面的功效，但这种效果在患有多种慢性疾病的老年人中不能持续超过六个月。其他数据显示，Charlson指数e 3的参与者在1年内保持低水平活动，2年内主要临床事件的发生率显着降低。候选人的长期目标是成为老年行为医学的独立临床研究者，专注于改善患有多种慢性疾病的老年人的健康和生活质量。该项目的总体目标是实现这一目标的下一步，即利用定期运动积极影响诱导（PAIRE）干预措施所取得的初步成功，长期维持身体活动，专门针对患有多种高危慢性疾病的老年人。中心假设是，定制PAIRE干预，定制以满足Charlson指数e 3的老年人的独特和复杂需求，与教育对照相比，将导致持续增加体力活动，即使是那些有间歇性医疗事件或高度抑郁症状的人。目的1是使PAIRE干预措施适用于患有多种高危慢性病的老年人。该方法将依赖于一种新的和严格的顺序混合方法策略，以确定关键的心理和临床因素，介导和适度维持体力活动的老年人与多种高风险的慢性疾病，然后由焦点小组与患者和社区为基础的供应商，以评估潜在的干预组件的可接受性。目标2是对新的PAIRE干预措施进行试点测试，该措施专门针对患有多种高风险慢性疾病的老年人。这项工作的创新，因为它将转化的好处，一个行之有效的干预措施，重点是积极的影响，以增加身体活动的老年人与多种高风险的慢性疾病， 这是专门针对这一特别弱势群体的临床和心理社会挑战。这项工作意义重大，因为促进身体活动的有效干预措施将改善患有多种高风险慢性疾病的老年人的结果，而目前还不存在。该项目预计将产生重要的积极影响，因为它将产生新的经验证的PAIRE干预措施，同时将候选人定位为提交竞争性R01申请作为主要研究者，并实现老年行为医学工作的新的临床重要轨迹。

DESCRIPTION (provided by applicant): Older adults with multiple chronic diseases are at high risk for both disability and adverse clinical events, outcomes that can be improved with physical activity, but there have been no trials to establish physical activity recommendations or clinical guidelines for this vulnerable population. Older adults with high comorbidity are a rapidl expanding subgroup, and thus there is a pressing need to develop effective approaches to motivate maintenance of physical activity to improve outcomes. A recent randomized controlled trial conducted by the applicant and mentors established the efficacy of inducing positive affect-a feeling of happiness and well-being-in motivating physical activity in older adults with cardiovascular disease, but the effect was not sustained beyond six months in older adults with multiple chronic diseases. Additional data shows that participants with a Charlson Index e 3 who maintained low levels of activity for 1 year had significantly lower rates of major clinical event t 2 years. The candidate's long-term goal is to become an independent clinical investigator in geriatric behavioral medicine focused on improving the health and quality of life of older adults with multiple chronic illnesses. The overall objective of this project, which is the next step towad that goal, is to leverage the initial successes achieved by the Positive Affect Induction for Regular Exercise (PAIRE) intervention for long-term maintenance of physical activity, targeted specifically to older adults with multiple high-risk chronic diseases. The central hypothesis is tht a tailored PAIRE intervention, customized to address the unique and complex needs of older adults with a Charlson Index e 3, will lead to sustained increases physical activity when compared to an educational control, even among those who have interval medical events or high depressive symptoms. Aim 1 is to adapt the PAIRE intervention to older adults with multiple high-risk chronic diseases. The approach will rest upon a novel and rigorous sequential mixed methods strategy to identify key psychosocial and clinical factors that mediate and moderate maintenance of physical activity in older adults with multiple high-risk chronic diseases, followed by focus groups with patients and community-based providers to assess the acceptability of potential intervention components. Aim 2 is to pilot test the new PAIRE intervention that is specific to older adults with multiple high-risk chronic illnesses. This work s innovative because it will translate the benefits of a proven intervention focused on positive affect to increase physical activity in older adults with multiple high-risk chronic illnesses, one that is tailored to the clinical and psychosocial challenges of this particularly vulnerable population. This work is significant because an effective intervention promoting physical activity will improve outcomes for older adults with multiple high-risk chronic diseases, and currently one does not exist. This project is expected to have an important positive impact because it will result in a new validated PAIRE intervention, while both positioning the candidate to submit a competitive R01 application as Principal Investigator, and enabling a novel and clinically important trajectory of work in geriatric behavioral medicine.