MIPARC - Multilevel Intervention for Physical Activity in Retirement Communities

描述（由申请人提供）：参加定期体育活动（PA）与降低老年人的全因发病率和死亡率有关，特别是由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%符合PA建议。因此，开发和评估促进老年人PA的干预措施是很重要的。生态学模型认为，行为干预在个体、人际、环境和政策等多个层面上发挥作用是最有效的。许多老年人生活在持续护理退休社区（CCRCs）中，这些环境为基于这种生态方法的PA干预提供了良好的环境。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，以增加身体活动。大多数社区中心都有当地的管理机构，为政策倡导提供了机会，以改善PA和步行的社会和建筑环境。本研究将采用一组随机对照设计，测试为期6个月的多层次养老干预（MIPARC）的有效性。MIPARC将与圣地亚哥16个CCRCs的320名久坐（每日步数在1000- 5000步之间）老年人（bb0 - 65岁）居民的成功老年教育注意控制条件进行比较。MIPARC包括个人组成部分（基于计步器的自我监控、教育材料和量身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（步行标志提示、量身定制的步行地图、张贴的步数和PA资源枚举）和政策组成部分（审查现场活动机会和步行性、改变建议和同伴领导的倡导）。我们的主要目的是验证一个假设，即与对照组相比，生活在退休社区的久坐居民在接受6个月的MIPARC干预后，他们的轻强度和中等强度PA（通过7天加速度计测量）的分钟数显著增加。我们的次要目的是验证与对照条件相比，MIPARC显著改善血压，身体活动表现和生活质量的假设。探索性目标将考察MIPARC对个人、人际、环境和政策的影响。收集12个月的过程测量将用于检查MIPARC在主要试验期间实施的保真度，是否在干预后的6个月期间持续，以及在后期是否看到对PA的持续影响。混合模型分析将用于解释嵌套设计，地点作为随机效应。据我们所知，这项研究将是第一个评估多层次生态干预以促进生活在cccs中的老年人PA的研究。

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. PUBLIC HEALTH RELEVANCE: To our knowledge, this is the first study to design, implement and evaluate a long term multilevel physical activity intervention for a growing older adult population at risk for disease. Older adults will greatly benefit from increasing their activity levels and this study will inform the design and provision of physical activity opportunities in retirement communities.