A Tailored Physical Activity Smartphone App for Patients with Alcohol Dependence

 描述（由申请人提供）：酒精使用障碍（AUDs）非常普遍，是一个代价高昂的公共卫生问题。鉴于有令人信服的证据表明增加体力活动对身体健康和心理功能有益，以及关于预防酒精复发的有希望的发现，帮助AUD患者采用和维持增加的体力活动水平（PA）的努力可能会对公共卫生产生重大影响。 人们一直关注在这一不健康的高危人群中制定多层次的身体活动干预措施。基于使用技术所提供的可扩展性和传播优势，我们建议开发一个基于智能手机的体力活动应用程序（应用程序），我们称之为Fit&Sober，为AUD患者量身定制。大多数现有的PA应用程序都缺乏基于理论的概念来影响行为改变。然而，结合了与体力活动促进相关的关键行为原则的PA应用程序已经证明了增加体力活动的有希望的结果，尽管没有一个应用程序被检查或针对AUD个体定制。以自我决定理论和社会认知理论为基础，我们将为AUD患者开发Fit&Sober应用程序，通过设计帮助患者制定内在价值驱动目标的功能（例如，与清醒有关的益处的锻炼），特别关注于增加与PA相关联的即时奖励的显著性（例如，减少酒精冲动/渴望和改善的影响）。从AUD早期恢复，当负面影响是复发的风险，并且饮酒的冲动很常见时，可能是一个合适的时机，通过经验性地将运动与影响和渴望的急性改善联系起来，帮助患者发展内化，自我决定的动机。这项研究的设计分两个阶段进行-R21阶段将专注于开发Fit&Sober应用程序，而R33阶段将致力于评估应用程序在小型RCT中的初步疗效。R21阶段（第1年和第2年）将包括3个阶段：1）开发Fit&Sober原型; 2）对AUD患者和成瘾治疗顾问的焦点小组进行一系列可用性研究;以及3）为期12周的开放试点试验（n=20），以测试Fit&Sober应用程序的可行性和可接受性。（第3-5年）将涉及随机分配160名目前正在接受酒精成瘾治疗的患者， 部分住院治疗计划：1）一次简短的建议（BA）会议，以增加PA加上 健身和清醒应用程序或2）一个BA会话。将在3个月、6个月和12个月时进行随访评估，以确定短期和长期坚持体力活动和应用程序使用的情况。我们预计，该项目将导致开发一种为AUD患者量身定制的新型PA应用程序，为他们提供传统治疗的宝贵辅助手段，可以在任何环境和任何时间提供，从而改善他们的整体健康和福祉。

 DESCRIPTION (provided by applicant): Alcohol Use Disorders (AUDs) are highly prevalent and a costly public health problem. Given the compelling evidence for the benefits of increased physical activity for physical health and psychological functioning as well as promising findings regarding alcohol relapse prevention, efforts to help patients with AUDs adopt and sustain increased levels of physical activity (PA) are likely to result in significant public health impact Yet, not only are patients with AUDs engaging in low levels of physical activity, relatively little attention has been given to the development of multilevel physical activity interventions in this unhealthy, at-risk population. Building on the advantages for scalability and dissemination afforded by the use of technology, we propose to develop a smartphone-based physical activity application (app), which we call Fit&Sober, tailored for patients with AUDs. Most existing PA apps suffer from a lack of theory-based concepts known to influence behavior change. However, PA apps that incorporate key behavioral principles relevant to physical activity promotion have demonstrated promising results of increases in physical activity, though none have been examined or tailored for individuals with AUDs. Grounded in Self-Determination Theory and Social Cognitive Theory, we will develop the Fit&Sober app for patients with AUDs by designing features that will help patients develop intrinsic, value-driven goals (e.g., exercisig for benefits related to sobriety) with a particular focus on increasing the saliency of immediate rewards associated with PA (e.g., decreased alcohol urges/craving and improved affect). Early recovery from AUDs, when negative affect is a risk for relapse and urges to drink are common, may be an opportune time to help patients develop internalized, self-determined motivation through experientially making connections between exercise and acute improvements in affect and cravings. The design of this study takes place in 2 phases -- the R21 phase will be focused on the development of the Fit&Sober app, while the R33 phase will be devoted to evaluating the preliminary efficacy of the app in a small RCT. The R21 phase (Years 1 & 2) will consist of 3 stages: 1) development of the Fit&Sober prototype; 2) series of usability studies with patients with AUDs and focus group with addiction treatment counselors; and 3) a 12-week open pilot trial (n=20) to test the feasibility and acceptability of the Fit&Sober app. The R33 Phase (Years 3-5) will involve randomizing 160 patients currently receiving treatment for alcohol addiction at a partial hospitalization program to either: 1) one brief advice (BA) session to increase PA plus the Fit&Sober app OR 2) one BA session. Follow-up assessments will be conducted at 3, 6, & 12-months to determine both the short- and long-term adherence to physical activity and app usage. We expect that this project will lead to the development of a novel, PA app tailored to patients with AUDs, providing them with a valuable adjunct to traditional treatment that can be delivered in any setting and at any time, thereby improving their overall health and well-being.