Peer-Facilitated Physical Activity Intervention Delivered During Methadone Maintenance

摘要 有250万美国人滥用或依赖阿片类药物。美沙酮维持 MMT是阿片类药物依赖最常见的治疗方法。虽然MMT在以下方面有效， 改善药物使用的结果，绝大多数人继续从事不健康的生活方式（例如， 缺乏身体活动），导致严重的精神和身体健康疾病，如心血管疾病 疾病、糖尿病、高血压、肥胖症、抑郁症、睡眠困难和认知障碍。鉴于 体力活动（PA）的身心健康益处，针对MMT中PA增加的干预措施 患者可以对降低总体发病率和死亡率产生重大影响。 本研究的目的是开发一种可行的，可接受的和有效的多层次PA干预， 解决了在卫生保健环境中提供的个人和人际因素（即， 美沙酮诊所）。为此，我们建议在下列地点为已参与私人执业的失智症患者提供培训： 公共卫生推荐水平，以向身体不活跃的MMT患者提供基于组的PA干预 在一个大型社区美沙酮诊所越来越多的同行促进的巴勒斯坦权力机构干预措施， 被发现有效地增加和维持身体活动水平，但没有在物质滥用 人口。同伴在MMT中增加体力活动方面可能发挥特别重要的作用，因为这 人口面临着独特的和重大的障碍，以PA（例如，抑郁症，吸烟，药物使用的触发因素 环境）。成功通过这些障碍并且身体活跃的MMT同行 可以分享信息，帮助解决问题的障碍，作为榜样，并提供支持， 鼓励，从而帮助非活跃的MMT患者增加自我效能和维持PA的动机。 本研究的设计分2个阶段进行-R21阶段将专注于开发 同伴促进PA+Fitbit干预（Peer-PA+Fitbit），而R33阶段将评估同伴促进PA + Fitbit干预的有效性。 RCT中的PA+Fitbit。R21阶段将包括：1）与潜在同行的焦点小组， 非活动性MMT患者; 2）开发整合Fitbit使用的PA手册; 3）开发培训 同行协议; 4）在参与者社区确定安全，可步行的路径，以及5）12周的开放试点 试验（n=20），以测试Peer-PA+Fitbit干预的可行性和可接受性。R33阶段将 涉及将目前接受MMT的150名患者随机分配到三个组之一：1）Peer-PA+Fitbit干预， 2)接触控制健康组（Well+Fitbit），和3）家庭护理（UC）。后续评估将 在3个月、6个月和12个月时进行，以确定对体力活动的短期和长期坚持。我们 我希望这个项目将导致一个可扩展的，多层次的同行促进PA干预的发展 为MMT患者量身定制，从而改善这一高危人群的整体健康和福祉。

ABSTRACT There are 2.5 million Americans who abuse or are dependent on opioids. Methadone maintenance treatment (MMT) is the most common treatment for opioid dependence. While MMT has been effective in improving drug use outcomes, the overwhelming majority continue to engage in unhealthy lifestyles (e.g., physical inactivity) that lead to significant mental and physical health morbidities such as cardiovascular disease, diabetes, hypertension, obesity, depression, sleep difficulties, and cognitive impairments. Given the mental and physical health benefits of physical activity (PA), interventions targeting increases in PA in MMT patients could have a significant impact on reducing the overall morbidity and mortality. The purpose of this study is to develop a feasible, acceptable and effective multilevel PA intervention that addresses both individual and interpersonal factors delivered in the context of a health care setting (i.e., methadone clinics). To do so, we are proposing to train MMT patients who are already engaging in PA at public health recommended levels to deliver a group-based PA intervention to physically inactive MMT patients at a large community-based methadone clinic. An increasing number of peer-facilitated PA interventions have been found to effectively increase and sustain physical activity levels, though none in substance abusing populations. Peers may play a particularly important role in increasing physical activity in MMT, as this population faces unique and significant barriers to PA (e.g., depression, smoking, triggers for drug use in environment). MMT peers who have successfully navigated through these barriers and are physically active can share information, help in problem solving barriers, act as role models, and offer support and encouragement, thereby helping inactive MMT patients increase self-efficacy and motivation for sustaining PA. The design of this study takes place in 2 phases -- the R21 phase will be focused on the development of a peer-facilitated PA+Fitbit intervention (Peer-PA+Fitbit), while the R33 phase will evaluate the efficacy of Peer- PA+Fitbit in an RCT. The R21 phase will consist of: 1) focus groups with potential peers and physically inactive MMT patients; 2) development of a PA manual that integrates use of the Fitbit; 3) developing a training protocol for peers; 4) identifying safe, walkable paths in participant neighborhoods, and 5) a 12-week open pilot trial (n=20) to test the feasibility and acceptability of the Peer-PA+Fitbit intervention. The R33 Phase will involve randomizing 150 patients currently receiving MMT to one of three arms: 1) Peer-PA+Fitbit intervention, 2) contact control wellness groups (Well+Fitbit), and 3) Usual Care (UC). Follow-up assessments will be conducted at 3, 6, & 12-months to determine both the short- and long-term adherence to physical activity. We expect that this project will lead to the development of a scalable, multilevel peer-facilitated PA intervention tailored to patients in MMT, thereby improving the overall health and well-being of this at-risk population.