MIPARC - Multilevel Intervention for Physical Activity in Retirement Communities

描述(由申请人提供)：参加定期体力活动(PA)与减少老年人所有原因的发病率和死亡率有关，特别是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%的人符合PA的建议。因此，开发和评估促进老年人PA的干预措施是重要的。生态学模型认为，当行为干预在包括个人、人际、环境和政策在内的多个层面上运作时，行为干预是最有效的。许多老年人生活在持续护理退休社区(CCRC)，这些环境为提供和评估基于这种生态方法的PA干预提供了一个极好的环境。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，需要鼓励和支持才能更多地锻炼身体。大多数CCRC都有地方管理结构，为政策宣传提供机会，以改善PA和步行的社会和建筑环境。这项研究将使用一组随机对照设计测试为期6个月的多水平PA干预的有效性，MIPARC(退休社区中PA的多水平干预)。MIPARC将与圣地亚哥16个CCRC中320名久坐(每日步数在1000-5000步之间)的老年(65岁)居民的成功老龄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(步行指示牌提示、定制步行地图、张贴的步数和PA资源枚举)以及政策组成部分(审查现场活动机会和步行能力、变革建议和同伴主导的倡导)。我们的主要目的是测试这样一种假设，即居住在退休社区的久坐居民接受为期6个月的MIPARC干预后，与对照条件相比，他们的光和中等强度PA的分钟数将显著增加(通过7天加速计测量)。我们的第二个目标是检验这一假设，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。探索性目标将考察MIPARC对个人、人际、环境和PA的政策调解人和主持人的影响。12个月收集的过程措施将用于检查在主要试验期间执行MIPARC的忠诚度，它是否在干预后的6个月期间持续，以及在后一段时间内是否对PA产生持续影响。将采用混合模型分析来考虑嵌套设计，场地作为随机效应。据我们所知，这项研究将是第一次评估多水平的生态干预措施，以促进生活在CCRC的老年人的PA。

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.