Goal Setting to Promote Physical Activity Adherence in Midlife to Reduce Risk of Alzheimer's Disease and Related-Dementias: A Randomized Mechanistic Proof-of-Concept Trial

项目摘要 超过600万美国成年人患有阿尔茨海默病和相关痴呆症 (AD/ADRD)，预计到2050年病例高达1380万例。AD/ADRD没有治愈方法，使 生活方式是降低风险的关键目标，因为它们至少占AD/ADRD病例的三分之一。从事 有规律的体力活动(PA)，特别是在中年，与AD/ADRD风险降低有关。然而，几乎 一半的中年成年人(48%)没有达到国家规定的每周150分钟中等强度PA的PA标准。 设定目标是一种常用的行为改变策略，以增加PA。关键的心理社会机制 据悉，支持使用目标设置来促进PA的方法包括自我调节和自我效能。然而， 最有效的目标设定技巧，以加强这些成功晋升的心理社会机制 目前仍不清楚巴勒斯坦权力机构是否遵守国家权力机构的指导方针。在拟议的研究中，我们将使用两个- 分阶段实证检验三种提高自我心理社会机制的目标设置技术 监管和自我效能感，以成功地促进PA并遵守国家PA指南，包括 患有肥胖症的中年成年人活动不足。在R61阶段，第一阶段试点研究将确定可行性 并帮助完善干预措施。在R33阶段，第二阶段为期9个月的4臂概念验证机械试验 (6个月积极干预和3个月无接触随访)初步建立 目标设定技术的有效性，以增加PA并促进遵守国家PA指南。全 参与者将收到Fitbit，以自我监控PA并参与PA行动计划会议和研究 干涉主义者。此外，参与者将被随机分配到四组中的一组：i)每周静态目标150 每周中等强度的PA，这与公共卫生的方法最相似 活动和护理提供者；二)每周自行选定的巴勒斯坦权力机构目标，允许自决和 适应目标；iii)每周适度增加PA的目标(即，研究人员确定的PA目标 每周比前一周PA的分钟/周多20%)；或iv)非目标设置 对照组。在目标设置理论的基础上，假设增量目标组的参与者 会在自我调节和自我效能感方面有最大的提高，这反过来又会导致最大的 在为期9个月的干预中，PA的改善和对国家PA指南的遵守。此外， 遵守PA最多的个人预计会在AD/ADRD中体验到最大的改善 风险因素，包括认知功能(记忆、执行功能、处理速度)、AD血浆 生物标志物(血浆淀粉样蛋白42/40比率。血浆磷酸化tau231)和心脏代谢的测量 疾病风险(BMI、血压、血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、低密度脂蛋白胆固醇、 胰岛素和胰岛素敏感性)。

Project Summary More than 6 million U.S. adults live with diagnoses of Alzheimer's Disease and Related Dementias (AD/ADRD), with projections as high as 13.8 million cases by 2050. There are no cures for AD/ADRD, making lifestyle factors key targets for reducing risk, as they account for at least a third of AD/ADRD cases. Engaging in regular physical activity (PA), particularly in midlife, is associated with reduced risk for AD/ADRD. Yet nearly half of midlife adults (48%) do not meet national PA guidelines of 150 minutes/week of moderate-intensity PA. Goal setting is a commonly used behavior change strategy to increase PA. Key psychosocial mechanisms believed to underpin the use of goal setting to promote PA include self-regulation and self-efficacy. Yet, the most effective goal setting technique to enhance these psychosocial mechanisms for the successful promotion of PA and adherence to national PA guidelines remains unclear. In the proposed study, we will use a two- phased approach to empirically test three goal setting techniques to enhance psychosocial mechanisms of self- regulation and self-efficacy for the successful promotion of PA and adherence to national PA guidelines among insufficiently active midlife adults with obesity. In the R61 phase, a Phase 1 pilot study will establish feasibility and help refine the intervention. In the R33 phase, a Phase 2 9-month 4-arm proof-of-concept mechanistic trial (6-month active intervention and 3-month no contact follow-up) will be implemented to establish preliminary efficacy of goal setting techniques to increase PA and promote adherence to national PA guidelines. All participants will receive a Fitbit to self-monitor PA and engage in PA action planning sessions with a study interventionist. In addition, participants will be randomly assigned to 1 of 4 groups: i) static weekly goal of 150 minutes/week of moderate-intensity PA, which most closely resembles the approach of public health campaigns and care providers; ii) weekly self-selected PA goals, which allows for self-determination and adaptation of the goal; iii) modest incremental weekly PA increase goal (i.e., researcher determined PA goal that 20% minutes/week greater than the minutes/week of PA in the previous week); or iv) non-goal setting control group. Based on Goal Setting Theory, it is hypothesized that participants in the incremental goal group will have the greatest increases in self-regulation and self-efficacy, which in turn, will lead to the greatest improvements in PA and adherence to national PA guidelines over the 9-month intervention. Further, individuals with the greatest PA adherence are expected to experience the greatest improvements in AD/ADRD risk factors, including cognitive functioning (memory, executive functioning, processing speed), AD plasma biomarkers (plasma amyloid 42/40 ratio. plasma phosphorylated tau 231), and measures of cardiometabolic disease risk (BMI, blood pressure, plasma glucose, TG, total cholesterol, LDL-C, HDL-C, VLDL-C, IDL-C, insulin and insulin sensitivity).