Peer Empowerment Program for Physical Activity in Low Income & Minority Seniors

描述（由申请人提供）：低收入和少数族裔老年人体育活动同伴赋权计划老年人是美国最不活跃的人群。然而，研究表明，体力活动（PA）的增加可以对心血管健康产生直接而深远的影响。活跃的老年人使用的医疗资源明显较少，随着美国老年人数量的增加，遏制这一群体的医疗支出势在必行。许多PA干预措施是有缺陷的，因为它们关注个人动机，而忽略了社区资源、社区步行性和安全性的变化。低收入和种族多元化社区的资源和社区支持度都相对较低。这导致了较低的PA水平和肥胖、糖尿病、高血压和心脏病的健康差异。国家和国际卫生机构呼吁以社区为基础的PA项目来改善人口健康。老年中心是PA干预的理想场所，因为它们为大量老年人提供服务，并且有提供基于证据的项目的资助机制。虽然不同的健身计划有多种好处，但国家健身指南仍然强调有氧运动。老年中心目前提供以团体为基础的PA项目，但我们的初步研究表明，1)参加这些中心的低收入、种族多样化的老年人不符合PA指南，2)这些中心的基于证据的项目不能产生中等强度的PA， 3)他们没有提供行为策略来支持更频繁和独立的PA， 4)成员没有参与这些项目的实施，这可能会增加参与度和可持续性。我们建议在NHLBI R01资助的PA项目的基础上增加退休社区居民的有氧运动。该项目由加州大学圣地亚哥分校的健康教育工作者在同行领导的帮助下进行，为期6个月，然后持续了12个月。为了改进这项工作，我们提出了一种培训师模式，更侧重于授权同行领导、中心工作人员和参与者从一开始就自我监督、自我组织和倡导额外资源。由于我们的目标是测试一个PA计划，该计划可以被当地的老龄化机构采用，并使用《美国老年人法案》第三章的资金，我们将采用效率-实施混合设计；它允许同时测试干预和实施策略和结果。我们还将把项目监测延长至24个月。因此，在一项为期2年的随机对照试验中，来自12个低收入老年中心的408名不同种族的老年人（50岁以上）

DESCRIPTION (provided by applicant): Peer Empowerment Program for Physical Activity in Low Income & Minority Seniors Older adults are the least active population group in the US. Yet, research has shown that an increase in physical activity (PA) can have immediate and profound effects on cardiovascular health. Older adults who are active use significantly fewer health care resources, and with the increasing number of older adults in the US it is imperative to curb health care expenditure in this group. Many PA interventions are flawed because they focus on individual motivations and ignore variations in community resources, neighborhood walkability, and safety. Low income and ethnically diverse communities have disproportionately fewer resources and less supportive neighborhoods. This contributes to lower PA levels and health disparities in obesity, diabetes, hypertension and heart disease. National and international health institutions have called for community based PA programs to improve population health. Senior centers are an ideal setting for PA interventions because they serve a large number of older adults and there are funding mechanisms for delivery of evidence based programs. While there are multiple benefits of different PA programs, national guidelines for PA still emphasize aerobic activity. Senior Centers currently offer group based PA programs but our preliminary studies show that 1) low income, ethnically diverse older adults attending such centers are not meeting PA guidelines, 2) evidence based programs in such centers do not generate moderate intensity PA, 3) they do not provide behavioral strategies to support more frequent and independent PA and 4) members are not involved in the delivery of such programs which may increase engagement and sustainability. We propose to build upon our NHLBI R01 funded PA program that increased aerobic activity in retirement community residents. The program was delivered by UCSD health educators for 6 months with the help of peer leaders who then sustained it over 12 months. To improve upon this work, we propose a train the trainer model with a greater focus on empowering the peer leaders, center staff and participants to self-monitor, self-organize and advocate for additional resources from the start. Since our aim is to test a PA program that can be adopted by local area aging agencies with Older Americans Act Title IIID funds, we will employ an effectiveness-implementation hybrid design; which allows for the concurrent testing of both intervention and implementation strategies and outcomes. We will also extend program monitoring to 24 months. Thus, in a 2-year cluster randomized controlled field trial of 408 ethnically diverse, older adults (50+ years old) in 12 low income Senior Centers in San Diego County we will investigate the efficacy of PEP4PA (Peer Empowerment Program 4 Physical Activity) to reduce disparities in PA by increasing the percentage of participants achieving 150 minutes of PA per week and to improve physical functioning & fitness, blood pressure, depressive symptoms and quality of life at 6, 12 & 24 months. We will assess the incremental cost effectiveness ratio of PEP4PA in terms of cost per MET hour and cost per QALY compared to usual programming in the control centers at 12 & 24 months.