Testing Multi-Level Remote Physical Activity Interventions in a National Sample of Older Women: The WHISH EnCore Trial

项目摘要/摘要 老年妇女受到一系列慢性病和疾病的影响不成比例，例如 认知障碍，可以通过有规律的体力活动(PA)来缓解，包括步行；然而，他们 是美国人口中最不活跃的部分。虽然大多数老年女性使用智能手机， 很少有远程提供的PA干预措施专门针对这个年龄+性别的PA开发的 差距，而且很少有这样的干预措施利用可能每天都会增加的既有和社会环境因素 爸。使用健康行为变化的动态社会生态模型，这项研究的主要目的是 是为了提高对老年妇女的远程教育干预的效果 通过测试创新、远程交付的公民科学计划的额外影响，以识别和 解决步行和其他PA的当地环境障碍(称为Our Voice TM[OV])。“轻触” 自2015年以来，已向23,000名妇女提供了PA教育方案，至今已有70年 参与全美妇女健康倡议(Whish)务实的PA试验 (U01HL122280-03)。WHISH使用了一个务实的“选择退出”同意注册程序，其中包括 在PA干预研究中发现的最广泛的PA、身体功能水平和地理区域 约会。最初的Whish教育计划带来了显著但总体上不大的PA增长- 在整个WHISH人群中，调查表明许多WHISH参与者可以受益 强烈反对进一步干预。原始远程程序的丰富版本(称为Encore)将 在拟议的审判中单独担任重演。解决当地建筑和社会环境PA问题 许多Whish女性描述的障碍，移动应用程序加上基于网络的OV计划将被添加到 安可(安可+OV ARM)。我们将随机选取300名接受干预的妇女(平均年龄=85岁 年。)用智能手机不够活跃的两只胳膊。我们假设女性会收到 与接受安可的女性相比，安可+OV将显示出更高的计步器测量的12个月PA水平 独自一人。其他问题包括认知功能和久坐行为的变化；探索一种理论- 从理论上推导出的假定调解者的多级别集合(例如，社会凝聚力，评价的邻里可走性， 社区寻路)和项目成功的基准主持人(例如，种族/民族、家庭支持、 地理区域)；以及探索两个计划在PA变化方面的相对成本。这项研究将补充 有关将这些远程交付、实用和 针对这一快速增长的人口群体的潜在可扩展的行为健康交付方法。

Project Summary/Abstract Older women are disproportionately impacted by a range of chronic diseases and conditions, such as cognitive impairments, that can be alleviated by regular physical activity (PA), including walking; yet they are the most inactive segment of the US population. While the majority of older women use smartphones, few remotely delivered PA interventions have been developed specifically to address this age + gender PA disparity, and few such interventions leverage built and social environmental factors that can increase daily PA. Using a dynamically based socio-ecological model of health behavior change, this study’s primary aim is to enhance the efficacy of a “light-touch”, remotely delivered PA educational intervention for older women by testing the added impacts of an innovative, remotely delivered citizen science program to identify and address local environmental barriers to walking and other PA (called Our Voice TM [OV]). The “light-touch” PA educational program has been delivered since 2015 to >23,000 women >70 years that have been participating in the U.S.-wide Women’s Health Initiative Strong and Healthy (WHISH) pragmatic PA trial (U01HL122280-03). WHISH, which used a pragmatic, ‘opt-out’ consent enrollment process, includes the broadest range of PA, physical function levels, and geographic regions found in PA intervention studies to date. The original WHISH educational program has resulted in significant but generally modest PA increas- es in the overall WHISH population, and surveys indicate that many WHISH participants could benefit strongly from further intervention. An enriched version of the original remote program (called enCore) will serve as the enCore Alone arm in the proposed trial. To address local built and social environmental PA barriers that many WHISH women describe, the mobile app plus web based OV program will be added to enCore (enCore+OV arm). We will randomize a total of 300 WHISH intervention women (mean age=85 yrs.) with smartphones who are insufficiently active to the two arms. We hypothesize that women receiving enCore+ OV will show higher pedometer-measured 12-month PA levels than women receiving enCore Alone. Additional questions include changes in cognitive function and sedentary behavior; exploring a theo- retically derived multi-level set of putative mediators (e.g., social cohesion, rated neighborhood walkability, community wayfinding) and baseline moderators of program success (e.g., race/ethnicity, family support, geographic region); and exploring the relative costs of the two programs for PA change. The study will add important information on the benefits and trade-offs of combining these remotely delivered, practical, and potentially scalable behavioral health delivery approaches for this fast-expanding demographic group.