WalkIT: Neighborhood walkability and moderation of adaptive walking interventions

 描述(申请人提供)：运动就是药。已知的中等到剧烈体力活动(MVPA)的好处包括改善心肺健康、肥胖、骨骼健康、心血管疾病风险因素、某些癌症以及抑郁和焦虑症状。尽管如此，8%的美国成年人符合MVPA指南。增加MVPA的现有干预措施大多是相对静态的(教育材料或内容，如参与MVPA的目标不会随着时间的推移而改变)，而且是在个人一级。技术和理论的进步使得对MVPA的适应性干预(AIS)对个人来说是可行的。与静态干预不同，人工智能具有时变组件，以独特的方式响应个人的表现和不断变化的需求。人工智能有可能减少治疗错配，增加依从性，增强效力，并使行为医学个性化。微激励(MI)是“较小的、较早的激励”，用于实现目标，可以通过技术实现，并假设比“较大的、较晚的激励”产生更大的MVPA。综合管理信息系统和人工智能系统有可能促进MVPA的采用。此外，多层次生态模型假定，体力活动对建成环境的设计很敏感。从生态模型得出的一个核心假设是，步行能力较低的社区限制了体育活动的采用和维持，即使在个人层面的干预背景下也是如此，以增加此类行为。高步行社区的假设是为PA的采用和维护提供一个支持性的环境，增强个人层面干预的效果。很少有研究先验地检验了这样一个前提，即当在支持(而不是不支持)身体活动的邻里环境中进行个人层面的干预时，会导致更多的人采用和维持MVPA。在我们试点工作的基础上，我们将开发新的适应性(AI)和微激励(MI)干预措施，并在一项四臂随机析因试验中测试它们与静态(SI)和延迟激励干预(DI)的对比，以增加480名不活跃的男性和女性(18-60岁)的MVPA。利用地理信息系统测量的社区可步行性和社会经济状况，我们将从四种社区类型招募参与者：“高可步行/高SES”、“高可步行/低SES”、“低可步行/高SES”和“低可步行/低SES”。析因设计和抽样方法将使我们能够在多水平框架内测试干预措施和邻里因素对MVPA采用和维护的协同或拮抗交互作用效果。这项建议的主要目的是(1)在12个月内测试人工智能和管理信息对MVPA每天分钟的主要和交互影响；(2)调查人工智能和管理信息是否会在18和24个月时促进MVPA的持续；以及(3)确定在高步行(与低步行)社区进行的人工智能和管理信息(与SIS和DIS相比)是否会导致更多的人在12个月时采用MVPA，并在18和24个月时维持MVPA。结果将为未来生态模型的假设和MVPA的采用和维护以改善公共健康的研究提供依据。

 DESCRIPTION (provided by applicant): Exercise is medicine. Known benefits of moderate-to-vigorous physical activity (MVPA) include improvements to cardiorespiratory fitness, obesity, bone health, cardiovascular disease risk factors, some cancers, and depression and anxiety symptoms. Nevertheless, <8% of US adults as measured by accelerometry meet MVPA guidelines. The majority of existing interventions to increase MVPA have been relatively static (with educational materials or components such as goals to engage in MVPA not changing over time) and at the individual level. Technological and theoretical advances make adaptive interventions (AIs) for MVPA feasible for individuals. Unlike static interventions, AIs have time-varying components that respond uniquely to an individual's performance and changing needs. AIs have potential to reduce treatment mismatch, increase adherence, enhance potency, and personalize behavioral medicine. Micro-incentives (MIs) that are "smaller, sooner incentives" for goal attainment are possible with technology and hypothesized to result in greater MVPA than "larger, later incentives". Combined MIs and AIs have the potential to enhance adoption of MVPA. Additionally, multilevel ecological models posit that physical activity is sensitive to the design of built environments. One core hypothesis derived from ecological models is that low walkable neighborhoods constrain physical activity adoption and maintenance, even in the context of individual-level interventions to increase such behavior. High walkable neighborhoods are hypothesized to provide a supportive environment for PA adoption and maintenance, enhancing the effect of individual-level interventions. Few studies have tested a priori the premise that individual-level interventions result in greater adoption and maintenance of MVPA when conducted in neighborhood environments supportive (vs. unsupportive) of physical activity. Based on our pilot work, we will develop novel adaptive (AI) and micro-incentive (MI) interventions and test them against static (SI) and delayed-incentive interventions (DI) in a 4-arm, randomized factorial trial to increase MVPA among 480 inactive men and women (18-60 years). Using GIS-measured neighborhood walkability and socioeconomic status, we will recruit participants from four neighborhood types: "high walkable/high SES," "high walkable/low SES," "low walkable/high SES," and "low walkable/low SES." The factorial design and sampling approach will allow us to test, within a multilevel framework, synergistic or antagonistic interaction effects of interventions and neighborhood factors on MVPA adoption and maintenance. Primary aims of this proposal are to (1) test main and interaction effects for AIs and MIs on MVPA minutes/day by 12 months, (2) investigate whether AIs and MIs foster persistence of MVPA at 18 and 24 months, and (3) determine whether AIs and MIs (compared to SIs and DIs) conducted in high walkable (vs. low walkable) neighborhoods result in greater adoption by 12 months and maintenance of MVPA at 18 and 24 months. Results will inform future hypotheses of ecological models and studies for MVPA adoption and maintenance to improve public health.