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

低收入群体体育活动同伴赋权计划

• 批准号: 8797221
• 负责人: Jacqueline Kerr
• 金额: $ 77.43万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8797221
• 关键词: Address; Adopted; Adult; Advocacy; Advocate; Aerobic Exercise; Affect; Age; Aging; American; Area; Behavioral; Blood Pressure; Caring; Caucasians; Chronic Disease; Cognitive; Communities; Counseling; County; Data; Deterioration; Diabetes Mellitus; Diagnosis; Disease; Education; Effectiveness; Elderly; Environmental Risk Factor; Evidence based program; Exercise; Funding; Funding Mechanisms; Guidelines; Health; Health Educators; Health Expenditures; Health Status; Healthcare; Hour; Hybrids; Hypertension; Income; Individual; Institution; International; Intervention; Life; Low income; Measures; Mental Depression; Minority; Modeling; Monitor; Motivation; National Health and Nutrition Examination Survey; National Heart, Lung, and Blood Institute; Neighborhoods; Obesity; Outcome; Participant; Performance; Physical Fitness; Physical Function; Physical activity; Population; Population Group; Positioning Attribute; Quality of life; Randomized; Recreation; Reporting; Research; Resources; Retirement; Route; Safety; Sleep; Testing; Time; Trainers Training; Variant; Walking; Work; base; behavior change; cardiovascular health; cost; cost effectiveness; depressive symptoms; design; empowered; empowerment; ethnic minority population; executive function; experience; functional loss; health disparity; hypertensive heart disease; improved; instructor; loss of function; meetings; member; peer; population health; prevent; programs; public health relevance; secondary outcome; sedentary; treatment as usual; volunteer

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.

描述（由申请人提供）：低收入和少数族裔老年人体育活动的同伴赋权计划老年人是美国最不活跃的人口群体。然而，研究表明，增加身体活动（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保健资源显著减少，随着美国老年人数量的增加，必须遏制这一群体的医疗保健支出。许多PA干预措施是有缺陷的，因为他们专注于个人动机，忽视了社区资源，邻里步行能力和安全的变化。低收入和种族多样化的社区资源少得不成比例，社区的支持也少得不成比例。这有助于降低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，因为它们为大量老年人提供服务，并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活动。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、种族多样的老年人不符合PA指南，2）此类中心的循证计划不会产生中等强度的PA，3）他们没有提供行为策略来支持更频繁和独立的PA，以及4）成员不参与这些方案的实施，这可能会增加参与度和可持续性。我们建议建立在我们的NHLBI R01资助的PA计划，增加退休社区居民的有氧活动。该计划由UCSD健康教育工作者在同行领导者的帮助下提供了6个月，然后持续了12个月。为了改进这项工作，我们提出了一个培训师模型，更注重授权同行领导者，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的资源。由于我们的目标是测试PA计划，可以通过当地的老龄化机构与美国老年人法案标题IIID基金，我们将采用有效性实施混合设计，这使得同时测试的干预和实施策略和结果。我们还将把项目监测时间延长至24个月。因此，在12个低收入老年中心的408名不同种族的老年人（50岁以上）的2年群集随机对照现场试验中， 在圣地亚哥县，我们将调查PEP4PA（同伴授权计划4体育活动）的有效性，通过增加每周达到150分钟PA的参与者百分比来减少PA的差异，并改善身体功能和健身，血压，抑郁症状和6，12和24个月的生活质量。我们将在12和24个月时评估PEP4PA的增量成本效益比，即与控制中心的常规编程相比，每MET小时的成本和每QALY的成本。