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

描述(由申请人提供)：针对低收入和少数族裔老年人的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，增加体力活动(PA)可以对心血管健康产生直接和深远的影响。活跃的老年人使用的医疗资源明显减少，随着美国老年人数量的增加，控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，因为它们侧重于个人动机，而忽视了社区资源、邻里可步行和安全方面的变化。低收入和种族多元化的社区拥有不成比例的更少的资源和更少的支持。这有助于降低PA水平，并在肥胖、糖尿病、高血压和心脏病方面造成健康差距。国家和国际卫生机构呼吁以社区为基础的PA计划，以改善人口健康。老年中心是PA干预的理想场所，因为它们服务于大量老年人，而且有提供循证方案的资金机制。虽然不同的PA计划有多种好处，但PA的国家指南仍然强调有氧运动。老年中心目前提供基于群体的PA计划，但我们的初步研究表明，1)参加此类中心的低收入、种族多元化的老年人不符合PA指南，2)此类中心基于证据的计划不会产生中等强度的PA，3)它们没有提供行为策略来支持更频繁和独立的PA，以及4)成员没有参与此类计划的实施，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计划的基础上，增加退休社区居民的有氧活动。该项目由加州大学圣迭戈分校的健康教育者在同行领导的帮助下进行了6个月，然后他们将其维持了12个月。为了改进这项工作，我们建议培训培训员模式，更注重增强同行领导、中心工作人员和参与者的自我监督、自组织和从一开始就倡导额外资源的能力。由于我们的目标是测试可由拥有老年美国人法案第IIID基金的当地老龄机构采用的PA计划，我们将采用有效性-实施混合设计；该设计允许同时测试干预和实施战略和结果。我们还将把计划监测延长到24个月。因此，在对12个低收入老年中心的408名不同种族的老年人(50岁以上)进行的为期2年的随机分组对照现场试验中 在圣地亚哥县，我们将调查PEP4PA(同伴赋权计划4体力活动)的有效性，通过增加参与者每周达到150分钟PA的百分比来减少PA中的差异，并在6个月、12个月和24个月时改善身体功能和健身、血压、抑郁症状和生活质量。我们将评估PEP4PA在12个月和24个月时与控制中心通常的编程相比的每表时成本和每QALY成本的增量成本效益比。

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.