MIPARC - Multilevel Intervention for Physical Activity in Retirement Communities

描述（由申请人提供）：参与定期体力活动（PA）与降低老年人的全因发病率和死亡率有关，特别是由心脏事件和心血管疾病引起的发病率和死亡率。然而，对PA的客观监测表明，60岁以上的成年人中只有不到3%符合PA的建议。因此，重要的是要制定和评估干预措施，促进PA的老年人。生态模型认为，行为干预在个体、人际、环境和政策等多个层面上发挥作用时最为有效。许多老年人生活在持续护理退休社区（CCRC），这些设置提供了一个很好的环境，在其中提供和评估PA干预措施，是基于这种生态方法。我们的试点工作发现，CCRC居民大多久坐不动，受环境影响很大，需要鼓励和支持来进行更多的体育活动。大多数社区康复中心都有当地的管理结构，为政策宣传提供机会，以改善PA和步行的社会和建筑环境。本研究将采用分组随机对照设计，测试为期6个月的多层次PA干预MIPARC（退休社区PA多层次干预）的有效性。将在圣地亚哥16个CCRC的320名久坐（每日步数在1000- 5000步之间）的老年人（>65岁）居民中将MIPARC与成功的老化教育注意力控制条件进行比较。MIPARC包括个人组成部分（基于计步器的自我监测，教育材料和定制的每月咨询电话），人际组成部分（每月小组会议和同伴指导），环境组成部分（步行标志提示，定制的步行地图，张贴步数和PA资源枚举）和政策组成部分（现场活动机会和步行性的审查，变革建议和同伴领导的宣传）。我们的主要目的是检验这一假设，即与对照条件相比，接受6个月MIPARC干预的居住在退休社区的久坐居民将显著增加其轻度和中度强度PA的分钟数（通过7天加速度计测量）。我们的次要目的是检验假设，即与对照条件相比，MIPARC显著改善血压、体力活动表现和生活质量。探索性目标将研究MIPARC对个人，人际，环境和政策调解人和主持人的PA的影响。收集12个月的过程测量将用于检查主试验期间MIPARC实施的保真度，是否持续6个月的干预后阶段，以及在后一阶段是否观察到对PA的持续影响。将采用混合模型分析来解释嵌套设计，研究中心作为随机效应。据我们所知，这项研究将是第一个评估多层次的生态干预，以促进PA在老年人生活在CCRC。 公共卫生相关性：据我们所知，这是第一项针对不断增长的老年人疾病风险人群设计、实施和评估长期多层次体力活动干预的研究。老年人将大大受益于增加他们的活动水平，这项研究将告知退休社区的体育活动机会的设计和提供。

DESCRIPTION (provided by applicant): Participation in regular physical activity (PA) is related to reduced all cause morbidity and mortality in older adults, in particular that caused by cardiac events and cardiovascular disease. However, objective monitoring of PA suggests that fewer than 3% of adults over age 60 meet PA recommendations. Thus it is important to develop and evaluate interventions that promote PA for older adults. Ecological models posit that behavioral interventions are most effective when they operate on multiple levels including individual, interpersonal, environment and policy. Many older adults live in Continuing Care Retirement Communities (CCRCs) and these settings provide an excellent environment in which to deliver and evaluate PA interventions that are based upon this ecological approach. Our pilot work has found that CCRC residents are mostly sedentary, highly influenced by their environment, and in need of encouragement and support to be more physically active. Most CCRCs have local management structures that provide opportunities for policy advocacy to improve social and built environments for PA and walking. This study will test the efficacy of a 6-month multilevel PA intervention, MIPARC (Multilevel Intervention for PA in Retirement Communities), using a group randomized controlled design. MIPARC will be compared to a successful aging educational attention control condition in 320 sedentary (daily step count between 1000- 5000 steps) older adult (>65 years) residents of 16 CCRCs in San Diego. MIPARC includes individual components (pedometer based self monitoring, educational materials and tailored monthly counseling calls), interpersonal components (monthly group sessions and peer mentoring), environmental components (walking signage prompts, tailored walking maps, posted step counts, and PA resource enumeration), and policy components (review of onsite activity opportunities and walkability, recommendations for change, and peer led advocacy). Our Primary Aim is to test the hypothesis that sedentary residents living in retirement communities who receive the 6-month MIPARC intervention will significantly increase their minutes of light and moderate intensity PA (measured by 7-day accelerometry) compared to the control condition. Our Secondary Aim is to test the hypothesis that, compared to the control condition MIPARC significantly improves blood pressure, physical activity performance and quality of life. Exploratory Aims will examine the impact of MIPARC on individual, interpersonal, environmental, and policy mediators and moderators of PA. Process measures collected for 12 months will be used to examine the fidelity of MIPARC implementation during the main trial, whether it is sustained for the 6-month post-intervention period and whether continued effects on PA are seen during this latter period. Mixed model analyses will be employed to account for the nested design, with site as a random effect. To our knowledge, this study will be the first to assess a multilevel ecological intervention to promote PA in older adults living in CCRCs. PUBLIC HEALTH RELEVANCE: To our knowledge, this is the first study to design, implement and evaluate a long term multilevel physical activity intervention for a growing older adult population at risk for disease. Older adults will greatly benefit from increasing their activity levels and this study will inform the design and provision of physical activity opportunities in retirement communities.