INSPIRE: Intervention to Support Participation in Regular Exercise in the Elderly

描述（由申请人提供）：患有多种慢性疾病的老年人在残疾和不良临床事件方面都有很高的风险，结果可以通过体育锻炼来改善，但目前还没有针对这一弱势群体建立体育锻炼建议或临床指南的试验。具有高合并症的老年人是一个迅速扩大的亚群，因此迫切需要开发有效的方法来激励维持身体活动以改善结果。最近，申请人和导师进行了一项随机对照试验，证实了在患有心血管疾病的老年人中诱导积极情绪（一种幸福和幸福的感觉）激励体育锻炼的功效，但这种效果在患有多种慢性疾病的老年人中持续时间不超过6个月。另外的数据显示，Charlson指数为e - 3的参与者在1年内保持低水平的活动，在2年内发生重大临床事件的几率显著降低。候选人的长期目标是成为一名独立的老年行为医学临床研究者，专注于改善患有多种慢性疾病的老年人的健康和生活质量。该项目的总体目标是实现这一目标的下一步，即利用定期运动积极影响诱导（PAIRE）干预所取得的初步成功，长期维持身体活动，专门针对患有多种高风险慢性病的老年人。中心假设是，与教育控制相比，针对Charlson指数为e 3的老年人的独特和复杂需求而定制的PAIRE干预将导致持续的身体活动增加，即使在那些有间隔医疗事件或高度抑郁症状的人中也是如此。目的1是使PAIRE干预适应于患有多种高风险慢性疾病的老年人。该方法将基于一种新颖而严格的顺序混合方法策略，以确定在患有多种高风险慢性病的老年人中调节和适度维持身体活动的关键社会心理和临床因素，然后与患者和社区提供者进行焦点小组讨论，以评估潜在干预成分的可接受性。目的2是对新的PAIRE干预进行试点测试，该干预针对患有多种高风险慢性疾病的老年人。这项工作是创新的，因为它将把一种已证实的专注于积极影响的干预措施的好处转化为增加患有多种高风险慢性疾病的老年人的身体活动

DESCRIPTION (provided by applicant): Older adults with multiple chronic diseases are at high risk for both disability and adverse clinical events, outcomes that can be improved with physical activity, but there have been no trials to establish physical activity recommendations or clinical guidelines for this vulnerable population. Older adults with high comorbidity are a rapidl expanding subgroup, and thus there is a pressing need to develop effective approaches to motivate maintenance of physical activity to improve outcomes. A recent randomized controlled trial conducted by the applicant and mentors established the efficacy of inducing positive affect-a feeling of happiness and well-being-in motivating physical activity in older adults with cardiovascular disease, but the effect was not sustained beyond six months in older adults with multiple chronic diseases. Additional data shows that participants with a Charlson Index e 3 who maintained low levels of activity for 1 year had significantly lower rates of major clinical event t 2 years. The candidate's long-term goal is to become an independent clinical investigator in geriatric behavioral medicine focused on improving the health and quality of life of older adults with multiple chronic illnesses. The overall objective of this project, which is the next step towad that goal, is to leverage the initial successes achieved by the Positive Affect Induction for Regular Exercise (PAIRE) intervention for long-term maintenance of physical activity, targeted specifically to older adults with multiple high-risk chronic diseases. The central hypothesis is tht a tailored PAIRE intervention, customized to address the unique and complex needs of older adults with a Charlson Index e 3, will lead to sustained increases physical activity when compared to an educational control, even among those who have interval medical events or high depressive symptoms. Aim 1 is to adapt the PAIRE intervention to older adults with multiple high-risk chronic diseases. The approach will rest upon a novel and rigorous sequential mixed methods strategy to identify key psychosocial and clinical factors that mediate and moderate maintenance of physical activity in older adults with multiple high-risk chronic diseases, followed by focus groups with patients and community-based providers to assess the acceptability of potential intervention components. Aim 2 is to pilot test the new PAIRE intervention that is specific to older adults with multiple high-risk chronic illnesses. This work s innovative because it will translate the benefits of a proven intervention focused on positive affect to increase physical activity in older adults with multiple high-risk chronic illnesses, one that is tailored to the clinical and psychosocial challenges of this particularly vulnerable population. This work is significant because an effective intervention promoting physical activity will improve outcomes for older adults with multiple high-risk chronic diseases, and currently one does not exist. This project is expected to have an important positive impact because it will result in a new validated PAIRE intervention, while both positioning the candidate to submit a competitive R01 application as Principal Investigator, and enabling a novel and clinically important trajectory of work in geriatric behavioral medicine.