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(AUD)非常普遍，是一个代价高昂的公共卫生问题。鉴于令人信服的证据表明，增加体育锻炼对身体健康和心理功能的好处，以及关于预防酒精复发的有希望的发现，帮助AUDS患者采用并维持更高水平的体育活动(PA)的努力可能会导致重大的公共健康影响，但AUDS患者不仅从事低水平的体育活动，而且相对较少 已经注意到在这一不健康的高危人群中制定多层次的体育活动干预措施。在利用技术提供的可扩展性和传播优势的基础上，我们建议开发一个基于智能手机的体力活动应用程序(APP)，我们称之为Fit&Sober，为AUDS患者量身定做。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，整合了与促进体力活动相关的关键行为原则的PA应用程序已经展示了增加体力活动的良好结果，尽管还没有针对AUD患者进行检查或量身定做。以自我决定理论和社会认知理论为基础，我们将为AUDS患者开发Fit&Sober应用程序，通过设计功能来帮助患者制定内在的、价值驱动的目标(例如，努力实现与清醒相关的好处)，并特别关注增加与PA相关的即时奖励的显著程度(例如，减少酒精冲动/渴望和改善情绪)。AUDS的早期康复，当负面情绪是复发的风险和饮酒冲动很常见时，可能是帮助患者通过经验将锻炼与情绪和渴望的急剧改善联系起来，形成内在化的、自主的动机的好时机。这项研究的设计分两个阶段进行--R21阶段将专注于Fit&Sober应用程序的开发，而R33阶段将致力于评估该应用程序在小型随机对照试验中的初步疗效。R21阶段(第1年和第2年)将包括3个阶段：1)Fit&Sober原型的开发；2)针对AUDS患者和有成瘾治疗顾问的焦点小组进行的一系列可用性研究；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。R33阶段(3-5年)将包括随机选择目前正在接受酒精成瘾治疗的160名患者 部分住院计划：1)一次简短的建议(BA)会议，以增加PA加上 Fit&Sober应用程序或2)一次BA课程。将在3个月、6个月和12个月进行后续评估，以确定短期和长期坚持体力活动和应用程序的情况。我们预计，该项目将导致为AUDS患者量身定做的新型PA应用程序的开发，为他们提供传统治疗的宝贵补充，可以在任何情况下和任何时间进行，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.